Wishing you and yours a very merry Christmas and a fantastic 2026!
Ejaculation-sparing minimally invasive surgical therapies for benign prostatic hyperplasia – MIST
Ejaculation-sparing minimally invasive surgical therapies for benign prostatic hyperplasia (BPH) include water vapor thermal therapy (REZUM), prostatic urethral lift (PUL), temporarily implanted nitinol device (iTIND), Aquablation and prostatic artery embolization (PAE) and certain variations of transurethral resection (TURP) that involve selective tissue removal. These treatments aim to relieve symptoms while minimizing the risk of ejaculatory dysfunction, such as retrograde ejaculation, a common side effect of traditional prostate surgeries.
Ejaculation-sparing minimally invasive BPH therapies
- Water Vapor Thermal Therapy (Rezum): This therapy delivers targeted steam energy to ablate excess prostate tissue. By using convection, the thermal energy minimizes spread to surrounding structures, achieving high rates of ejaculatory preservation (around 70-90%). It is often with general anesthesia.
- Temporarily Implanted Nitinol Device (iTIND): A temporary device is placed in the prostatic urethra for 5 to 7 days to reshape the channel through localized pressure, then removed. Studies have shown no reports of ejaculatory dysfunction with this approach.
- Prostatic Urethral Lift (PUL) (UroLift): This non-ablative procedure uses small implants to pin back the enlarged prostate lobes, opening the urethra without cutting or heating tissue. It boasts one of the highest ejaculatory function preservation rates, often reported around 80-90% or higher, and can be performed in an office setting, typically under local anesthesia.
- Prostatic Artery Embolization (PAE): Performed by interventional radiologists, this procedure involves blocking the blood supply to the prostate to cause it to shrink. It is associated with a high rate of ejaculatory preservation (around 70-90%), though its efficacy in improving urinary symptoms may be moderate compared to more invasive techniques.
- Aquablation: This procedure uses a robotically controlled, heat-free, high-velocity waterjet to precisely remove prostate tissue based on real-time imaging. The surgical planning allows for deliberate sparing of the anatomical landmarks responsible for ejaculation, with reported preservation rates of 60-99.6% in various studies. Not readily available in Queensland.
- Ejaculation-sparing TURP: Modified versions of the traditional TURP can be performed to preserve ejaculation. This involves careful removal of only the obstructing tissue, particularly the middle lobe, while leaving a safety margin around the verumontanum (where the ejaculatory ducts enter the urethra).
Key Considerations
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- Patient Priority: These procedures are suitable for men who prioritize maintaining sexual and ejaculatory function over maximal urinary symptom relief, as the latter is often better achieved with traditional, but higher-risk, surgeries like Transurethral Resection of the Prostate (TURP).
- Prostate Size: Different MISTs are suited to different prostate sizes and anatomies (e.g., UroLift for smaller prostates without an obstructive median lobe, Aquablation for a wider range of sizes).
- Shared Decision-Making: A discussion with a urologist about patient preferences, prostate anatomy, and potential trade-offs is crucial for selecting the optimal treatment.
Links:
Information obtained with the help of AI
Dr Jo Schoeman
Functional Urologist
Wesley Hospital
Brisbane Queensland
Trental for Peyronie’s Disease
Pentoxifylline for Peyronie’s Disease: An Evidence-Based Therapeutic Approach
Peyronie’s disease (PD) involves abnormal scar tissue (plaques) forming in the penile tunica albuginea, causing penile curvature, pain, shortening, and often erectile dysfunction. Affecting 3-9% of middle-aged men, this condition carries physical and psychological burdens. Pentoxifylline (PTX), originally developed for vascular conditions, has emerged as a promising nonsurgical treatment due to its unique antifibrotic properties that target PD’s underlying mechanisms.
Pathophysiological Basis: Pentoxifylline’s Mechanism
PD plaques develop through a complex inflammatory process initiated by penile trauma in genetically susceptible individuals. Key pathological events include:
- Oxidative Stress: Reactive oxygen species activate nuclear factor kappa-B (NF-κB)
- Fibrotic Signaling: NF-κB upregulates profibrotic factors (TGF-β1, PDGF), transforming fibroblasts into collagen-producing myofibroblasts
- Matrix Disruption: Excessive collagen deposition with reduced elastin creates inelastic scar tissue, potentially calcifying in 20-31% of cases
Pentoxifylline’s Multitargeted Actions:
- TGF-β1 Suppression: Reduces collagen synthesis
- Phosphodiesterase Inhibition: Elevates cAMP, blocking inflammatory cytokines
- Oxidative Stress Reduction: Neutralizes free radicals
- Fibrinolysis Enhancement: Improves microcirculation
- Anticalcification Effects: May stabilize mineral deposition
Table 1: Pentoxifylline’s Actions Against Peyronie’s Pathogenesis
| Pathological Process | Pentoxifylline Intervention |
|---|---|
| TGF-β1 Upregulation | Inhibits expression & signaling |
| ROS/RNS Surge | Scavenges free radicals |
| NF-κB Activation | Reduces activation via cAMP pathway |
| PDGF Upregulation | Modulates growth factor activity |
| Fibrin Deposition | Enhances fibrinolysis, improves circulation |
| Elastin Degradation | Indirect protection via reduced MMP activity |
Clinical Evidence: Efficacy Data
Research demonstrates PTX’s benefits across PD stages:
- Curvature and Plaque Improvement:
- A 6-month RCT showed significant curvature reduction (~10°) with oral PTX (400mg twice daily) versus placebo
- Combination therapy (oral PTX + perilesional injections + antioxidants) demonstrated 46.9% mean plaque reduction and 10.1° curvature improvement
- Calcification Management:
- Patients with calcified plaques receiving PTX showed 91.9% stabilization/improvement versus 44.4% in untreated controls
- Case reports document complete resolution of small calcifications after prolonged therapy
- Symptom Relief:
- Combination regimens achieved 67.6% pain resolution
- Significant improvements in erectile function reported with multimodal approaches
- PTX with traction therapy improved penile hemodynamics
Treatment Protocols: Optimizing Outcomes
Oral Administration:
- Dosage: 400mg 2-3 times daily (800-1200mg total)
- Duration: Minimum 6 months, with benefits extending to 12-18 months
- Administration: Take with food to reduce GI effects
Advanced Delivery Methods:
- Perilesional Injections: 100mg around (not into) plaque every 2 weeks (significantly boosts outcomes)
- Topical Adjuvants: Diclofenac 4% gel applied twice daily
Multimodal Synergy:
- PTX + Antioxidants: Propolis (600mg), blueberry extract (160mg), vitamin E (600mg)
- PTX + Traction Therapy: 1 hour daily device use
- PTX + PDE5 Inhibitors: Particularly for comorbid erectile dysfunction
*Table 2: Evidence-Based Treatment Approaches*
| Regimen | Clinical Outcomes | Therapeutic Advantage |
|---|---|---|
| Oral Monotherapy | Curvature reduction (~10°), Plaque stabilization | Simplicity, cost-effectiveness |
| Oral + Injections | 46.9% plaque reduction, >10° curvature improvement | Enhanced efficacy |
| Oral + Antioxidants | Improved pain relief, rigidity | Oxidative stress mitigation |
| Oral + Traction Therapy | Curvature reduction, hemodynamic improvement | Mechanical plaque modification |
| Extended Therapy (Calcification) | 91.9% stabilization/regression | Unique anticalcification effect |
Comparative Analysis with Other Treatments
- Vitamin E: Lacks robust efficacy evidence
- Colchicine: Limited by gastrointestinal side effects
- Collagenase (CCH): FDA-approved but high-cost, multiple injections required, not indicated for acute phase or calcification
- Verapamil: Variable results, less evidence for calcified plaques
PTX Advantages: Lower cost, applicability in acute/chronic phases (including calcification), flexible combination options, and favorable safety profile.
Clinical Implementation: Key Considerations
Adverse Effect Management:
- GI symptoms (30% incidence): Dose titration, administration with meals
- CNS effects (headache/dizziness): Evening dosing, hydration
- Contraindications: Recent hemorrhage, severe cardiac disease, anticoagulant use, methylxanthine hypersensitivity
Adherence Strategies:
- Gradual dose escalation
- Realistic expectation setting (3–6-month onset)
- Emphasizing stabilization benefits
Ideal Candidates:
- Acute phase (<12 months) with changing plaques
- Chronic disease with calcification
- Mild-moderate curvature (<60°)
- Motivated for long-term therapy
Poor Candidates:
- Severe curvature preventing intercourse
- Absolute contraindications
- Expecting rapid complete resolution
Research Directions and Clinical Integration
While current evidence supports PTX, further investigation should:
- Establish optimal injection protocols
- Validate long-term outcomes (>24 months)
- Identify predictive biomarkers
- Refine multimodal combinations
Pentoxifylline represents a pathophysiological grounded option in PD management, particularly valuable for:
- Early disease intervention
- Calcified plaques
- Cost-conscious treatment plans
- Multimodal approaches combining oral and injectable routes
Conclusion: Therapeutic Position
Pentoxifylline offers a unique mechanism-based approach to Peyronie’s disease by targeting multiple pathological pathways. Its efficacy in plaque reduction, curvature improvement, and calcification management—especially in combination protocols—positions it as a valuable conservative option. When integrated with antioxidants, traction therapy, or topical agents, PTX provides urologists with an evidence-supported, cost-effective tool between observation and invasive procedures. Future research will further clarify its optimal role in the PD treatment algorithm.
Indwelling Urinary Catheter
An indwelling urinary catheter (IDC or Foley catheter) is a flexible tube inserted into the bladder to drain and collect urine continuously. The catheter is held in place by a small, water-filled balloon at its tip to prevent it from falling out.
Types of Indwelling Catheters
There are two main types based on the insertion method:
- Urethral Catheter: Inserted into the bladder through the urethra. This is the most common type.
- Suprapubic Catheter: Inserted into the bladder through a small incision in the abdominal wall, above the pubic bone. This minor surgical procedure is often used for long-term management or if the urethra is blocked or damaged.
Indications
Catheterization is a medical procedure and should only be performed when a clear clinical indication is present. Common reasons include:
- Urinary retention: Inability to empty the bladder.
- Surgery: To drain the bladder before, during, or after certain surgical procedures (e.g., prostate or hip surgery).
- Monitoring: To accurately measure urine output in critically ill patients.
- Incontinence management: When other methods have failed and the patient has severe skin impairment or pressure ulcers.
- Nerve damage: For individuals with neurological conditions like spinal cord injury or multiple sclerosis who cannot control their bladder.
- End-of-life care: To provide comfort
Living with an Indwelling Catheter
- Drainage: The catheter connects to a drainage bag (leg bags for daytime use, larger bags for overnight use) or a catheter valve, which allows for controlled emptying of the bladder.
- Maintenance: Catheters typically need to be changed every few weeks to three months by a healthcare professional.
- Daily Care:
- Wash the area where the catheter enters the body with soap and water daily.
- Keep the drainage bag below the level of the bladder to ensure proper drainage and prevent urine backflow.
- Ensure the tubing is free of kinks or twists.
- Drink plenty of fluids to help flush the urinary system and reduce infection risk
Potential Complications
- The most common and serious complication is a catheter-associated urinary tract infection (CAUTI), as bacteria can form a biofilm on the catheter surface.
- Bladder spasms,
- Blockages,
- Leakage around the catheter, and
- Urethral trauma.
It is important to seek immediate medical advice if you notice signs of infection (fever, cloudy/strong-smelling urine, abdominal pain), a blocked catheter, or if the catheter falls out
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane
Angiomyolipoma – AML
An angiomyolipoma (AML) is the most common benign kidney growth. It has 3 components:
- abnormal blood vessels,
- smooth muscle,
- and fat cells.
While typically benign, the main risk is the potential for the blood vessels to dilate and rupture, leading to serious, life-threatening internal bleeding (hemorrhage).
Symptoms
Most angiomyolipomas are asymptomatic, and the tumors are often discovered incidentally during imaging for other conditions. However, if the tumor grows large or bleeds, symptoms may include:
- Pain or discomfort in the abdomen, back, or side (flank pain).
- A palpable mass in the abdomen.
- Blood in the urine (hematuria).
- Nausea and vomiting.
- High blood pressure (hypertension).
- Anemia (due to chronic blood loss or acute hemorrhage).
Acute, severe pain, sometimes with signs of shock, can indicate a spontaneous rupture and is a medical emergency.
Causes and Risk Factors
The exact cause of sporadic AMLs is not known, but they are linked to genetic mutations.
- Sporadic cases: Account for 80% of cases, typically affecting women over 40 with a single tumor.
- Associated with genetic syndromes: The remaining cases are often linked to genetic disorders like
- Tuberous sclerosis complex (TSC). In TSC patients, AMLs tend to be multiple, bilateral (in both kidneys), larger, and present at a younger age.
- Lymphangioleiomyomatosis (LAM).
Diagnosis
Diagnosis primarily relies on imaging studies, as the fat content in the tumor gives a characteristic appearance.
- Computed Tomography (CT) scans are the standard diagnostic tool for identifying the fat component.
- Magnetic Resonance Imaging (MRI) is useful for cases where CT results are inconclusive, particularly in detecting fat-poor lesions.
- Ultrasound can be used for initial screening or monitoring, but its findings can sometimes overlap with other kidney conditions.
- Biopsy may be necessary if imaging cannot definitively differentiate the mass from a potentially malignant tumor, such as renal cell carcinoma.
Treatment and Management
Management depends on the patient’s symptoms, the tumor’s size and growth rate, and the risk of hemorrhage.
- Active Surveillance: For small (<4 cm) and asymptomatic AMLs, routine monitoring with imaging is generally recommended.
- Embolization: This minimally invasive procedure seals off the blood vessels in the tumor to prevent or treat bleeding. It is a first-line treatment for acute hemorrhage or for preventing rupture in high-risk cases (e.g., aneurysms >5 mm).
- Surgery: Nephron-sparing surgery (partial nephrectomy) is often the preferred surgical option to remove the tumor while preserving kidney function.
- mTOR Inhibitors: Medications like everolimus (Afinitor) are approved for treating TSC-associated AMLs (typically >3 cm) and can shrink the tumors and their associated aneurysms, reducing the risk of bleeding.
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane
Meatal Stenosis: Lichen Sclerosis
Lichen sclerosus (LS) affecting the penile meatus causes white, atrophic plaques and scarring that can narrow the meatus. This leads to lower urinary tract symptoms and in severe case urinary retention. This condition can also lead to phimosis, where the foreskin becomes tight, and can cause difficulty with urination and sexual function. Treatment typically starts with topical corticosteroids, and surgery such as circumcision or meatotomy may be necessary for more severe or stubborn cases.
Symptoms and effects
- Narrowed meatus: The meatus can narrow to the point of causing urinary retention, potentially damaging the bladder and kidneys over time.
- Phimosis: In uncircumcised men, LS can cause the foreskin to become so tight that it cannot be retracted.
- Urinary problems: A less powerful stream, spraying of urine, and urinary frequency are common symptoms.
- Pain and scarring: It can cause pain during urination and intercourse, and lead to scarring of the glans, foreskin, and frenulum.
- Other symptoms: Blisters, sores, and itching can also occur, though these are less common.
Treatment
- Medical therapy: The first-line treatment is often an ultrapotent topical corticosteroid, such as clobetasol propionate, applied to the affected areas.
- Circumcision: This is often curative for LS confined to the foreskin and glans.
- Meatotomy: In some cases, a surgical procedure to widen the meatus may be required.
- Dilation: Daily self dilations
- Other treatments: Depending on the individual case, other treatments may be considered, including phototherapy or laser treatments.
- Surgical reconstruction: Some patients may require more extensive reconstructive procedures.
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane
Premature Ejaculation
Premature ejaculation (PE) is the most common male sexual dysfunction. It is defined as the inability to delay ejaculation long enough to satisfy oneself or your partner. This causes personal distress. While most men experience occasional rapid ejaculation, frequent occurrences may indicate a treatable medical condition.
Causes
The exact cause of PE is a complex interaction of psychological and biological factors.
Psychological factors:
- Anxiety and Stress: Performance anxiety, general anxiety, and high-stress levels (from work or relationships) are common contributors.
- Relationship Issues: Communication problems or unresolved conflicts with a partner can play a significant role.
- History: Early sexual experiences characterized by haste (e.g., to avoid being caught), a strict upbringing about sex, or a history of sexual trauma can establish a pattern.
- Depression and Confidence: Feelings of guilt, depression, or poor self-esteem can affect sexual function.
Biological factors:
- Chemical and Hormone Levels: Irregular levels of certain brain chemicals (neurotransmitters) like serotonin and dopamine, or hormones such as testosterone and those related to the thyroid, may be involved.
- Inflammation or Infection: Problems with the prostate or urethra can contribute to PE.
- Erectile Dysfunction (ED): Men with ED may rush through sex to ejaculate before losing their erection, forming a difficult habit to break.
- Genetics: Lifelong PE may have a genetic predisposition.
- Penile Sensitivity: Increased sensitivity of the penis has been suggested as a possible cause in some cases.
Treatment and Management
Treatment for PE often involves a combination of approaches and may include the partner for the best outcome.
- Behavioral Techniques: These are often the first line of treatment and aim to build tolerance and control over ejaculation.
- Start-and-Stop Method: The man or partner stimulates the penis until the man feels he is near orgasm. Stimulation is stopped until the sensation passes, then resumed. This is repeated multiple times before allowing ejaculation.
- Squeeze Technique: Similar to the start-and-stop method, but when the man is close to ejaculating, the partner or the man himself gently squeezes the head of the penis for several seconds until the urge to ejaculate lessens.
- Other self-help options: Masturbating an hour or two before sex, using thicker condoms to reduce sensation, or trying to distract oneself (though this may reduce pleasure for both partners).
- Medications: Oral medications or topical numbing agents can help delay ejaculation.
- Topical Anesthetics: Creams or sprays containing lidocaine or prilocaine can be applied to the penis 10 to 15 minutes before sex to reduce sensation. A condom should be used to prevent the numbing effect from transferring to the partner.
- Oral Medications: Certain selective serotonin reuptake inhibitors (SSRIs), which are a type of antidepressant, can be prescribed off label to delay orgasm. Dapoxetine (Priligy) is an SSRI developed specifically for on-demand use for PE and is available in some countries.
- Other Medications: Tramadol (a pain reliever) or medications for erectile dysfunction may also be used in some cases, often in combination with SSRIs.
- Counseling and Therapy: Talking with a mental health professional, certified sex therapist, or couple’s counselor can help address underlying psychological or relationship issues, reduce performance anxiety, and improve communication.
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane
Delayed Ejaculation
This can be a huge issue for those guys that suffer with this. It leads to psychological issues and even breakdown of relationships. Treatment for delayed ejaculation depends on its cause and may involve a combination of approaches like adjusting medications, counseling and other therapies. Options include psychological therapy, adjusting or switching medications (such as SSRIs), and addressing lifestyle factors like alcohol or drug use. Some men may also benefit from physical therapies or specific drugs like testosterone replacement, bupropion, or cabergoline, depending on the underlying cause and a doctor’s recommendation.
Delayed ejaculation affects an estimated 1% to 4% of sexually active men, though a recent study suggests the prevalence may be higher, possibly between 5% and 10%.
Diagnosis:
Some studies use a specific timeframe to define delayed ejaculation, such as a man taking 30 minutes or longer to ejaculate, which may lead to higher reported numbers.
Medical and pharmaceutical treatments
- Medication adjustment: If a medication like an SSRI is the cause, a doctor may recommend switching to a different antidepressant or adjusting the dose.
- Testosterone replacement: If low testosterone is a contributing factor, testosterone replacement therapy can be used.
- Other drugs: Other medications that may be used include bupropion, cabergoline, yohimbine, and cyproheptadine, which may be prescribed to counteract the effects of other drugs or address the issue directly.
- Topical anesthetics: Products containing lignocaine or prilocaine can be applied to the penis to reduce sensation and delay ejaculation.
Psychological and behavioral treatments
- Psychotherapy: Counseling with a psychologist, psychotherapist, or sex therapist can help address psychological issues like anxiety, stress, or relationship problems that may contribute to delayed ejaculation.
- Couples counseling: If the issue affects the couple’s dynamic, counseling together can be very beneficial.
- Behavioral techniques: A therapist may suggest techniques like using sexual aids, exploring erotic fantasies, or trying different sexual positions and techniques to increase stimulation.
Lifestyle and other considerations
- Reduce or eliminate alcohol and drugs: Limiting or stopping the use of alcohol and non-prescription drugs can help resolve delayed ejaculation if they are a contributing factor.
- Manage underlying medical conditions: Treating any underlying medical issues, such as neurological problems, can also help.
- Penile vibratory stimulation (PVS): This may be an option for men with decreased penile sensitivity.
When to see your GP
- It is best to consult a healthcare professional to determine the cause and appropriate treatment.
- See a doctor if delayed ejaculation is an ongoing issue, if you have other health problems, or if you take medications that could be the cause.
- Do not stop taking any prescribed medication without first speaking to your doctor.
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane
Dr Richard Marsden – Urologist
Richard Marsden
Many of my older patients in Bundaberg will remember Richard. Richard was a well-known and respected Urologist in Bundaberg for many years. He was the only Urologist in Bundy and very committed to regional QLD. This legend passed away on the 5th of November.
I owe my big move from South Africa to Australia to him. I met him at the bi-annual UROSA (Urology Society of South Africa) conference at Sun City in 2005. We struck up a conversation and by the end of this I was given a business card and told to contact him if I was keen to take over his practice in Bundaberg. He was in the process of retiring. It took me a few weeks to realize what an opportunity he had given me.
My wife and I flew out to Bundaberg a couple of months later to do our LSD-trip (look, see and decide). A trip most South Africans do before we make the huge decision to uproot our families for the unknown. Australia held a huge promise of safety, freedom and a future for our daughters. We flew into Bundaberg and fell in-love with the town. It reminded us of the East Coast of South Africa (the then Natal province) with its ocean, sugarcane and humidity.
Richard and Carol welcomed us. Richard showed me his routine and introduced me to the operating room and ward staff. We learnt that Richard was also an immigrant, from the UK. He spent his childhood years during WW2 in Johannesburg, South Africa. He joined his parents in Melbourne after the war after which they returned to the UK. He embarked on his medical career in London. He too made the decision to re-locate to Australia with his 2 daughters. Natasha and I made the heavy decision that this was where we wanted to raise our girls.
Thank you, Richard!
Pelvic floor rehabilitation post prostatectomy
Pelvic floor physiotherapy after a prostatectomy helps regain bladder control and addresses erectile dysfunction through exercises and other therapies. A physiotherapist can create a personalized plan, which may include pre- and post-operative pelvic floor muscle training (Kegels), bladder retraining, and, in some cases, treatments like focused shockwave therapy for erectile dysfunction.
What pelvic floor physiotherapy involves
- Pelvic floor muscle training: A physiotherapist will guide you on how to perform exercises (like Kegels) to strengthen the pelvic floor muscles. This can significantly improve urinary incontinence and support bladder control.
- Bladder retraining: This involves a combination of exercises, tracking bladder use, and scheduling toilet breaks to improve bladder control and reduce urgency or leakage.
- Individualized assessment: Each person’s recovery is unique, so a physiotherapist will conduct a comprehensive assessment to create a treatment plan tailored to your specific symptoms and needs.
When to start
- Pelvic floor exercises can be started before surgery or soon after the catheter is removed.
- Starting pelvic floor rehabilitation before surgery is recommended by some organizations, as it can help with recovery.
Why it’s important
- The prostate gland sits below the bladder, and its removal can weaken the surrounding pelvic floor muscles and surrounding structures.
- This can lead to issues like urinary incontinence (leaking), urgency, and erectile dysfunction.
- Pelvic floor physiotherapy helps by strengthening the muscles that support bladder and sexual function.
Getting started
- It is highly beneficial to see a physiotherapist, as they can provide guidance and ensure you are performing exercises correctly.
- You can start with basic exercises on your own, but a physiotherapist can help you get more benefit from your training.
I use 3 groups of physiotherapy practices depending on your location:
1. Wesley Hospital Physiotherapy
Women and men’s physiotherapy | Allied health | The Wesley Hospital
2. Bodyworks Physiotherapy in Kallangur – Rashiq Patel
3. Coral Coast Physiotherapy in Bargara, Bundaberg – Reuben Wharerau
Bargara Physiotherapy | Coral Coast Physiotherapy Bargara
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane