Focal Therapy for Prostate Cancer: Targeting the Cancer While Preserving the Prostate

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Established management of localised prostate cancer includes active surveillance for suitable low-risk disease and whole gland treatment with surgery or radiotherapy when treatment is indicated. ProFocal® is a newer focal approach that uses laser energy to destroy a selected cancerous area while leaving much of the surrounding prostate untreated.

This approach is known as focal laser therapy or focal laser ablation. Its intended aim is to control the treated cancer focus while reducing urinary and sexual side effects. Whether it provides cancer control equivalent to established whole-gland treatments over the long term has not been demonstrated.

Early Australian research is encouraging. However, ProFocal remains an investigational treatment, and important questions about its long-term cancer control have not yet been answered.

What is ProFocal therapy?

ProFocal is an Australian-developed focal therapy system designed to treat a carefully selected area of prostate cancer.

A fine laser applicator is inserted through the skin between the scrotum and anus, the perineum, and guided into the prostate using imaging. Laser energy heats the targeted tissue to a temperature that causes cancer-cell death.

The system incorporates cooling and real-time temperature monitoring. This is intended to make the area of ablation more predictable and to limit unintended heat damage to nearby structures such as the:

  • Urinary sphincter
  • Urethra
  • Bladder neck
  • Rectum
  • Neurovascular bundles involved in erections

Unlike radical prostatectomy, ProFocal does not remove the prostate. Unlike conventional radiotherapy, it does not expose the whole prostate to radiation.

Is ProFocal approved by the TGA?

This requires careful clarification.

As at September 2026, the manufacturer states that ProFocal is not included in the Australian Register of Therapeutic Goods, ARTG. It therefore does not have general TGA market authorisation for routine supply and use in Australia.

This is different from saying that the treatment has received unrestricted “TGA approval.”

ProFocal may be accessible in Australia through a clinical trial or a specific TGA pathway for an unapproved therapeutic good, such as the Authorised Prescriber Scheme or Special Access Scheme. These pathways permit access in defined circumstances; they are not equivalent to ARTG inclusion or routine TGA market authorisation. The applicable approval, governance and consent arrangements should be confirmed for the individual patient.

Authorised Prescriber access does not mean that the device has been entered on the ARTG or endorsed as routine standard treatment. Regulatory status, trial availability and funding arrangements should always be confirmed directly before treatment.

Medicare, private insurance and professional oversight in Australia

The Medicare Benefits Schedule (MBS) lists professional medical services subsidised by the Australian Government. As at September 2026, no specific MBS item for “ProFocal” or focal laser ablation of prostate cancer was identified in the current public MBS material reviewed for this article. This should not be interpreted as a definitive ruling on every component of an episode of care: consultations, anaesthesia, imaging, pathology or hospital services may each have different billing arrangements.

An MBS rebate for an associated service would not establish that ProFocal itself is TGA-approved, guideline-endorsed or proven effective. Conversely, lawful access through a TGA pathway does not guarantee Medicare or private-insurance funding. The Department of Health and Aged Care’s Medical Services Advisory Committee (MSAC) is the independent body that advises government on whether public funding of medical services and technologies is supported by evidence of safety, clinical effectiveness and cost-effectiveness.

The Australian Medical Association (AMA) is a professional representative body, not the regulator of therapeutic goods and not the agency that creates Medicare items. No AMA clinical guideline specifically recommending ProFocal was identified for this review. It would therefore be inappropriate to imply AMA endorsement. Relevant professional duties instead arise from the Medical Board of Australia’s code of conduct: patients should receive understandable information about the proposed treatment, reasonable alternatives, material risks, uncertainties, costs and any practitioner conflicts of interest so that consent is genuinely informed.

Who may be considered for ProFocal therapy?

ProFocal is principally being studied in men with localised, non-metastatic and MRI-visible prostate cancer.

In the first prospective phase II ProFocal study, eligible men had:

  • Prostate cancer confined to the prostate
  • An MRI-visible cancer target
  • ISUP Grade Group 2 or 3 disease
  • A PSA of 15 ng/mL or lower
  • A clinical stage of T2c or lower
  • Biopsy findings corresponding with the abnormality seen on MRI

Outside a clinical trial, suitability would need to be assessed individually by a multidisciplinary prostate cancer team.

A potential candidate generally requires a cancer that can be clearly identified, biopsied and safely surrounded by an adequate treatment margin. Detailed assessment usually includes:

  • Multiparametric prostate MRI
  • Targeted and systematic transperineal biopsies
  • PSA and PSA-density assessment
  • Clinical staging
  • Consideration of PSMA PET/CT in selected men
  • Review of the MRI and pathology at a multidisciplinary meeting

When may ProFocal be unsuitable?

ProFocal would generally not be considered appropriate when there is:

  • Metastatic prostate cancer
  • High-risk or locally advanced disease requiring comprehensive treatment
  • Cancer outside the prostate
  • Extensive cancer involving several areas of the gland
  • Cancer that cannot be reliably identified on MRI
  • A tumour position where an adequate and safe treatment margin cannot be achieved
  • Significant uncertainty about the true extent or grade of the cancer
  • An inability or unwillingness to undergo ongoing MRI scans and repeat biopsies
  • A medical condition that makes anaesthesia or the procedure unacceptably risky

Men with low-risk Grade Group 1 prostate cancer may be better managed with active surveillance, avoiding treatment and its potential complications altogether.

Focal therapy should not be regarded as an easier substitute for appropriate surgery or radiotherapy in men with aggressive, high-volume or advanced prostate cancer.

How is ProFocal treatment performed?

ProFocal is usually performed as a day procedure under general anaesthesia.

Treatment planning

The cancer identified on MRI and biopsy is mapped carefully. The treatment plan includes the visible tumour and an additional safety margin intended to treat microscopic cancer immediately around it.

Placement of the laser applicator

With the patient under anaesthesia, a transrectal ultrasound probe is used to visualise the prostate. A fine laser applicator is inserted through the perineum and positioned within the selected treatment area.

The route is similar to that used for a transperineal prostate biopsy.

Laser ablation

Controlled laser energy heats and destroys the targeted prostate tissue. Temperature monitoring helps the surgeon assess treatment delivery and protect surrounding structures. More than one applicator position may be needed to cover the planned treatment zone.

The published phase II study reported a median treatment time of approximately 60 minutes, although the complete anaesthetic and theatre procedure may take longer.

Recovery

A urinary catheter may be required temporarily because prostate swelling can make urination difficult. Many patients can return home on the day of treatment or after a short admission, depending on their recovery and ability to pass urine.

What are the potential advantages?

The proposed advantages of ProFocal include:

  • Treatment directed at the known cancer rather than the whole prostate
  • No abdominal incision
  • A transperineal, minimally invasive approach
  • Short hospital stay
  • Faster initial recovery than major surgery
  • No ionising radiation
  • Preservation of untreated prostate tissue
  • A potentially lower risk of persistent urinary incontinence
  • A potentially lower risk of erectile dysfunction than whole gland treatment
  • The possibility of further focal or whole-gland treatment if cancer remains or returns

These are potential benefits and should not be interpreted as guarantees.

How does it compare with established alternatives?

There is no mature randomised evidence showing that ProFocal gives the same long-term protection from metastasis or prostate-cancer death as radical prostatectomy or radiotherapy. A balanced consultation should therefore compare all reasonable options:

  • Active surveillance: avoids or delays treatment side effects and is preferred for many men with low-risk disease, but requires PSA testing, MRI and repeat biopsy, with treatment if the cancer progresses.
  • Radical prostatectomy: removes the prostate and provides complete surgical pathology. It has long-term cancer-control data, but carries risks including urinary incontinence, erectile dysfunction, loss of ejaculation and surgical complications.
  • Radiotherapy: has established long-term cancer-control data and avoids surgery, but may cause urinary, bowel and sexual adverse effects; androgen-deprivation therapy may be advised for some risk groups.
  • ProFocal/focal laser ablation: may offer quicker recovery and less short-term urinary or sexual morbidity for carefully selected men, but leaves untreated prostate tissue, requires MRI and repeat-biopsy surveillance, and has uncertain long-term comparative cancer-control outcomes.

The most appropriate option depends on cancer grade, volume and location; PSA and stage; age and general health; baseline urinary and sexual function; personal priorities; and willingness to accept surveillance or treatment uncertainty. A multidisciplinary opinion and, where useful, separate discussions with a urologist and radiation oncologist can reduce treatment-selection bias.

What did the early ProFocal study find?

The first published phase II trial included 100 men with localised, MRI-visible Grade Group 2 or 3 prostate cancer.

At the three-month biopsy:

  • 84% had no clinically significant Grade Group 2 or higher cancer within the treated area
  • Approximately 16% therefore had residual clinically significant cancer within the treatment zone
  • Erectile dysfunction was reported in 12%
  • The average sexual-function scores decreased by approximately 15%
  • Urinary-domain scores decreased by approximately 4.5%
  • No significant deterioration was reported in the other measured functional outcomes

These results are promising, but they represent very early follow-up. The study had no surgery, radiotherapy or active surveillance control group. It therefore cannot establish whether ProFocal provides equivalent long-term protection against recurrence, metastasis or death from prostate cancer.

Possible side effects and complications

Short-term effects may include:

  • Bruising or discomfort in the perineum
  • Blood in the urine
  • Blood in the semen
  • Burning or discomfort when urinating
  • Urinary frequency or urgency
  • Temporary difficulty passing urine
  • Temporary catheterisation
  • Urinary tract infection
  • Pelvic or rectal discomfort
  • Fatigue following anaesthesia

Potential longer-term or less common problems include:

  • New or worsening erectile dysfunction
  • Reduced ejaculatory volume
  • Retrograde ejaculation
  • Urinary incontinence
  • Urethral or bladder-neck scarring
  • Persistent urinary symptoms
  • Damage to tissue outside the intended treatment zone
  • Infection or abscess
  • A fistula involving the urinary tract and rectum, expected to be rare
  • Incomplete cancer treatment
  • Cancer developing or becoming apparent elsewhere in the untreated prostate
  • A requirement for repeat focal therapy, radiotherapy or radical prostatectomy

The risk of sexual or urinary dysfunction depends partly on the size and location of the tumour. A lesion near the neurovascular bundles, urethra, urinary sphincter or bladder neck may be more difficult to treat without affecting function.

The untreated prostate remains important

Prostate cancer is frequently multifocal, meaning that separate areas of cancer may exist within the same prostate. MRI is very useful but cannot detect every small or biologically significant tumour.

ProFocal treats the selected target, not every prostate cell.

This creates two possible patterns of treatment failure:

  1. In-field disease: cancer remains or returns inside the treated area.
  2. Out-of-field disease: cancer is subsequently found elsewhere in the untreated prostate.

A successful early scan does not prove that all clinically significant cancer has been eliminated.

Follow-up after ProFocal therapy

Follow-up is more intensive than simply checking the PSA.

Because the prostate remains in place, PSA will not normally fall to an undetectable level. There is also no universally accepted PSA threshold that defines successful focal treatment or recurrence.

Follow-up may include:

  • Regular PSA testing
  • Clinical review and symptom assessment
  • Multiparametric MRI
  • Quality-of-life and erectile function assessment
  • Repeat targeted biopsy of the treated area
  • Systematic biopsy of the untreated prostate
  • Additional imaging when recurrence is suspected

The Prostate Cancer Foundation of Australia cautions that PSA testing alone is not sufficient to exclude recurrent cancer after focal therapy. Patients must be willing to undergo long-term imaging and, when recommended, further prostate biopsies.

Can treatment be repeated?

Repeat focal treatment may be possible when residual or recurrent cancer remains localised and clearly targetable.

Depending on the findings, subsequent options may include:

  • Repeat focal ablation
  • Radical prostatectomy
  • External-beam radiotherapy
  • Another focal therapy technique
  • Active surveillance for selected low-volume disease
  • Systemic treatment if the cancer has spread

Salvage surgery or radiotherapy may still be possible after focal therapy, but treatment can sometimes be technically more complex because of scarring and tissue changes. The likely salvage options should therefore be discussed before proceeding with ProFocal.

Important limitations

Patients considering ProFocal should understand that:

  • ProFocal is not currently included on the Australian ARTG
  • It is not established as routine standard-of-care treatment
  • Published ProFocal evidence currently comes from a small number of men
  • The pivotal study was single-arm and had very short follow-up
  • Long-term rates of metastasis-free, cancer-specific and overall survival are unknown
  • There are no mature randomised comparisons with prostatectomy, radiotherapy or modern active surveillance
  • Approximately 16% of men in the initial study had clinically significant cancer remaining in the treated area at three months
  • Cancer may be missed elsewhere in the prostate
  • Repeat MRI scans and biopsies are required
  • Further cancer treatment may be needed
  • Access may be limited to trials or special regulatory pathways
  • Medicare or private health insurance may not cover treatment or follow-up costs

What do Australian and international guidance sources say?

The Prostate Cancer Foundation of Australia (PCFA) describes focal therapies as emerging and experimental. It notes that focal treatment may reduce side effects but that the prostate remains in place, PSA monitoring is less straightforward, and ongoing MRI and biopsy are required.

Australian evidence-based resources regard active surveillance, radical prostatectomy and radiotherapy as established pathways for appropriately selected localised disease. ProFocal has not yet acquired the same evidence base or standard-of-care status. The absence of a treatment-specific recommendation should not be reframed as support.

The European Association of Urology (EAU) states that focal therapy has favourable functional outcomes but that definitive evidence of long-term oncological benefit remains unavailable. Its guideline recommends focal HIFU or cryotherapy only within a prospective registry and other ablative methods—including focal laser therapy—only within a well-designed prospective clinical trial.

The American Urological Association and American Society for Radiation Oncology advise clinicians that comparative evidence for focal ablation is lacking and that patients must be informed that further treatment may be required. Focal or whole-gland ablation should not be offered for high-risk prostate cancer outside a clinical trial.

The UK National Institute for Health and Care Excellence (NICE) guidance for focal HIFU and focal cryoablation—not ProFocal specifically—also emphasises special governance, consent, audit/research arrangements and uncertainty about long-term cancer control. This is relevant context for focal therapy but must not be represented as device-specific approval of ProFocal.

The Prostate Cancer Foundation of Australia similarly describes focal therapies as experimental and emphasises the need for continuing MRI, biopsies and careful long-term monitoring.

The bottom line

ProFocal is an Australian-developed investigational technology that may eventually provide selected men with an additional option between surveillance and whole-gland treatment.

Its early results suggest that precisely delivered cooled laser therapy can destroy an MRI-visible prostate cancer target with relatively limited short-term urinary morbidity. However, early cancer clearance is not the same as proven long-term cancer control.

At present, ProFocal should be considered an investigational focal therapy. Consistent with current guidance for focal laser ablation, its most defensible use is within a well-designed prospective clinical trial with ethics and regulatory oversight, multidisciplinary assessment, explicit informed consent, independent outcome reporting and mandatory long-term follow-up.

The decision should be made only after comparing ProFocal with all appropriate alternatives, including active surveillance, radical prostatectomy and radiotherapy.

This article provides general information and does not replace individual medical advice. Regulatory status and treatment availability can change and should be confirmed at the time of consultation.

References and further reading

Hydrocoele in Younger Men: Causes, Fertility and Treatment Options

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A hydrocoele is a collection of clear fluid around the testicle. It usually causes a painless swelling on one side of the scrotum, although both sides can occasionally be affected.

Hydrocoeles are common in babies and older men, but they can also develop during adolescence or young adulthood. In a younger man, the important question is not only “Is this a hydrocoele?” but also “Why has it developed?”

Most hydrocoeles are benign and do not threaten the testicle. Nevertheless, any new scrotal swelling should be examined because conditions such as an inguinal hernia, infection, testicular torsion or testicular tumour can sometimes produce a similar appearance or cause a secondary hydrocoele.

What causes a hydrocoele?

The testicle is partly surrounded by a thin membrane called the tunica vaginalis. This membrane normally produces a small amount of lubricating fluid, which is continually reabsorbed. A hydrocoele develops when fluid production exceeds absorption.

In younger men, possible causes include:

  • Idiopathic hydrocoele: No specific cause is identified. This is common.
  • Persistent communication with the abdomen: A small channel through which the testicle descended before birth may remain open. This is more typical in children but can occasionally persist into young adulthood and may be associated with an inguinal hernia.
  • Inflammation or infection: Epididymitis, orchitis and some sexually transmitted infections may cause fluid to collect around the testicle.
  • Trauma: A sporting injury, direct blow or previous scrotal injury can lead to a reactive hydrocoele.
  • Previous surgery: Hydrocoeles may occasionally follow groin, hernia, varicocele or testicular surgery.
  • Testicular torsion: Twisting of the spermatic cord can produce a reactive hydrocoele, although severe sudden pain is normally the dominant symptom.
  • Testicular tumour: A tumour may occasionally be accompanied by a hydrocoele. The hydrocoele itself is not cancer, but the fluid can make examination of the underlying testicle difficult.

What does a hydrocoele feel like?

A typical hydrocoele produces a smooth, soft or tense swelling around the testicle. It may fluctuate in size and often feels heavier as it enlarges.

Symptoms can include:

  • painless scrotal enlargement;
  • a dragging or heavy sensation;
  • discomfort when walking, running or exercising;
  • irritation from clothing;
  • difficulty examining the testicle;
  • embarrassment or concern about appearance; and
  • discomfort during sexual activity.

A very large hydrocoele can become inconvenient and may interfere with sport, work or everyday activities.

When is urgent assessment needed?

A hydrocoele usually develops gradually and is not an emergency. Seek urgent medical care, however, if there is:

  • sudden or severe testicular pain;
  • rapid swelling;
  • nausea or vomiting with scrotal pain;
  • redness, fever or increasing tenderness;
  • a hard lump within the testicle;
  • scrotal swelling following a significant injury; or
  • a swelling that cannot be pushed back and is associated with groin or abdominal pain.

Sudden testicular pain may represent torsion, in which the blood supply to the testicle becomes twisted. This requires emergency assessment and should never be attributed to “just a hydrocoele.”

How is a hydrocoele diagnosed?

Assessment usually begins with a discussion about how and when the swelling developed, followed by examination of the abdomen, groin and scrotum.

A hydrocoele may transmit light when a torch is placed behind it, a finding called transillumination. This can support the diagnosis, but it does not replace a proper examination.

A scrotal ultrasound is commonly arranged in a younger man, particularly when:

  • the hydrocoele is new;
  • the testicle cannot be examined clearly;
  • there is pain or tenderness;
  • the swelling developed after injury;
  • the diagnosis is uncertain; or
  • an underlying testicular abnormality needs to be excluded.

Ultrasound can confirm that the swelling contains fluid and assess the testicle, epididymis, blood flow and surrounding structures. The European Association of Urology recommends high-frequency ultrasound when investigating a suspected testicular mass because it can determine whether a lesion is inside or outside the testicle and assess the opposite testis. EAU Testicular Cancer Guideline

Urine tests, STI testing or blood tests may also be appropriate when infection or inflammation is suspected.

Can a hydrocoele affect fertility?

For most younger men, a small or moderate uncomplicated hydrocoele does not cause infertility. It does not normally block sperm transport and does not automatically mean that sperm production is abnormal.

There are, however, several important qualifications:

  1. The underlying cause may matter more than the fluid.
    Previous torsion, testicular trauma, severe infection, an undescended testicle, testicular cancer or another testicular disorder may affect fertility independently of the hydrocoele.
  2. A very large or tense hydrocoele may theoretically affect the testicle.
    Prolonged pressure or increased local temperature has been proposed as a possible mechanism for impaired testicular function. Evidence in adults remains limited, and clinically significant infertility from an isolated hydrocoele appears uncommon.
  3. Surgery carries a small fertility-related risk.
    Hydrocoele repair is performed close to the epididymis, vas deferens and testicular blood supply. Injury to one of these structures is uncommon but could affect fertility, particularly when operating on both sides or when the opposite testicle is abnormal. The British Association of Urological Surgeons lists inadvertent injury to these structures as an uncommon recognised complication of surgery. BAUS hydrocoele repair information

A semen analysis is not routinely required for every man with a hydrocoele. It may be appropriate when:

  • a couple has been unable to conceive;
  • the hydrocoele is very large or present on both sides;
  • the opposite testicle is small or abnormal;
  • there is a history of undescended testis, torsion, chemotherapy, testicular surgery or significant infection; or
  • fertility preservation is an important concern before surgery.

The EAU recommends that the assessment of male infertility include a reproductive and medical history, physical examination, semen analysis and, where indicated, hormonal tests and imaging. It also stresses that semen analysis must be interpreted as part of the couple’s overall reproductive assessment rather than as a simple “fertile or infertile” test. EAU Male Infertility Guideline

Does every hydrocoele need treatment?

No. Treatment depends on the cause, size, symptoms and effect on quality of life.

Observation

A small, painless hydrocoele with a normal underlying testicle can often be monitored. It does not need to be removed merely because it is present.

Observation may include:

  • self-awareness of any change in size or consistency;
  • periodic clinical review when appropriate; and
  • reassessment if pain, rapid enlargement or a new lump develops.

The British Association of Urological Surgeons supports observation when an adult hydrocoele is small or not bothersome. BAUS

Treating an underlying cause

If the fluid is secondary to infection, inflammation or another condition, treatment should address that cause. The hydrocoele may reduce once the underlying problem settles, although established hydrocoeles do not always disappear.

Aspiration

Aspiration involves inserting a needle and draining the fluid. Although this can provide temporary relief, the fluid usually returns because the lining that produces it remains in place.

Aspiration also carries risks of bleeding and infection. BAUS does not regard aspiration alone as curative or standard treatment because recurrence is common. It may occasionally be considered for someone who is unsuitable for surgery. In selected circumstances, a sclerosant may be injected after aspiration, but recurrence and inflammation remain concerns.

Hydrocoelectomy

Hydrocoelectomy is the most reliable definitive treatment for a bothersome adult hydrocoele. Surgery may be considered when the swelling:

  • is large or progressively enlarging;
  • causes discomfort, heaviness or skin irritation;
  • interferes with exercise, work or sexual activity;
  • causes significant cosmetic or psychological concern; or
  • makes examination of the testicle difficult.

The operation is generally performed through a small scrotal incision under general or spinal anaesthesia. The fluid is drained, and the fluid-producing sac is folded, turned behind the testicle or partly removed to reduce the likelihood of recurrence.

Most procedures are performed as day surgery.

What should you expect after surgery?

Bruising, swelling and discomfort are expected and may initially make the scrotum look larger rather than smaller. Supportive underwear, simple pain relief and protected ice packs can help during the early recovery period.

Strenuous exercise and heavy lifting are generally avoided for several weeks. The testicle may continue to feel somewhat bulkier after repair because of the folded or thickened tissues around it.

Possible complications include:

  • bleeding or a scrotal haematoma;
  • wound or testicular infection;
  • persistent swelling;
  • recurrence of the hydrocoele;
  • chronic scrotal discomfort;
  • anaesthetic complications; and
  • uncommon injury to the epididymis, vas deferens or testicular blood supply.

The current BAUS patient information notes that temporary bruising and swelling are very common, while infection, haematoma, recurrence and injury to adjacent reproductive structures occur much less often. Individual risks depend on the size and complexity of the hydrocoele, previous surgery, infection and general health. BAUS hydrocoele repair leaflet

The important message for younger men

A hydrocoele is usually harmless, and many do not require treatment. However, a new scrotal swelling in a younger man should not be self-diagnosed or ignored. Clinical examination and often an ultrasound can confirm the diagnosis and ensure that the testicle underneath is healthy.

Most isolated hydrocoeles do not impair fertility. When fertility is a concern, the entire reproductive history and both testicles should be assessed rather than assuming that the hydrocoele is responsible.

Management should be individualised. For one man, reassurance and observation may be entirely appropriate. For another, surgery may provide worthwhile relief from heaviness, discomfort or embarrassment.

This article provides general patient information and does not replace individual medical assessment. Seek urgent care for sudden testicular pain, rapid swelling, fever or a hard testicular lump.

So, if you have noted a scrotal swelling and this is concerning you and need to have this checked out, see your GP or obtain a referral to see you Brisbane Urologist, Uro-Jo, for peace of mind.

Father’s Day, Quirky Gifts and the Quiet Joy of Being Dad

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Father’s Day has just passed here in Australia. Across the country, dads have been celebrated with breakfasts, phone calls, handmade cards and an impressive assortment of slightly quirky gifts.

There were novelty socks, barbecue tools, coffee mugs with questionable slogans and gadgets whose purpose may never be fully understood. Some fathers received homemade creations constructed from cardboard, glue and enormous amounts of love. Others simply enjoyed a message, a hug or precious time with their children.

And truthfully, being remembered is what matters most.

The joy of fatherhood

Fatherhood is difficult to describe in a single word. It is joy, pride, worry, responsibility, frustration, laughter and love; often experienced simultaneously.

From the moment our children arrive, they occupy a permanent place in our hearts and minds. We celebrate their successes, worry about their struggles and continue offering advice long after they have stopped asking for it.

Our children also have a remarkable ability to keep us humble. They know our habits, our favourite stories and the jokes we have repeated far too many times. They see the sensible father we try to be, as well as the wonderfully quirky person underneath.

Perhaps that is why those unusual Father’s Day presents can feel so personal. A funny mug or pair of loud socks may say, “Dad, we know exactly who you are, and we love you anyway.”

The attached photo is of my new lanyard, exactly that quirky and thoughtful present from my 2 loving daughters. I realized how privileged I am to have such great daughters!

Every stage of fatherhood is different

For fathers of young children, Father’s Day may begin very early, with enthusiastic little people climbing onto the bed carrying toast that is slightly burnt and coffee that is slightly cold.

As children grow older, celebrations change. Teenagers may offer a brief hug before disappearing. Adult children may telephone from another city or bring their own children to visit. Grandfathers may find themselves watching the next generation of dads discovering the same joys and challenges.

The form of the celebration changes, but the meaning remains: connection, gratitude and belonging.

Fatherhood also continues through difficult seasons. Relationships may change, families may be separated by distance, and some fathers carry grief for children or fathers who are no longer present. Father’s Day can therefore bring mixed emotions. It is worth remembering that love and loss often sit quietly beside one another.

Dads can be quirky and that is part of the charm

Fathers are famous for having their own peculiarities.

We may insist on keeping mysterious screws “because they will be useful one day.” We can spend hours researching a new barbecue but postpone making a medical appointment. We may refuse to ask for directions, become overly invested in controlling the household thermostat, or believe that every family gathering needs the same collection of well-worn jokes.

These quirks become part of the family story. Children may roll their eyes at them today, but they are often the very things they remember fondly later.

The lesson is not that fathers need to become less quirky. It is that we should remain present, engaged and healthy enough to keep sharing those quirks for many years to come.

A Father’s Day reminder about men’s health

Men are often excellent at looking after their families while being less attentive to themselves. We may service the car on schedule, repair something the moment it breaks and remind everyone else to see a doctor, yet quietly ignore changes in our own health.

Father’s Day is a useful prompt to take stock.

Urinary difficulties, blood in the urine, testicular changes, erectile problems, pelvic pain or concerns about the prostate should not be dismissed simply because they are embarrassing. These symptoms are common, and asking for help is sensible rather than weak.

Looking after your health is not a selfish act. It allows you to remain involved in the lives of the people who value you most.

The greatest gift

The best Father’s Day gifts are rarely the most expensive ones. They are the phone call, the shared meal, the handwritten card, the private joke and the knowledge that our children thought of us.

The quirky gifts are simply the wrapping around a much deeper message:

“You matter to me. I remember you. I am glad you are my dad.”

So, to all the fathers, stepfathers, grandfathers, foster fathers, mentors and father figures: I hope you felt appreciated this Father’s Day.

Wear the bright socks. Use the strange gadget. Display the handmade card proudly. Continue telling the terrible jokes.

After all, our children do not love us despite our quirks. Very often, they love us because of them.

Peyronie’s Disease: When a Curved Erection Becomes a Medical Problem

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Peyronie’s disease is a condition in which scar tissue develops within the penis, causing it to bend or curve during an erection.

A slight natural curve can be completely normal. Peyronie’s disease is different because the change is usually new, may worsen over time, and can sometimes cause pain or make sexual intercourse difficult.

What causes Peyronie’s disease?

The exact cause is not always clear.

In many cases, the condition may develop after repeated minor injury or trauma to the penis. This can lead to the formation of fibrous scar tissue, known as a plaque.

The plaque does not stretch normally during an erection, causing the penis to bend toward the affected area.

Some men do not remember any specific injury.

Common symptoms

Symptoms of Peyronie’s disease can include:

  • A new bend or curve in the penis
  • A hard area or plaque beneath the skin
  • Pain during erections
  • Shortening of the penis
  • Narrowing or indentation of the shaft
  • Difficulty with sexual intercourse
  • Erectile dysfunction

The severity can vary considerably between patients.

Does Peyronie’s disease get worse?

Peyronie’s disease commonly develops in phases.

During the early or active phase, the curvature may continue to change and erections may be painful.

After a period of time, the condition often becomes more stable.

In some men the pain settles, while the curvature remains.

When should you see a urologist?

A new or worsening penile curvature should be assessed, particularly when it causes pain, affects erections or interferes with sexual activity.

A urologist can assess the degree of curvature, check for plaque formation and determine whether treatment is necessary.

Not every patient requires surgery.

Treatment options

Treatment depends on the severity of the condition, how long it has been present and whether it is affecting sexual function.

Options may include:

  • Observation
  • Medication in selected cases
  • Penile traction therapy
  • Injection treatments
  • Surgical correction

Surgery is generally considered when the condition is stable and the curvature significantly affects sexual intercourse.

Peyronie’s disease and erectile dysfunction

Some men with Peyronie’s disease also develop erectile dysfunction.

This may occur because of changes in penile structure, blood flow or anxiety related to pain and curvature.

Assessment is therefore important so that both problems can be considered together.

Specialist assessment in Brisbane

Peyronie’s disease can be uncomfortable to discuss, but it is a recognised medical condition and treatment options are available.

If you have noticed a new change in penile shape, persistent pain during erections or difficulty with sexual activity, speak with your GP or arrange an assessment with a urologist.

 

Penis Problems: 7 Signs You Should See a Urologist

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Problems affecting the penis can be difficult or embarrassing to talk about, but they are also surprisingly common.

Pain, swelling, changes in shape, difficulty with erections or unusual lumps can have many different causes. Some are minor and temporary, while others may need proper medical assessment.

If a problem persists, becomes painful or begins affecting sexual or urinary function, speaking with your GP or a urologist in Brisbane may be the right next step.

Here are seven signs that should not simply be ignored.

1. Persistent Pain in the Penis

Penile pain can occur for several reasons.

Minor irritation or injury may settle on its own, but persistent pain should be assessed, particularly when it occurs during erections or sexual activity.

Possible causes can include injury, inflammation, infection or conditions such as Peyronie’s disease.

Sudden severe pain following an injury to an erect penis can be particularly important.

A penile fracture involves tearing of tissue within the penis and may cause sudden pain, swelling, bruising or a noticeable popping sensation.

This requires urgent medical attention.

2. A New Bend or Curve During Erections

A small natural curve in the penis is common.

However, if the penis gradually becomes noticeably more curved, particularly if erections become painful or intercourse becomes difficult, it could be a sign of Peyronie’s disease.

Peyronie’s disease occurs when scar tissue develops inside the penis.

This can cause:

  • Curvature during an erection
  • Pain
  • A palpable hard area or lump
  • Shortening or narrowing of the penis
  • Difficulty with sexual intercourse
  • Erectile dysfunction

Some men delay seeking help because they assume the problem will disappear.

If the curvature is new or worsening, a urologist can assess the condition and discuss available treatment options.

3. Difficulty Getting or Maintaining an Erection

Occasional difficulty achieving an erection can happen to many men.

Persistent erectile dysfunction is different.

Erectile dysfunction, commonly referred to as ED, can have physical, psychological or combined causes.

Possible physical factors include problems with blood flow, diabetes, cardiovascular disease, hormonal issues, prostate conditions and certain medications.

Peyronie’s disease can also contribute to erectile problems.

Because erectile dysfunction can sometimes be associated with broader health conditions, persistent ED is worth discussing with a doctor rather than simply treating the symptom yourself.

A Brisbane urologist may also be involved when the problem relates to the urinary or male reproductive system.

4. Lumps or Hard Areas in the Penis

Finding a lump or hardened area can understandably cause concern.

Not every lump is cancerous.

Some may be related to scar tissue, blocked glands or other benign conditions.

A hard plaque beneath the skin may, for example, occur with Peyronie’s disease.

However, any new or unexplained lump that persists should be properly assessed.

Changes that should be checked include:

  • A persistent lump
  • Thickening of the skin
  • A hard area beneath the skin
  • Changes in colour or texture
  • A sore that does not heal

Early assessment can determine whether further investigation is necessary.

5. Persistent Swelling, Redness or Inflammation

Temporary swelling can occur after injury or irritation.

Persistent swelling, however, may indicate inflammation, infection or another underlying problem.

The penis may become:

  • Red
  • Tender
  • Painful
  • Itchy
  • Swollen
  • Difficult to retract if the foreskin is involved

Inflammation of the head of the penis is known as balanitis and can sometimes affect the foreskin as well.

Poor hygiene, irritation and infection can all contribute.

Persistent or recurrent inflammation should be discussed with a doctor.

6. Discharge, Sores or Unusual Lesions

Discharge from the penis or the appearance of sores, ulcers or unusual lesions can sometimes be associated with a sexually transmitted infection.

Possible STIs include gonorrhoea, chlamydia, herpes and syphilis.

Not every sore or discharge is caused by an STI, but these symptoms should be assessed rather than self-diagnosed.

If you believe you may have been exposed to an STI, your GP or a sexual health clinic is usually the appropriate first point of contact.

STI testing can identify infections even when symptoms are mild or absent.

What About HIV?

HIV is a viral infection that affects the immune system and is not primarily treated by a urologist.

Importantly, HIV cannot be diagnosed by looking at the penis or by relying on symptoms alone.

Someone who believes they may have been exposed to HIV should seek medical advice and appropriate testing through a GP or sexual health service.

Modern HIV treatment is highly effective, and people receiving effective treatment can live long and healthy lives.

7. Problems With the Foreskin

Foreskin problems are another common reason men seek medical advice.

These can include:

  • Difficulty retracting the foreskin
  • Pain when retracting it
  • Recurrent infections
  • Cracking or bleeding
  • Swelling
  • Difficulty cleaning underneath the foreskin

A tight foreskin is known as phimosis.

In some cases it can cause pain, infections or difficulty urinating.

Treatment depends on the severity of the problem and may include medication or, in some circumstances, a surgical procedure.

A foreskin that has been pulled back and becomes trapped behind the head of the penis is known as paraphimosis.

This can restrict blood flow and requires urgent medical treatment.

When Should You See a Doctor?

It is worth arranging an assessment if you notice a penile problem that:

  • Persists for more than a short period
  • Is becoming worse
  • Causes significant pain
  • Affects erections or sexual activity
  • Causes difficulty urinating
  • Involves a persistent lump or sore
  • Causes recurrent swelling or inflammation
  • Is associated with discharge
  • Follows a significant injury

Some problems can be treated relatively simply once the cause has been identified.

Waiting because the issue feels embarrassing can sometimes allow the problem to become more difficult to manage.

When Is It an Emergency?

Seek urgent medical attention if you experience:

  • A significant injury to an erect penis
  • Sudden severe pain and swelling
  • Heavy bleeding
  • An erection lasting several hours that will not go away
  • Inability to urinate
  • A foreskin trapped behind the head of the penis with increasing swelling or pain

These situations should not wait for a routine appointment.

Seeing a Urologist in Brisbane

Urologists specialise in conditions affecting the urinary system and the male reproductive system.

Depending on the problem, a urologist may investigate penile pain, erectile dysfunction, penile curvature, foreskin problems, injuries and other conditions affecting male genital health.

If you have a persistent penile problem or have been referred for specialist assessment speak with your GP about whether a urology referral is appropriate.

Ignoring a problem because it feels embarrassing rarely makes it easier.

Getting the right diagnosis is the first step toward deciding whether treatment is actually needed.

Urologist Brisbane: 7 Symptoms You Shouldn’t Ignore

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Many urinary symptoms are easy to dismiss.

You may notice that you are going to the toilet more often, getting up several times during the night, experiencing a weaker urine stream or feeling as though your bladder never fully empties.

Sometimes these changes develop gradually and become something you simply learn to live with.

However, persistent urinary symptoms can be a sign that it is worth speaking with your GP and, where appropriate, seeing a urologist in Brisbane for further investigation.

Below are seven symptoms that should not simply be ignored.

1. Blood in Your Urine

Seeing blood in your urine can be alarming, but even a small amount should be taken seriously.

Blood in the urine is known as haematuria.

There are many possible causes, including urinary tract infections, kidney stones, prostate conditions and other problems affecting the urinary system.

Importantly, blood in the urine may sometimes occur without any pain.

Because the cause cannot usually be determined from the symptom alone, further investigation may be recommended.

A urologist can assess the urinary tract and determine whether additional testing is required.

2. A Weak or Slow Urine Stream

A gradual reduction in urinary flow is particularly common in men as they get older.

You may notice that:

  • It takes longer to start urinating
  • The urine stream is weaker than it used to be
  • The stream stops and starts
  • You need to strain
  • Urination takes longer
  • You still feel full afterwards

One possible cause is an enlarged prostate.

The prostate surrounds part of the urethra, so when it enlarges it can restrict the normal flow of urine.

While an enlarged prostate is often benign, persistent symptoms should still be assessed.

A Brisbane urologist can investigate the cause and discuss whether monitoring, medication or another treatment may be appropriate.

3. Getting Up Several Times During the Night

Waking once occasionally to use the bathroom may not be unusual.

Regularly getting up several times every night is different.

This is known as nocturia and can significantly affect sleep quality.

Night-time urination can be associated with several conditions, including bladder problems and prostate enlargement.

If you find yourself automatically planning your evening around bathroom trips or waking repeatedly during the night, it may be worth discussing the problem with your doctor.

4. Feeling Like Your Bladder Never Completely Empties

One of the more frustrating urinary symptoms is finishing urination but still feeling as though there is urine left in the bladder.

Some people return to the toilet shortly afterwards.

Others may experience frequent urges because the bladder has not emptied effectively.

Incomplete bladder emptying can have several possible causes and may require further investigation.

A urologist may assess urinary flow, bladder function and the prostate where relevant to determine what is contributing to the problem.

5. Sudden or Frequent Urges to Urinate

Do you find yourself constantly looking for the nearest bathroom?

An increased need to urinate, or sudden powerful urges that are difficult to control, may indicate a bladder or urinary issue.

Some people begin changing their routine without even realising it.

They may:

  • Avoid long drives
  • Choose seats near toilets
  • Limit drinks before leaving home
  • Avoid certain social activities
  • Use the bathroom “just in case”

When urinary symptoms begin affecting everyday decisions, it is a good indication that they deserve proper assessment.

6. Urinary Leakage

Urinary leakage is common, but that does not mean it should automatically be accepted as part of ageing.

Incontinence can range from occasional small leaks to significant loss of bladder control.

Some people experience leakage when coughing, lifting or exercising.

Others experience a sudden urge to urinate and cannot reach the bathroom in time.

There are several different types of urinary incontinence, and treatment depends heavily on identifying the underlying cause.

Seeing a urologist can help determine which type of incontinence is occurring and what treatment options may be available.

7. An Abnormal PSA Result

A PSA blood test measures the level of prostate-specific antigen in the blood.

An elevated PSA does not automatically mean prostate cancer.

PSA levels can change for several reasons, including benign prostate enlargement and other prostate conditions.

However, an abnormal or rising PSA result may lead your GP to recommend further specialist assessment.

A urologist can review your PSA history, symptoms, examination findings and other relevant information before deciding whether additional investigation is needed.

Don’t Wait Until Symptoms Become Severe

One of the most common reasons people delay seeing a doctor is because their symptoms are manageable.

They may think:

“It’s annoying, but I can live with it.”

The problem is that urinary symptoms can develop slowly.

What begins as getting up once during the night may eventually become three or four bathroom trips.

A slightly weaker stream may gradually become difficulty emptying the bladder.

Minor leakage can eventually begin influencing work, exercise or social activities.

If a urinary problem is persistent, changing or interfering with everyday life, having it properly assessed is usually better than simply adapting around it.

What Happens When You See a Urologist?

Seeing a urologist does not necessarily mean you will need surgery.

The first step is usually determining why the symptoms are occurring.

Depending on the problem, assessment may involve discussing your symptoms and medical history, examining relevant areas and arranging appropriate investigations.

Once the cause is better understood, your urologist can discuss the available treatment options.

For some patients, treatment may involve monitoring or medication.

For others, additional procedures may be appropriate.

The important point is that treatment should be based on the cause of the problem rather than the symptom alone.

Looking for a Urologist in Brisbane?

If you are experiencing persistent urinary symptoms, prostate concerns, urinary leakage, kidney stone symptoms or have received an abnormal PSA result, your GP may recommend specialist assessment.

A urologist in Brisbane can investigate symptoms involving the urinary system and help determine the most appropriate next step.

Dr Jo Schoeman provides specialist urological assessment and treatment for patients in Brisbane and surrounding areas.

If you are concerned about changes in your urinary health, speak with your GP about whether a referral to a urologist is appropriate.

Benign Prostate Enlargement and Water-Vapour Therapy: A Patient Guide

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Benign prostate enlargement, also called benign prostatic hyperplasia or BPH becomes more common as men age. Enlargement may narrow the urethra, increase resistance to urinary flow and affect the way the bladder stores or empties urine.

Not every enlarged prostate causes symptoms, and not every urinary symptom is caused by the prostate. Treatment should therefore begin with an assessment of the likely cause, the effect on quality of life and whether complications are present.

This article explains BPH and the role of transurethral water-vapour therapy as one of several possible treatments. It does not recommend a particular product, device, clinician or health service.

What symptoms can BPH cause?

Lower urinary tract symptoms may include:

  • a slow or weak urinary stream
  • difficulty starting urination
  • stop–start flow
  • straining to urinate
  • a feeling that the bladder has not emptied
  • passing urine frequently
  • urgency
  • waking at night to urinate
  • dribbling after urination
  • urinary retention

The size of the prostate does not always match symptom severity. A large prostate may cause few problems, while a smaller prostate can obstruct flow because of its shape, a tight bladder neck or a prominent median lobe.

What else can cause urinary symptoms?

Similar symptoms may arise from:

  • urinary tract infection
  • overactive bladder
  • urethral stricture
  • bladder stones
  • impaired bladder-muscle contraction
  • neurological disease
  • prostate or bladder cancer
  • medicines that affect bladder function
  • excessive fluid, caffeine or alcohol intake
  • constipation or sleep disorders

Visible blood in the urine, recurrent infection, kidney impairment, bladder stones, persistent retention or rapidly worsening symptoms require appropriate investigation.

How is BPH assessed?

Assessment may include:

  • a urinary, medical and medication history
  • a validated symptom questionnaire
  • physical examination
  • digital rectal examination
  • urine testing
  • PSA testing after discussion of its benefits and limitations
  • kidney-function testing when indicated
  • urinary flow measurement
  • ultrasound assessment of prostate size and post-void residual urine
  • a bladder diary
  • cystoscopy or urodynamic testing in selected cases

It is particularly important to distinguish bladder-outlet obstruction from weak bladder contraction. Opening the prostate outlet may not restore normal emptying if the bladder muscle is unable to contract adequately.

Does every man with BPH need treatment?

No. Men with mild, non-bothersome symptoms and no complications may choose observation with periodic review.

Conservative measures may include:

  • moderating excessive evening fluid intake
  • reducing caffeine or alcohol when these worsen symptoms
  • treating constipation
  • reviewing relevant medicines
  • avoiding habitual “just in case” voiding where appropriate
  • managing diabetes, sleep apnoea or leg swelling when they contribute to nocturia

Fluid should not be restricted excessively, particularly in hot weather or when dehydration is a risk.

What treatment options are available?

Depending on symptoms, anatomy and risk, options may include:

  • monitoring and lifestyle measures
  • prescription medicines
  • minimally invasive surgical therapies
  • transurethral resection or vaporisation
  • laser enucleation
  • other endoscopic enucleation techniques
  • simple prostatectomy for selected very large glands

Each option differs in speed of improvement, durability, anaesthetic requirements, catheter time, bleeding risk, sexual effects and likelihood of retreatment.

What is transurethral water-vapour therapy?

Water-vapour therapy is a minimally invasive treatment intended to reduce selected areas of benign prostate tissue that are contributing to obstruction.

A specialised instrument is passed through the urethra. A needle delivers controlled water vapour into planned areas of prostate tissue. As the vapour condenses, thermal energy disrupts the targeted cells. The body then gradually reabsorbs treated tissue over the following weeks and months.

Unlike resection or enucleation, obstructing tissue is not physically removed during the procedure. Improvement is therefore delayed while inflammation settles and treated tissue reduces.

The exact device, intended purpose, contraindications and instructions for use should be confirmed from the current Australian Register of Therapeutic Goods entry and manufacturer-approved documentation.

Who might be considered?

Water-vapour therapy may be discussed with selected men whose bothersome symptoms are likely to arise from benign prostate obstruction and who understand the alternatives and likelihood of retreatment.

Assessment may consider:

  • symptom severity and quality-of-life impact
  • prostate volume and shape
  • lateral-lobe or median-lobe obstruction
  • urinary flow and residual urine
  • bladder contractility
  • previous urinary retention
  • coexisting bladder or urethral disease
  • anaesthetic and bleeding risk
  • the importance of preserving ejaculation
  • the patient’s preference regarding recovery, durability and retreatment

The pivotal randomised study enrolled a defined group of men, including prostate volumes between 30 and 80 mL. Evidence outside the studied population is less mature and may rely on observational data.

Larger prostates, catheter-dependent retention or previous prostate procedures do not automatically determine suitability, but the expected results and evidence may differ. A tissue-removing operation may provide more predictable or faster relief in some patients.

When may it be unsuitable?

Reasons to avoid or reconsider water-vapour therapy may include:

  • active urinary infection
  • suspected prostate or bladder cancer requiring investigation
  • urethral stricture preventing safe access
  • poor bladder contractility
  • symptoms caused mainly by overactive bladder rather than obstruction
  • bladder stones or another condition better treated during a different operation
  • anatomy unlikely to be treated adequately
  • severe obstruction or complications requiring rapid, predictable decompression
  • a contraindication in the approved instructions for the proposed device

Suitability must be decided individually. A median lobe is not necessarily an exclusion, but its anatomy and treatment plan require careful assessment.

How is the procedure performed?

The procedure is performed through the urethra, without an external incision. The device is positioned within the prostatic urethra, and treatment is delivered to selected areas according to prostate length, volume and shape.

Anaesthesia and perioperative care vary by patient and facility. The procedure is often performed as day surgery, but same-day discharge is not guaranteed.

Patients should receive individual instructions about:

  • fasting and anaesthesia
  • urine testing
  • antibiotics where clinically indicated
  • anticoagulant and antiplatelet medicines
  • transport and activity after the procedure
  • catheter care
  • symptoms requiring urgent review

Anticoagulant or antiplatelet medicines must not be stopped without advice from the clinician who manages them.

Will a catheter be needed?

Many patients need a temporary urinary catheter because treatment initially causes swelling. Catheter duration varies with prostate anatomy, baseline bladder emptying, pre-existing retention and the clinical course.

Some patients cannot pass urine after the catheter is removed and require reinsertion or intermittent catheterisation. Urgent review is needed if a patient cannot urinate and develops increasing lower-abdominal pain.

When might symptoms improve?

Water-vapour therapy does not usually provide immediate improvement. Urgency, frequency, discomfort or flow may temporarily worsen because of inflammation and swelling.

Improvement may begin over several weeks and continue for several months. The timing and degree of benefit vary, and some patients obtain inadequate relief.

Possible short-term effects

Common or expected effects can include:

  • burning or discomfort when urinating
  • blood in the urine
  • blood or discolouration in the semen
  • urinary frequency or urgency
  • a temporarily weaker stream
  • pelvic or perineal discomfort
  • catheter-related discomfort
  • temporary urinary retention

Patients should follow the written aftercare advice from their treating team.

Other risks and complications

Possible complications include:

  • urinary tract infection
  • prostatitis or systemic infection
  • bleeding
  • persistent urinary retention
  • worsening urgency or incontinence
  • urethral stricture or bladder-neck narrowing
  • ejaculatory change
  • erectile or sexual symptoms
  • chronic pelvic or urinary discomfort
  • failure to improve symptoms
  • need for repeat treatment or another prostate operation

Serious complications are uncommon but possible. Fever, chills, inability to urinate, heavy bleeding, severe pain or feeling systemically unwell require prompt assessment.

What about ejaculation and erections?

Preserving sexual and ejaculatory function is an important goal for many patients considering minimally invasive treatment. Clinical studies have reported relatively low rates of new sexual dysfunction after water-vapour therapy in selected populations.

However:

  • preservation cannot be guaranteed
  • changes in ejaculation can occur
  • erectile function may change for reasons unrelated to the procedure
  • trial definitions and selected participants may not reflect every patient
  • comparison with other procedures depends on technique, anatomy and baseline function

Sexual priorities should be discussed before treatment, along with the more established risk of ejaculatory change after tissue-removing operations.

What did the pivotal five-year study find?

Five-year follow-up from a sham-controlled randomised study reported sustained average improvement in symptoms and urinary flow among study participants who received water-vapour therapy. Reported outcomes included an approximate 48% improvement in symptom score and a 4.4% surgical retreatment rate over five years.

These figures require context:

  • they are group averages, not a prediction for an individual
  • the trial used defined eligibility criteria
  • follow-up does not show what happens over a lifetime
  • some participants did not obtain adequate relief
  • “surgical retreatment” does not capture every medication restart, investigation or non-surgical intervention
  • results may differ with larger prostates, retention, previous surgery or different anatomy

The evidence supports water-vapour therapy as a possible option for selected men; it does not establish it as the best treatment for all men with BPH.

Can the prostate continue to grow?

Yes. The procedure treats selected obstructing tissue present at the time. It does not stop the biological process of benign prostate growth.

Symptoms may remain controlled, recur because of further growth, or persist for another reason such as bladder dysfunction. Younger patients should consider the possibility of needing additional treatment during their lifetime.

How does it compare with tissue-removing surgery?

Water-vapour therapy generally involves less immediate tissue removal and slower improvement than transurethral resection or enucleation.

Potential reasons a patient might consider it include a preference for a less invasive approach and a desire to reduce the chance of ejaculatory change. Potential disadvantages include delayed benefit, postoperative irritation, catheterisation, uncertainty in less-studied anatomies and the possibility of retreatment.

Tissue-removing surgery may be more suitable when there is:

  • severe or recurrent urinary retention
  • very large or complex obstructing anatomy
  • bladder stones
  • recurrent infection caused by poor emptying
  • kidney or upper-tract effects from obstruction
  • substantial bleeding attributable to BPH
  • a need for faster or more predictable relief

No procedure is best for every patient.

Follow-up

Review may assess:

  • urinary symptoms and quality of life
  • urinary flow
  • post-void residual urine
  • infection or retention
  • catheter-related problems
  • sexual or ejaculatory effects
  • need for continuing BPH medicine
  • whether another diagnosis or treatment should be considered

Persistent or worsening symptoms should prompt reassessment rather than repeated reassurance that improvement will eventually occur.

Questions to discuss with a urologist

  • Are my symptoms caused by prostate obstruction?
  • Is my bladder contracting adequately?
  • What is my prostate size and anatomy?
  • Do I have complications that favour a more definitive operation?
  • What are the alternatives, including observation and medicines?
  • How quickly is each option likely to help?
  • What are the risks to ejaculation, erections and continence?
  • How long might I need a catheter?
  • What is the likelihood of needing another procedure?
  • Is the exact proposed device included in the ARTG for this use?
  • What out-of-pocket costs may apply?

Australian regulatory considerations

The Australian Register of Therapeutic Goods (ARTG) records therapeutic goods that may be legally supplied in Australia, unless an exemption or authorised access pathway applies. Inclusion is specific to the sponsor, device and intended purpose; it is not a recommendation that the device is suitable or superior for an individual patient.

Device status, instructions for use, contraindications, reimbursement and availability can change. These should be checked at the time treatment is considered.

The bottom line

BPH is common, but urinary symptoms require assessment because prostate obstruction is only one possible cause.

Transurethral water-vapour therapy is one minimally invasive option for selected men. It may improve urinary symptoms while offering a different balance of recovery, sexual effects and retreatment risk from tissue-removing surgery. Improvement is gradual, catheterisation is common, benefit is not guaranteed and further treatment may be needed.

The choice should follow an informed discussion of observation, medicines, minimally invasive treatments and established surgical options, taking account of prostate anatomy, bladder function, complications and personal priorities.

This article provides general disease education and does not replace individual medical advice. It does not promote or recommend a particular therapeutic device, brand, clinician or health service.

References and further reading

 

Clips for Benign Prostatic Enlargement: A Minimally Invasive Treatment That Preserves Ejaculation

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Benign prostatic hyperplasia, or BPH, is a non-cancerous enlargement of the prostate. As the prostate enlarges, its lateral lobes may compress the urethra and obstruct the flow of urine from the bladder.

Common lower urinary tract symptoms include:

  • A weak or interrupted urinary stream
  • Difficulty starting urination
  • Straining to pass urine
  • Urinary frequency and urgency
  • Getting up repeatedly at night
  • Dribbling after urination
  • A feeling that the bladder has not emptied properly

Medication is usually the first treatment offered to men with troublesome symptoms. However, tablets may provide insufficient relief or cause dizziness, tiredness, reduced libido, erectile problems or altered ejaculation.

The UroLift procedure, also called a prostatic urethral lift or PUL, is a minimally invasive surgical therapy, or MIST, that may provide an alternative to long-term medication and conventional prostate surgery.

What is a MIST procedure?

Minimally invasive surgical therapies are designed to improve urinary symptoms with less tissue damage, less bleeding and a shorter recovery than conventional procedures such as TURP or prostate laser surgery.

Different MIST procedures work in different ways. Some use steam or other forms of energy to destroy prostate tissue. Some temporarily remodel the urinary passage. UroLift mechanically moves the obstructing prostate tissue away from the urethra using small permanent implants.

Its principal attractions are:

  • No cutting or removal of prostate tissue
  • No heat, laser or steam
  • Rapid improvement in many patients
  • Usually brief catheterisation, if any
  • Short recovery
  • A low reported risk of new erectile or ejaculatory dysfunction

The trade-off is that symptom improvement is generally more modest than after a tissue-removing operation, permanent implants remain within the prostate, and some patients will eventually require further treatment.

How does Clips work?

The UroLift system uses small implants to hold the enlarged lateral lobes of the prostate away from the urethra.

Each implant consists of:

  • A small capsular tab placed on the outside of the prostate
  • A stainless-steel urethral end-piece
  • A permanent suture connecting the two components

The implant compresses and retracts the obstructing prostate tissue, widening the urinary channel without cutting, burning or removing tissue.

Most patients require several implants. The exact number depends on the length, size and shape of the prostate and the degree of obstruction. These implants remain permanently in position.

Who may benefit from Clips?

UroLift may be considered for men who:

  • Have moderate or severe urinary symptoms caused by BPH
  • Have obtained inadequate relief from medication
  • Cannot tolerate the side effects of BPH medication
  • Prefer not to take daily medication indefinitely
  • Want a less invasive alternative to TURP or laser surgery
  • Place a high priority on preserving forward ejaculation
  • Want a relatively rapid return to normal activities
  • Have prostate anatomy suitable for a prostatic urethral lift
  • Understand the possibility of future retreatment

It is particularly attractive for sexually active men who wish to improve their urinary symptoms while minimising the risk of dry or retrograde ejaculation.

What prostate size is suitable?

Clinical guidelines and manufacturer labelling are not identical.

Current European Association of Urology guidance recommends offering prostatic urethral lift to men interested in preserving ejaculation who have prostates smaller than 70 mL and no obstructing middle lobe.

American Urological Association guidance supports the procedure for selected men with prostates approximately 30–80 mL and without an obstructing middle lobe.

Manufacturer and regulatory indications may extend to prostates as large as 100 mL and may include selected median-lobe anatomy in some jurisdictions. However, treatment outside the populations best supported by clinical guidelines requires careful patient selection and counselling.

Prostate volume alone does not determine suitability. The shape of the prostate, length of the prostatic urethra, bladder-neck anatomy, degree of obstruction and strength of the bladder muscle must also be considered.

What about an obstructing median lobe?

The median lobe is prostate tissue that projects upwards towards the bladder and may act like a ball valve over the bladder outlet.

UroLift can be used to treat selected obstructing median lobes, and the MedLift study reported encouraging outcomes. Nevertheless, major guideline recommendations remain more conservative because the strongest long-term randomised evidence relates mainly to lateral-lobe obstruction.

A large, mobile or unusually shaped median lobe may be better treated with TURP, laser surgery, Rezūm, Aquablation or another procedure capable of removing or reducing the obstructing tissue.

This is an important anatomical caveat to discuss before choosing UroLift.

Assessment before treatment

Not every urinary symptom is caused by BPH. Infection, urethral stricture, bladder weakness, overactive bladder, neurological disease, medication and prostate or bladder cancer may produce similar symptoms.

Assessment may include:

  • Medical history and examination
  • International Prostate Symptom Score
  • Urine testing
  • PSA testing when appropriate
  • Urinary-flow measurement
  • Ultrasound measurement of residual urine
  • Prostate imaging or ultrasound
  • Flexible cystoscopy
  • Urodynamic testing in selected patients

Cystoscopy may be particularly useful because it allows the urologist to assess the lateral lobes, bladder neck, median lobe and length of the obstructing prostate.

Any urinary infection should be treated before the procedure.

Patients taking aspirin, warfarin, clopidogrel, apixaban, rivaroxaban or other blood-thinning medication require an individual plan. Do not stop blood-thinning medication without instructions from your prescribing doctor and urologist.

How is the UroLift procedure performed?

UroLift is usually performed as a day procedure under local anaesthetic with sedation or a short general anaesthetic.

A cystoscope and specialised delivery device are passed through the urethra. No external incision is required.

The urologist:

  1. Examines the urethra, prostate and bladder.
  2. Positions the delivery device within the prostatic urethra.
  3. Moves the obstructing prostate tissue away from the urinary channel.
  4. Deploys an implant to hold the tissue in its new position.
  5. Repeats the process at selected points until an adequate channel has been created.
  6. Inspects the bladder outlet and controls any bleeding.

The procedure commonly takes less than an hour, although this varies with prostate anatomy and the number of implants required.

Because no prostate tissue is removed, there is usually no specimen for laboratory examination.

Will I need a catheter?

Many men can pass urine after the procedure and go home without a catheter. A catheter may nevertheless be required if there is:

  • Significant prostate swelling
  • Inability to pass urine
  • Pre-existing urinary retention
  • A weak bladder muscle
  • Bleeding or clot formation
  • A high residual urine volume

When required, the catheter is usually temporary. Patients with chronic retention or poor bladder function have a greater risk of failing an early trial without a catheter.

What should I expect after UroLift?

Temporary urinary irritation is common during the first few days.

You may experience:

  • Burning or stinging when passing urine
  • Urinary urgency and frequency
  • Pelvic, perineal or penile discomfort
  • Light blood in the urine
  • Bladder spasms
  • A temporarily weaker or more irregular stream
  • Increased night-time urination
  • A feeling of incomplete emptying

These symptoms generally improve over several days, although urinary irritation may occasionally persist for a few weeks.

Some men notice an improved stream soon after treatment. For others, the benefit develops over the following two to six weeks as swelling and irritation settle.

Managing pain and urinary discomfort

Discomfort after UroLift is usually mild to moderate.

Management may include:

Paracetamol

Paracetamol is commonly sufficient for mild discomfort. Take it according to the instructions provided by your doctor or the directions on the packet.

Avoid accidentally taking additional paracetamol contained in cold, influenza or combination pain medicines.

Anti-inflammatory medication

Ibuprofen or another anti-inflammatory medicine may help when medically appropriate. These medicines may not be suitable for patients with kidney impairment, stomach ulcers, certain heart conditions, bleeding disorders, anti-inflammatory-sensitive asthma or anticoagulant medication.

Check with your doctor or pharmacist before taking an anti-inflammatory medicine.

Medication for urinary symptoms

An alpha blocker may be continued temporarily to assist urine flow while swelling settles. Medication for bladder spasm or urinary burning may occasionally be prescribed.

Practical measures

It may help to:

  • Maintain normal hydration without forcing excessive fluids
  • Limit coffee, tea, alcohol, fizzy drinks and energy drinks
  • Avoid constipation
  • Avoid heavy lifting and vigorous exercise for several days
  • Take pain relief before discomfort becomes severe

Severe or worsening pain should be reported rather than simply tolerated.

Possible complications

Most side effects are mild and temporary, but complications can occur.

Common temporary effects

These include:

  • Pain or burning during urination
  • Blood in the urine
  • Urinary urgency
  • Increased frequency
  • Pelvic discomfort
  • Temporary urinary leakage associated with urgency

Urinary retention

Some men cannot pass urine after the procedure and require temporary catheterisation. The risk may be greater in patients with high residual urine volumes, chronic retention, severe obstruction or a weak bladder muscle.

Urinary tract infection

Infection may cause worsening burning, cloudy or offensive urine, fever, chills or feeling generally unwell. Antibiotics may be required.

Bleeding

Light haematuria is common. Significant bleeding, clot retention or the need for further intervention is uncommon but possible.

Implant-related problems

Potential implant complications include:

  • Incorrect placement
  • Implant exposure within the bladder
  • Encrustation or stone formation
  • Migration or loosening
  • Persistent pelvic discomfort
  • The need to remove an implant
  • Difficulty or irritation during later prostate surgery

Implants placed too close to or within the bladder are more likely to develop encrustation and may require endoscopic removal.

Persistent symptoms

UroLift treats obstruction but does not correct every cause of lower urinary tract symptoms. Urgency, frequency and nocturia may persist when they are caused by bladder overactivity, excessive night-time urine production, sleep apnoea, fluid intake, diabetes or other medical conditions.

Need for further treatment

Some patients obtain insufficient relief or develop recurrent symptoms as the prostate continues to enlarge. Further treatment may involve medication, additional implants, removal of exposed implants or another procedure such as TURP, GreenLight laser, HoLEP, Rezūm or Aquablation.

When should I seek urgent help?

Contact your urologist or attend an emergency department if you:

  • Cannot pass urine
  • Develop fever, shaking or chills
  • Feel generally unwell or confused
  • Pass large blood clots
  • Have heavy or persistent bright-red bleeding
  • Develop severe or increasing pelvic pain
  • Cannot keep fluids down
  • Experience pain that is not controlled by the recommended treatment

Does UroLift affect erections or ejaculation?

Preserving sexual function is one of the main reasons patients choose UroLift.

The pivotal L.I.F.T. study reported no new sustained erectile or ejaculatory dysfunction during five years of follow-up. Because the bladder neck, prostate tissue and ejaculatory pathways are not routinely cut or heated, the risk of retrograde ejaculation is substantially lower than with conventional TURP and many tissue-removing procedures.

However, no treatment can guarantee unchanged erections, sensation, orgasm or ejaculation in every patient.

Men who already have erectile or ejaculatory difficulties should not assume that UroLift will correct those problems. It is primarily a treatment for urinary obstruction.

How effective are Clips?

Clinical studies show meaningful average improvement in:

  • Urinary symptom scores
  • Quality of life
  • Peak urinary-flow rate
  • The patient’s perception of urinary function

Symptoms may improve quickly because the urethra is mechanically opened during the procedure.

However, the average improvement in urinary flow and symptoms is generally less than that achieved with TURP or prostate enucleation. UroLift is therefore best understood as a compromise: less invasive treatment and better preservation of ejaculation in exchange for more modest de-obstruction and a greater chance of later retreatment.

How long do Clips last?

The implants are permanent, but the symptom relief is not necessarily lifelong.

The pivotal L.I.F.T. study demonstrated sustained average improvements for five years. The reported surgical retreatment rate was approximately 13.6% over five years, or roughly 2–3% per year.

Retreatment estimates vary among studies and real-world populations. The need for further treatment may be influenced by:

  • Prostate size and anatomy
  • Median-lobe obstruction
  • Implant position
  • Severity of the original obstruction
  • Bladder function
  • Continued prostate growth
  • The definition of retreatment used in a study

Patients should distinguish between an implant remaining in position and the treatment continuing to control symptoms. A permanent implant does not guarantee permanent symptom relief.

MRI considerations

UroLift implants are classified as MR Conditional, meaning MRI can generally be performed under specified scanner conditions. Patients should tell the radiology service that they have UroLift implants and provide the implant information card whenever possible.

The metallic components can create image artefact, particularly during prostate MRI. This may obscure portions of the prostate and reduce the diagnostic quality of an MRI used to investigate suspected prostate cancer.

This caveat is particularly relevant for:

  • Younger men with a long future need for prostate surveillance
  • Patients with an elevated or rising PSA
  • Men already undergoing prostate cancer monitoring
  • Patients likely to require prostate MRI or targeted biopsy

Appropriate prostate cancer assessment should be completed before UroLift when clinically indicated.

Can prostate surgery still be performed later?

Yes. TURP, laser surgery, HoLEP and other BPH procedures can be performed after UroLift.

However, the surgeon must account for the permanent implants. Clips may be encountered during resection or enucleation, may affect instruments or laser fibres, and may require removal. Some surgeons therefore consider later surgery technically more complex than treatment of an implant-free prostate.

UroLift does not close the door to future treatment, but it does leave permanent material that the future surgeon must manage.

Who should not undergo a Clip procedure?

Manufacturer contraindications include:

  • Active urinary tract infection
  • Current visible or gross haematuria
  • Urinary incontinence caused by an incompetent urinary sphincter
  • A urethral condition that prevents safe insertion of the delivery device
  • A prostate larger than the maximum permitted by the applicable product labelling

UroLift may also be unsuitable or less predictable in men with:

  • Severe chronic urinary retention
  • A poorly contracting bladder
  • Very high residual urine volumes
  • Urethral stricture disease
  • Bladder stones
  • Recurrent urinary infections
  • Significant ongoing bleeding
  • A very high bladder neck
  • A large or unfavourably shaped median lobe
  • A very large prostate
  • Suspected or untreated prostate cancer
  • Symptoms primarily caused by overactive bladder rather than obstruction
  • A need for maximal and durable removal of obstructing tissue

Advantages of Clips

Potential advantages include:

  • Minimally invasive day procedure
  • No prostate tissue removed
  • No laser, heat or steam
  • Rapid relief in many patients
  • Short recovery
  • Catheter often avoided
  • Low reported risk of new erectile dysfunction
  • Low reported risk of dry or retrograde ejaculation
  • Future BPH treatments remain possible

Limitations and important caveats

Patients should understand that:

  • Several permanent implants remain inside the prostate
  • Symptom and flow improvements are usually less than after TURP or enucleation
  • Retreatment is more common than after tissue-removing surgery
  • Not all median lobes are suitable
  • UroLift does not prevent continued prostate growth
  • Urgency and nocturia may persist if they have a bladder or medical cause
  • The implants may reduce the quality of future prostate MRI
  • Later prostate surgery remains possible but may be technically more complicated
  • Prostate cancer should be appropriately assessed before treatment
  • UroLift does not provide prostate tissue for laboratory examination

Are Clips the right option for me?

UroLift can be an excellent option for a carefully selected man who wants meaningful improvement in urinary symptoms, a rapid recovery and a low risk of ejaculatory dysfunction.

It may be less suitable for someone with severe obstruction, chronic retention, weak bladder function, unfavourable median-lobe anatomy or a need for the most powerful and durable improvement possible.

The decision should take account of:

  • Prostate size and shape
  • Presence of a median lobe
  • Severity of symptoms and obstruction
  • Bladder strength and residual urine
  • PSA and prostate cancer risk
  • Previous treatment
  • General health and medication
  • Importance of preserving ejaculation
  • Acceptance of permanent implants
  • Willingness to undergo future retreatment

A urological assessment allows UroLift to be compared fairly with medication, iTind, Rezūm, Aquablation, TURP, GreenLight laser, HoLEP and other appropriate options.

This information is intended for general education and does not replace individual medical advice. Treatment suitability, availability and costs vary. Always follow the instructions provided by your treating urologist.

References

  1. European Association of Urology: Management of non-neurogenic male lower urinary tract symptoms.
  2. American Urological Association: BPH clinical guideline.
  3. Roehrborn CG, et al. Five-year results of the prospective randomised controlled prostatic urethral L.I.F.T. study. Canadian Journal of Urology. 2017;24:8802–8813.
  4. Rukstalis D, et al. Prostatic urethral lift for the treatment of an obstructive median lobe: 12-month results of the MedLift study. Prostate Cancer and Prostatic Diseases. 2019;22:411–419.
  5. UroLift manufacturer safety information.
  6. Benidir T, et al. Impact of the UroLift device on prostate magnetic resonance image quality. Journal of Urology. 2023.

A Temporary Stent for Benign Prostatic Enlargement: Temporary Treatment Without a Permanent Implant

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Benign prostatic hyperplasia or BPH is a non-cancerous enlargement of the prostate. As the prostate grows, it may compress the urethra and interfere with emptying the bladder.

Typical symptoms include:

  • A weak or interrupted urinary stream
  • Difficulty starting urination
  • Straining to pass urine
  • Urinary frequency or urgency
  • Getting up repeatedly at night
  • Dribbling after urination
  • A feeling that the bladder has not emptied completely

Medication is often the first treatment. However, tablets do not help every patient and may cause dizziness, tiredness, reduced ejaculation, erectile difficulties or reduced libido. The iTind procedure offers selected men a minimally invasive alternative to long-term medication or conventional prostate surgery.

What is iTind / Temporary Stent?

The iTind is a small temporary device made from nitinol, a flexible nickel–titanium alloy with “shape memory.”

It is sometimes called a temporary prostatic stent, although it differs from a traditional stent because it is not intended to remain permanently within the prostate. The device is left in place for only five to seven days and is then removed completely.

While in position, three expanding struts apply controlled pressure to specific areas of the prostate and bladder neck. This remodels the prostatic urethra and creates channels through which urine can flow more easily.

The procedure does not:

  • Permanently implant metal within the prostate
  • Remove prostate tissue
  • Use laser, heat or steam
  • Prevent future prostate treatments if symptoms return

Who may benefit from iTind?

iTind may be considered for men who have bothersome urinary symptoms caused by BPH and who:

  • Have obtained insufficient benefit from medication
  • Have developed side effects from BPH tablets
  • Prefer not to take daily medication indefinitely
  • Want a less invasive alternative to TURP or laser surgery
  • Wish to minimise the risk of ejaculatory or erectile side effects
  • Prefer not to have a permanent prostatic implant
  • Have prostate size and anatomy suitable for the device

The procedure is generally best suited to men with moderate-to-severe symptoms and a prostate measuring approximately 25–75 mL, without a significantly obstructing median lobe.

These measurements are a guide rather than a guarantee of suitability. The shape of the prostate, severity of obstruction and function of the bladder are as important as prostate size.

Assessment before treatment

Urinary symptoms are not always caused by an enlarged prostate. Similar problems can result from infection, urethral narrowing, bladder weakness, an overactive bladder, neurological disease, medication or, less commonly, cancer.

Assessment may therefore include:

  • Medical history and examination
  • International Prostate Symptom Score
  • Urine testing
  • PSA testing when appropriate
  • Urinary-flow measurement
  • Ultrasound measurement of residual urine
  • Prostate ultrasound or other imaging
  • Flexible cystoscopy
  • Urodynamic testing in selected patients

Any urinary infection should be treated before the procedure.

Patients taking aspirin, warfarin, clopidogrel, apixaban, rivaroxaban or other blood-thinning medication require an individual management plan. Do not stop blood thinners without instructions from your prescribing doctor and urologist.

How is the iTind procedure performed?

Insertion

The folded iTind device is passed through the urethra using a small cystoscope. It is positioned in the prostatic urethra immediately below the bladder neck and then released.

The procedure is usually performed as day surgery. Depending on the patient and treatment setting, local anaesthetic, intravenous sedation or a short general anaesthetic may be used.

A soft retrieval string remains attached to the device and passes out through the urethra. It is usually secured to the penis until the device is removed.

Most patients can return home on the same day without a urinary catheter. Occasionally, temporary catheterisation is necessary if the patient is unable to pass urine.

The treatment period

The device remains inside the prostate for five to seven days. Its struts gradually apply pressure to the prostate and bladder neck, creating three longitudinal channels within the urinary passage.

Patients remain at home during this treatment period.

Removal

The device must be removed after five to seven days. It is collapsed into a soft catheter and withdrawn in one piece, usually during a brief outpatient visit.

Local anaesthetic gel is often sufficient, although additional pain relief or sedation may be offered when appropriate. No metal or permanent implant remains inside the prostate after removal.

What should I expect while the device is in place?

The five-to-seven-day treatment period is generally the most uncomfortable part of the process. Common temporary symptoms include:

  • Pelvic or perineal pressure
  • Burning or stinging when passing urine
  • Urinary urgency and frequency
  • Discomfort at the tip of the penis
  • Bladder spasms
  • Light bleeding in the urine
  • Interrupted sleep
  • Awareness of the retrieval string
  • A temporarily weak or irregular urinary stream

These symptoms are usually mild to moderate and commonly improve soon after the device is removed.

Patients should generally avoid heavy lifting, vigorous exercise, cycling and sexual activity while the device and retrieval string are in place. Follow the particular instructions provided by your urologist.

The retrieval string should not be pulled, cut, repositioned or removed by the patient.

How can pain and discomfort be managed?

Pain varies considerably between patients. Some men experience only mild pressure, while others find urinary urgency, bladder spasm or discomfort from the retrieval string more troublesome.

A pain-management plan may include the following measures.

Paracetamol

Paracetamol is usually the first choice for mild-to-moderate discomfort. Take it according to your doctor’s instructions or the directions on the packet.

Check cold, influenza and combination pain medicines carefully, as these may also contain paracetamol. Do not exceed the recommended daily dose.

Patients with significant liver disease or heavy alcohol consumption should discuss paracetamol use with their doctor.

Anti-inflammatory medication

An anti-inflammatory medicine such as ibuprofen may help reduce pain and inflammation when medically appropriate.

These medications may not be suitable for patients with:

  • Kidney impairment
  • Stomach ulcers or gastrointestinal bleeding
  • Heart failure or certain cardiovascular conditions
  • Asthma triggered by anti-inflammatory medication
  • Bleeding disorders
  • Anticoagulant or antiplatelet treatment

Check with your urologist, general practitioner or pharmacist before taking an anti-inflammatory medication.

Medication for bladder irritation

An alpha blocker may occasionally be continued or prescribed temporarily to help urine flow. A bladder-calming medication may be considered if urgency or bladder spasms are particularly troublesome.

These medicines are not necessary for every patient and have their own potential side effects.

Practical measures

It may also help to:

  • Maintain normal hydration without forcing excessive fluids
  • Reduce coffee, tea, cola drinks, alcohol and energy drinks
  • Avoid constipation
  • Wear loose, supportive underwear
  • Avoid heavy lifting and strenuous exercise
  • Take pain relief early rather than waiting until discomfort becomes severe

Strong opioid medication is not usually required. It may worsen constipation and, in susceptible patients, contribute to difficulty emptying the bladder.

Severe or increasing pain is not considered something that should simply be tolerated. Contact the treating practice if the discomfort is not controlled by the recommended measures.

What happens after removal?

Burning, urinary urgency and light bleeding may continue briefly after the device is removed, but these symptoms should progressively improve.

Some patients notice an improvement in their stream soon after removal. For others, improvement develops more gradually over several weeks as irritation settles and the remodelled urinary channels stabilise.

Many patients return to normal daily activities within a few days. Your urologist will advise when you may resume strenuous exercise and sexual activity.

Follow-up may include:

  • Review of urinary symptoms
  • Repeat symptom scoring
  • A urinary-flow test
  • Measurement of residual urine
  • Discussion about continuing or stopping BPH medication

Do not stop established prostate medication unless advised to do so.

Side effects and possible complications

Most side effects are temporary and occur while the device is in place. Reported problems include:

  • Burning during urination
  • Urinary frequency and urgency
  • Pelvic discomfort or pain
  • Blood in the urine
  • Temporary difficulty passing urine
  • Urinary tract infection
  • Bladder spasm
  • Movement or incorrect positioning of the device
  • Temporary catheterisation
  • Failure to obtain sufficient symptom relief

Published studies report different complication rates, but most events have been mild and self-limiting. Temporary haematuria, dysuria, urgency and pelvic discomfort are the most frequently reported problems.

Acute urinary retention, urinary infection or significant bleeding are less common but important complications.

When should I seek urgent medical attention?

Contact your urologist or attend an emergency department if you:

  • Cannot pass urine
  • Develop fever, shaking or chills
  • Feel generally unwell or confused
  • Develop severe or increasing pelvic pain
  • Pass large blood clots
  • Have heavy or persistent bright-red bleeding
  • Cannot keep fluids down
  • Notice that the retrieval string or device has moved
  • Develop pain that is not controlled by the agreed treatment plan

Does iTind affect erections or ejaculation?

One of the principal attractions of iTind is its favourable sexual side-effect profile.

Clinical studies have reported preservation of erectile and ejaculatory function in most treated patients. This contrasts with tissue-removing prostate procedures, which may carry a significant risk of retrograde or absent ejaculation.

Nevertheless, no treatment can guarantee that sexual or ejaculatory function will remain unchanged in every patient.

How effective is iTind?

Studies have demonstrated average improvements in:

  • Urinary symptom scores
  • Quality of life
  • Peak urinary-flow rate
  • The patient’s perception of urinary function

The improvement may be less dramatic than that achieved with a tissue-removing operation such as TURP or laser enucleation. The advantage is that iTind is less invasive, usually requires little recovery time and has a low reported risk of sexual side effects.

It is therefore best viewed as a balance between symptom improvement and treatment invasiveness.

How long does the benefit last?

Although the implant remains in place for only five to seven days, the channels produced within the prostate may remain open for several years.

Prospective studies have demonstrated sustained benefit for more than four years in some appropriately selected patients. This does not mean that iTind is guaranteed to last for four years—or that it will provide lifelong relief.

BPH may continue to progress as a man ages. Some patients will eventually need to restart medication or undergo another procedure. Longer-term evidence for iTind remains more limited than that available for established procedures such as TURP or laser enucleation.

Because nothing is left permanently inside the prostate, iTind does not generally prevent later treatment. Options may include medication, another minimally invasive procedure, TURP, GreenLight laser treatment, HoLEP or another form of prostate surgery.

Who should not undergo iTind?

Contraindications described in the manufacturer’s information include:

  • Active urinary tract infection
  • Acute prostatitis
  • Known prostate cancer
  • Known bladder cancer
  • An artificial urinary sphincter or another implant within the urethra
  • Bladder atonia or a non-contractile bladder
  • Neurogenic bladder dysfunction
  • Urinary obstruction caused by a urethral stricture or something other than BPH

The procedure may also be unsuitable or less predictable in men with:

  • A significantly obstructing median prostatic lobe
  • A prostate outside the best-studied size range
  • Severe chronic urinary retention
  • Very high residual urine volumes
  • Recurrent urinary infections
  • Bladder stones
  • Significant ongoing haematuria
  • Advanced bladder weakness
  • A need for rapid and substantial removal of obstructing tissue
  • Anatomy that prevents safe cystoscopic access

Previous prostate surgery, urethral surgery, nickel sensitivity and blood-thinning medication require individual consideration.

Patients with obstruction causing kidney impairment, repeated retention, recurrent infections, bladder stones or significant bleeding may receive more reliable relief from a definitive tissue-removing procedure.

Advantages of iTind

Potential advantages include:

  • Minimally invasive day procedure
  • No cutting, laser, steam or thermal energy
  • No permanent implant
  • Usually no postoperative catheter
  • Rapid return to ordinary activities
  • Low reported risk of new erectile dysfunction
  • Low reported risk of ejaculatory dysfunction
  • Does not usually compromise future BPH treatment

Limitations of iTind

Potential limitations include:

  • Discomfort during the treatment week
  • A retrieval string for five to seven days
  • A second procedure to remove the device
  • Not suitable for every prostate shape or size
  • Less improvement than some tissue-removing procedures
  • Possibility of persistent or recurrent symptoms
  • Potential need for future medication or surgery
  • Less very-long-term evidence than TURP or laser enucleation

Is iTind the right treatment for me?

iTind is not simply a smaller version of TURP. It offers a different compromise: a less invasive procedure with no permanent implant and a favourable sexual side-effect profile, but generally more modest improvement and less long-term evidence than tissue-removing surgery.

The best treatment depends on:

  • The severity of your symptoms
  • The size and shape of your prostate
  • The amount of urinary obstruction
  • Bladder strength and residual urine
  • Previous treatment
  • General health and medication
  • The importance of preserving ejaculation
  • Your willingness to accept possible future retreatment

A urological assessment is essential to confirm that BPH is responsible for the symptoms and to compare iTind fairly with medication, Rezūm, UroLift, TURP, GreenLight laser, HoLEP and other appropriate treatments.

This information is intended for general education and does not replace individual medical advice. Treatment suitability, availability and costs vary. Always follow the instructions provided by your treating urologist.

References

  1. Sandhu JS, et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2023. Journal of Urology. 2024.
  2. Chughtai B, et al. The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicentre, Randomised, Controlled Trial. Urology. 2021;153:270–276.
  3. Kadner G, et al. Second generation of temporary implantable nitinol device in men with lower urinary tract symptoms: two-year results of the MT-02 study. World Journal of Urology. 2020;38:3235–3244.
  4. Amparore D, et al. Three-year results following treatment with the second-generation temporary implantable nitinol device. Prostate Cancer and Prostatic Diseases. 2021;24:349–357.
  5. Amparore D, et al. Temporary implantable nitinol device for BPH-related lower urinary tract symptoms: over 48-month results. Minerva Urology and Nephrology. 2023;75:743–751.
  6. NICE: iTind for lower urinary tract symptoms caused by BPH.
  7. Olympus: iTind clinical and procedural information.

Persistent sperm after vasectomy: does this mean the procedure has failed?

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Finding sperm in a semen sample after vasectomy can be worrying. However, a positive result does not always mean that the vasectomy has failed.

Sperm may remain in the reproductive tract for several weeks or months after the procedure. The most important questions are:

  • How long has it been since the vasectomy?
  • How many sperm are present?
  • Are any of the sperm still moving?
  • Is the sperm count decreasing on repeat testing?

A vasectomy does not work immediately

During a vasectomy, the two vas deferens, the tubes carrying sperm from the testicles, are divided and sealed. Sperm already present beyond the site of the vasectomy may remain in the seminal tract and appear in subsequent ejaculations.

It can take several months and approximately 20 ejaculations to clear these remaining sperm. Australian patient guidance commonly recommends the first post-vasectomy semen analysis at approximately three months. International guidelines generally allow testing within about 8–16 weeks, depending on the surgeon’s protocol.

Another form of contraception must be used until your surgeon has reviewed the semen result and formally confirmed clearance.

What is a post-vasectomy semen analysis?

A post-vasectomy semen analysis, or PVSA, examines the semen for:

  • The presence or absence of sperm
  • The number of sperm present
  • Whether the sperm are motile or non-motile

The desired result is azoospermia, meaning that no sperm are detected. However, complete azoospermia is not always necessary for a vasectomy to be considered successful.

When should azoospermia occur?

Many men are azoospermic by approximately three months after vasectomy, particularly if they have ejaculated regularly. Others take longer to clear their residual sperm.

Delayed clearance may be associated with:

  • A relatively low number of ejaculations
  • Individual differences in reproductive-tract anatomy
  • Older age
  • A long interval between ejaculations
  • Laboratory technique and the timing of sample examination
  • Temporary early recanalisation of the vasectomy site

Persistent sperm at the first test should therefore not automatically be interpreted as surgical failure. The type of sperm and the trend on repeat testing are more informative.

What does an “immotile sperm count” mean?

Immotile or non-motile sperm are sperm that are present but show no movement when examined under the microscope.

Following vasectomy, this commonly represents old residual sperm that have not yet been completely cleared. Non-motile sperm have extremely limited capacity to cause pregnancy, particularly when present in very small numbers.

The generally accepted categories are:

Semen-analysis result Usual interpretation
No sperm detected Azoospermia, vasectomy clearance can usually be given
No motile sperm and ≤100,000 non-motile sperm/mL Rare non-motile sperm, generally regarded as successful vas occlusion
More than 100,000 non-motile sperm/mL Repeat testing and assessment of the trend are required
Any motile sperm Clearance should not be given; repeat testing is required

The report should be interpreted carefully because some laboratories report the concentration per millilitre, while others may report a total number or simply state that “occasional sperm” were seen.

A fresh sample is important when assessing motility. If examination is substantially delayed, sperm that were initially moving may have stopped, potentially producing a misleading “non-motile” result.

What are rare non-motile sperm?

Rare non-motile sperm, often abbreviated as RNMS, usually means that no moving sperm are seen and the concentration is no more than 100,000 non-motile sperm per millilitre.

Current Australian and American guidance generally regards either azoospermia or RNMS at or below this threshold as evidence of successful vas occlusion. Depending on the laboratory method and local protocol, your surgeon may provide clearance after one satisfactory sample or request another confirmatory sample.

The estimated risk of pregnancy after clearance based on azoospermia or RNMS is approximately 1 in 2,000. Vasectomy is therefore extremely reliable, but no method of contraception is completely infallible.

What happens if sperm are detected at three months?

Management depends on the result.

A small number of non-motile sperm

This is usually reassuring. If the count is no more than 100,000/mL and no motile sperm are present, clearance may be appropriate according to the treating surgeon’s protocol.

More than 100,000 non-motile sperm/mL

Continue contraception and repeat the semen analysis. A steadily decreasing count suggests delayed clearance rather than vasectomy failure.

Motile sperm

Continue contraception and arrange another semen analysis. Motile sperm early after vasectomy do not invariably mean that a repeat operation will be required, particularly if the number is low and decreasing. Persistent or increasing motile sperm are more concerning for incomplete occlusion or recanalisation.

What is recommended at six months?

Six months is an important decision point.

Motile sperm persisting at six months

If any motile sperm remain at six months, the vasectomy should generally be regarded as an occlusive failure. A repeat vasectomy should be discussed.

Possible explanations include:

  • One vas deferens was not successfully divided
  • An unusual or duplicated vas deferens was present
  • The divided ends have reconnected
  • A small channel has developed across the vasectomy site

More than 100,000 non-motile sperm/mL at six months

This result requires individual assessment rather than an automatic decision.

The surgeon will consider:

  • Whether the count is decreasing, stable or increasing
  • Whether motile sperm were present in earlier samples
  • The reliability and timing of sample collection
  • The vasectomy technique used
  • The couple’s tolerance for even a very small pregnancy risk
  • Whether further semen analyses are likely to provide clarity

Repeat vasectomy, continued contraception or further surveillance may be considered through shared decision-making.

Fewer than 100,000 non-motile sperm/mL at six months

If no motile sperm are present and the count is at or below 100,000/mL, most contemporary guidance considers this compatible with successful vasectomy. Formal clearance must nevertheless come from the treating surgeon.

When should a repeat vasectomy be considered?

A repeat procedure is usually considered when:

  • Motile sperm persist at six months
  • Motile sperm counts increase on consecutive tests
  • There is no meaningful reduction in the sperm count
  • More than 100,000 non-motile sperm/mL persist beyond six months and the results remain concerning
  • A pregnancy occurs after the vasectomy
  • Clinical or operative findings suggest that one vas deferens may not have been successfully occluded

Repeat vasectomy is required in no more than approximately 1% of procedures when an effective occlusion technique has been used.

Is repeat vasectomy the same as vasectomy reversal?

No. A repeat vasectomy aims to divide and seal the vas deferens again because the first procedure has not produced reliable contraception.

A vasectomy reversal is a different microsurgical procedure that attempts to restore fertility by reconnecting the vas deferens.

What should I do while waiting for another test?

Until formal clearance has been provided:

  • Continue using reliable contraception
  • Ejaculate regularly if comfortable
  • Follow the laboratory’s collection instructions carefully
  • Collect the entire sample
  • Record the collection time accurately
  • Deliver the sample within the laboratory’s required timeframe
  • Do not assume that “non-motile” automatically means that clearance has been granted

The important message

Persistent sperm after vasectomy does not necessarily mean that the procedure has failed.

A small number of non-motile sperm is common and may be compatible with successful vasectomy. Motile sperm, a persistently high non-motile count or a count that is increasing requires continued contraception and further assessment.

At six months, persistent motile sperm generally prompts consideration of repeat vasectomy. Persistent non-motile sperm above 100,000/mL requires review of serial results and an individual discussion with the treating urologist.

Do not stop contraception until your surgeon has confirmed in writing that your post-vasectomy semen analysis meets the required clearance criteria.

This information is intended for general education and does not replace individual medical advice or interpretation of your laboratory result.

References and further information

So, if you are having issues, come see your Brisbane Urologist to discuss management options.