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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.

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.

Robotic-Assisted Radical Prostatectomy: When Is a Non-Nerve-Sparing Procedure Necessary?

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Removing the prostate while putting cancer control first

Robotic-assisted radical prostatectomy is a well-established surgical treatment for localised and selected locally advanced prostate cancer. During the operation, the prostate gland and seminal vesicles are removed, and the bladder is reconnected to the urethra. In selected patients, pelvic lymph nodes may also be removed.

One of the important decisions made before and during prostate cancer surgery is whether the nerves responsible for erections can safely be preserved.

This is known as nerve-sparing prostatectomy.

Unfortunately, nerve preservation is not always appropriate. When prostate cancer is close to, involves, or is suspected of extending beyond the outer edge of the prostate near these nerves, attempting to preserve them may compromise the completeness of cancer removal.

In this situation, a partial or complete non-nerve-sparing robotic prostatectomy may be recommended.

The guiding principle is simple:

Preserve the nerves when it is oncologically safe to do so, but do not preserve them at the expense of adequately treating the prostate cancer.

What are the nerves that are being “spared”?

Running immediately alongside the prostate are delicate bundles of nerves and blood vessels known collectively as the neurovascular bundles.

These structures contain nerves that play an important role in producing erections.

They sit extremely close to the outer surface, or capsule, of the prostate. This anatomical relationship creates a challenge during prostate cancer surgery.

If the cancer is safely contained within the prostate and sufficiently distant from the neurovascular bundle, the surgeon may be able to carefully dissect the prostate away while preserving the nerves.

This is a nerve-sparing radical prostatectomy.

If cancer is suspected to extend towards or through the prostate capsule in this area, the surgeon may need to remove some or all of the neurovascular tissue together with the prostate.

This is a non-nerve-sparing prostatectomy.

Why would a surgeon deliberately remove the erectile nerves?

It may initially seem counterintuitive to remove structures that are so important for sexual function.

The reason is cancer control.

The primary purpose of radical prostatectomy is to completely remove the prostate cancer.

If a tumour is growing very close to the edge of the prostate, particularly next to a neurovascular bundle, dissecting too close to the prostate in an attempt to preserve the nerves could potentially leave cancer cells behind.

This is called a positive surgical margin.

In appropriately selected patients, taking a wider margin around the prostate may therefore provide a safer cancer operation.

The decision represents a balance between:

Cancer control

and

preservation of erectile function.

When these two goals conflict, cancer control generally takes priority.

When may a non-nerve-sparing prostatectomy be recommended?

Non-nerve-sparing surgery may be considered when there is a significant risk that prostate cancer has extended towards or into the tissues surrounding the prostate.

Examples include:

Locally advanced prostate cancer

A tumour suspected of extending through the prostate capsule, particularly clinical T3 disease, may require a wider surgical excision.

Cancer close to the neurovascular bundle on MRI

Modern multiparametric prostate MRI can provide valuable information about the location of the tumour and its relationship to the prostate capsule and neurovascular bundles.

Features suggesting extraprostatic extension may influence the decision not to preserve the nerve bundle on that side.

High-grade prostate cancer

Higher-grade cancers, including cancers with an unfavourable Gleason score or ISUP Grade Group, may have a greater likelihood of extending outside the prostate.

The biopsy result alone does not automatically determine whether the nerves can be preserved, but it forms part of the overall assessment.

Extensive cancer on prostate biopsy

Large-volume disease, particularly when concentrated along the outer portion of the prostate near a neurovascular bundle, may make nerve preservation less appropriate.

Very high PSA or other high-risk features

PSA level, PSA density, biopsy findings, MRI appearance and clinical examination are considered together when estimating the likelihood of disease extending beyond the prostate.

Cancer involving one particular side of the prostate

Importantly, nerve sparing does not necessarily have to be “all or nothing.”

If the cancer is predominantly on one side, it may sometimes be possible to preserve the neurovascular bundle on the opposite side.

This is known as unilateral nerve sparing.

Nerve sparing is not simply YES or NO

Modern robotic prostate surgery is more nuanced than dividing operations into completely nerve-sparing and completely non-nerve-sparing procedures.

Depending on the location and extent of the cancer, surgery may involve:

  • Bilateral nerve sparing
  • Unilateral nerve sparing
  • Partial nerve sparing
  • Wider excision on one side and nerve preservation on the other
  • Complete bilateral non-nerve-sparing surgery

The surgical plan can therefore be tailored to the individual patient and, importantly, to the cancer on each side of the prostate.

How does nerve-sparing surgery differ from non-nerve-sparing surgery?

During nerve-sparing surgery, the surgeon carefully separates the neurovascular bundle from the surface of the prostate while attempting to minimise traction, heat and other potential injury to these delicate nerves.

During non-nerve-sparing surgery, the dissection is deliberately performed further away from the prostate.

The neurovascular tissue is removed together with the prostate where necessary to obtain a wider cancer margin.

The robotic platform provides magnified three-dimensional vision and highly controlled instrument movement. This allows the surgeon to identify tissue planes with considerable precision.

However, robotic technology cannot make an unsafe nerve-sparing operation safe.

The biology and location of the cancer ultimately determine how close to the prostate the surgeon can safely operate.

What happens to erections after non-nerve-sparing prostatectomy?

This is one of the most important issues to discuss before surgery.

The nerves surrounding the prostate are responsible for signalling increased blood flow into the penis to produce a natural erection.

If both neurovascular bundles are completely removed, the likelihood of recovering spontaneous erections adequate for sexual intercourse is very low.

This is different from nerve-sparing surgery, where the nerves remain anatomically intact but may temporarily function poorly following surgery.

After nerve-sparing prostatectomy, erectile recovery can occur gradually over many months and sometimes over 18–24 months or longer.

After complete bilateral non-nerve-sparing surgery, however, the nerves themselves have been removed rather than temporarily stunned.

The expectations for recovery are therefore very different.

Does non-nerve-sparing surgery affect sensation or orgasm?

This is an important distinction.

The nerves responsible for penile sensation are different from the neurovascular nerves primarily responsible for erections.

Many men can therefore continue to experience penile sensation and sexual pleasure following radical prostatectomy.

Orgasm may also remain possible.

However, radical prostatectomy removes the prostate and seminal vesicles and disconnects the reproductive pathway. Consequently, there is no ejaculation of semen after surgery.

This is sometimes described as a dry orgasm.

The sensation of orgasm can also feel different after prostate surgery.

Does non-nerve-sparing prostatectomy cause infertility?

Yes.

Radical prostatectomy results in permanent infertility because the prostate and seminal vesicles are removed and sperm can no longer enter the ejaculate.

Men who may wish to father children in the future should discuss sperm banking before surgery.

This applies whether the operation is nerve sparing or non-nerve sparing.

Is a non-nerve-sparing procedure reversible?

No.

Once a neurovascular bundle has been surgically removed, it cannot simply be reattached at a later date.

This is an important difference between temporary nerve dysfunction and actual nerve removal.

After nerve-sparing surgery, the nerves may be anatomically preserved but temporarily injured or “stunned”. Recovery may therefore occur with time.

After complete non-nerve-sparing surgery, the erectile nerves have been physically removed as part of the cancer operation.

The procedure itself is therefore not reversible.

However, this does not mean that erections or sexual activity are impossible.

There are several effective treatments available for erectile dysfunction following prostatectomy.

Can erections still be achieved after non-nerve-sparing surgery?

Rarely yes, but they will usually require assistance.

Treatment options include:

PDE5 inhibitor tablets

Medications such as sildenafil or tadalafil are commonly used after prostate surgery.

They rely substantially on functioning nerve pathways and are therefore generally more effective following nerve-sparing surgery.

Their effectiveness following complete bilateral non-nerve-sparing surgery is considerably more limited.

Vacuum erection device

A vacuum erection device creates negative pressure around the penis, drawing blood into the erectile tissues.

A constriction ring can then be placed around the base of the penis to maintain the erection.

Because this technique does not depend on intact erectile nerves, it can be useful after non-nerve-sparing surgery.

Penile injection therapy

Medication can be injected directly into the erectile tissue of the penis.

These medications act directly on penile blood vessels and therefore do not require normal prostate-associated nerve signalling.

For this reason, penile injections can be highly effective even after bilateral non-nerve-sparing prostatectomy.

Penile prosthesis

For men with persistent erectile dysfunction who wish to restore reliable erections, a penile prosthesis can provide an effective long-term solution.

An inflatable penile prosthesis allows an erection to be mechanically produced when desired.

For appropriately selected men, satisfaction rates following penile prosthesis surgery are generally high.

What about penile rehabilitation?

Penile rehabilitation may be discussed following radical prostatectomy.

The objectives can include maintaining penile tissue health, encouraging regular oxygenation of the erectile tissues, minimising shortening and fibrosis, and assisting the return to sexual activity.

A rehabilitation program may involve:

  • PDE5 inhibitor medication where appropriate
  • Vacuum erection therapy
  • Penile injection therapy
  • Regular sexual stimulation
  • Early assessment and management of erectile dysfunction

The appropriate program depends heavily on whether surgery was bilateral nerve sparing, unilateral nerve sparing or completely non-nerve sparing.

It is therefore important that expectations are realistic.

After complete bilateral nerve removal, rehabilitation cannot make the removed nerves grow back. Instead, treatment focuses on maintaining penile health and providing alternative ways of achieving an erection.

Can the surgeon decide during the operation whether to spare the nerves?

Sometimes.

The intended degree of nerve sparing is usually planned before surgery using information from:

  • Prostate MRI
  • Prostate biopsy
  • PSA
  • Clinical examination
  • Location and volume of cancer
  • Gleason score and ISUP Grade Group
  • Estimated risk of extraprostatic extension
  • The patient’s existing erectile function
  • The patient’s priorities regarding cancer control and sexual function

However, the final surgical approach may occasionally need to be modified according to findings encountered during the operation.

The most important objective remains adequate removal of the cancer.

Does non-nerve-sparing surgery improve cancer cure rates?

Not every patient benefits from wider surgery.

For men with cancer safely confined within the prostate, unnecessary removal of the neurovascular bundles may produce significant functional consequences without providing additional cancer benefit.

Conversely, when cancer is suspected of extending close to or beyond the prostate capsule adjacent to a neurovascular bundle, wider excision may reduce the risk of leaving tumour at the surgical margin.

This is why the decision must be individualised.

The best operation is not automatically the operation that preserves the most nerves. It is the operation that provides appropriate cancer clearance while preserving as much normal function as can safely be preserved.

What about urinary continence?

Nerve sparing primarily relates to erectile function, rather than the urinary sphincter responsible for continence.

Urinary control after radical prostatectomy depends on several factors including:

  • Age
  • Pre-operative urinary function
  • Pelvic floor strength
  • Urethral length
  • Bladder function
  • Surgical anatomy and technique
  • Previous prostate treatments
  • Individual healing

Pelvic floor rehabilitation before and after surgery can be an important part of recovery.

Non-nerve-sparing surgery does not automatically mean that a patient will remain incontinent.

Questions worth asking before surgery

If a non-nerve-sparing robotic prostatectomy has been recommended, useful questions to discuss with your urologist include:

Why is nerve preservation considered unsafe in my particular cancer?

Is the concern on one side or both sides of the prostate?

Could unilateral or partial nerve sparing be considered?

What does my MRI show about the relationship between the cancer and neurovascular bundles?

What is my estimated chance of erectile recovery with the proposed operation?

What erectile rehabilitation options will be available after surgery?

Should I consider sperm banking before treatment?

These conversations are particularly important because the decision to remove a neurovascular bundle is generally irreversible.

The important message

A non-nerve-sparing robotic-assisted radical prostatectomy is not an inferior version of nerve-sparing surgery.

In the right patient, it is a deliberate cancer-control strategy.

When prostate cancer is close to or suspected of involving the tissues surrounding the prostate, preserving the erectile nerves too aggressively may risk leaving cancer behind.

Modern robotic surgery allows the operation to be tailored to the individual patient. Some men can undergo bilateral nerve preservation, others may benefit from preservation on only one side, while patients with more extensive disease may require a wider non-nerve-sparing excision.

The consequences for erectile function are important and should be understood before surgery.

Once the neurovascular nerves have been removed, the procedure cannot be reversed.

However, loss of spontaneous erections does not mean the end of sexual intimacy. Vacuum devices, penile injection therapy and penile prostheses can provide effective options when natural erections are no longer possible.

Ultimately, the aim is to achieve the best possible balance between two important goals:

Effective treatment of the prostate cancer and preservation of quality of life.

A note for patients

Every prostate cancer is different. MRI findings, biopsy results, PSA, cancer grade, age, general health, pre-existing erectile function and personal priorities all influence the appropriate surgical approach.

A detailed discussion with your urologist before robotic prostatectomy is essential so that you understand whether nerve sparing is appropriate, what degree of nerve preservation may be possible and what this means for cancer control, continence and sexual function.

This information is intended for general patient education and does not replace individual medical advice. Treatment recommendations should be based on your individual prostate cancer characteristics, imaging, pathology, general health and discussion with your treating urologist.

Laser Vaporisation for Benign Prostate Enlargement

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A Modern, Low-Bleeding Treatment for an Enlarged Prostate

Benign prostate enlargement, also called benign prostatic hyperplasia (BPH), is extremely common as men get older. As the prostate enlarges around the urethra, it can gradually restrict urinary flow, rather like slowly tightening a collar around the urinary pipe.

Symptoms may include:

  • A slow or weak urinary stream
  • Difficulty starting urination
  • Straining to urinate
  • Intermittent or stop-start flow
  • A feeling that the bladder has not emptied properly
  • Urinary frequency and urgency
  • Getting up several times at night to urinate
  • Episodes of urinary retention

Many men can initially be managed with lifestyle modification or medication. When symptoms become troublesome, complications develop, or medication is no longer effective or desirable, surgery may be considered.

One well-established minimally invasive surgical option is GreenLight laser photoselective vaporisation of the prostate (PVP).

What Is GreenLight Laser Prostate Surgery?

GreenLight PVP is an endoscopic procedure performed through the urethra. There are no abdominal incisions.

A telescope is passed through the urethra to the prostate. A specialised laser fibre is then used to progressively vaporise the obstructing prostate tissue and create a wider channel through which urine can flow.

Unlike TURP, where pieces of prostate tissue are physically cut away, GreenLight treatment predominantly converts the obstructing tissue into vapour while simultaneously sealing blood vessels.

The result is a combination of tissue removal and excellent haemostasis.

What Laser Is Used?

The GreenLight system uses a 532-nanometre green laser.

Modern GreenLight systems commonly use a lithium triborate (LBO) crystal to generate the 532 nm wavelength, with the contemporary high-powered platform delivering up to 180 watts.

Earlier systems included:

Generation Laser Maximum power
Early GreenLight KTP 80 W
GreenLight HPS LBO 120 W
GreenLight XPS LBO 180 W

The current European Association of Urology guideline describes the 180 W system as the contemporary standard platform for GreenLight PVP.

Why Is the Laser Green?

The colour is not merely decorative.

The 532 nm wavelength is strongly absorbed by haemoglobin, the pigment contained within red blood cells. It is much less strongly absorbed by water.

This property allows the laser energy to be preferentially absorbed by the vascular prostate tissue.

The laser has a relatively shallow tissue penetration of approximately 0.8 mm, producing rapid vaporisation while creating a limited zone of coagulation underneath the treated surface.

This gives GreenLight its two particularly useful characteristics:

Vaporisation + haemostasis

As prostate tissue is vaporised, small blood vessels are simultaneously coagulated.

This is why the operative field can remain remarkably clear and why GreenLight surgery generally produces less bleeding than traditional TURP.

Who May Benefit from GreenLight Laser Surgery?

GreenLight PVP may be considered for men with moderate to severe urinary symptoms caused by benign prostatic obstruction, particularly when conservative or medical treatment has not provided adequate relief.

Surgery may also be recommended when BPH results in complications such as:

  • Recurrent urinary retention
  • Dependence on a urinary catheter
  • Recurrent urinary tract infections associated with obstruction
  • Bladder stones
  • Recurrent visible haematuria attributable to BPH
  • Progressive bladder dysfunction
  • Significant residual urine
  • Upper urinary tract deterioration or renal impairment secondary to obstruction

Surgery is also reasonable when symptoms remain sufficiently troublesome despite medication, or when a patient does not wish to continue long-term medical therapy.

What Size Prostate Can Be Treated?

GreenLight PVP is particularly well established for prostates approximately 30–80 mL in volume.

The 2026 European Association of Urology guidelines recommend 532 nm GreenLight PVP as an alternative to TURP for men with moderate-to-severe LUTS and benign prostatic obstruction in this prostate-size range.

Larger prostates can certainly be treated by experienced GreenLight surgeons, but the operation becomes progressively more time-consuming as prostate volume increases.

Importantly, evidence supporting PVP in prostates above approximately 100 mL is less robust than the evidence supporting anatomical enucleation procedures such as HoLEP.

The AUA guideline similarly notes that PVP may be less effective in very large prostates and that retreatment becomes an increasingly important consideration.

For a very large prostate, HoLEP or robotic-assisted simple prostatectomy/enucleation may therefore provide more complete adenoma removal.

What Happens During GreenLight PVP?

The operation is usually performed under general or spinal anaesthesia.

A telescope is passed through the penis and urethra until the obstructing prostate is visualised.

The laser fibre is introduced through the telescope.

The surgeon progressively vaporises the obstructing prostate tissue, generally working from the bladder neck towards the apex of the prostate while carefully protecting the urinary sphincter.

The goal is not necessarily to remove the entire prostate.

Instead, the obstructing transition-zone tissue is removed sufficiently to create a wide, low-resistance urinary channel.

A urinary catheter is usually placed at the end of the operation.

Because bleeding is generally limited, catheterisation and hospitalisation can often be shorter than following conventional TURP.

Some appropriately selected patients can undergo the procedure as day surgery.

Advantages of GreenLight Laser Surgery

Less bleeding

This is arguably GreenLight’s greatest strength.

Because the 532 nm wavelength is absorbed by haemoglobin, tissue vaporisation and coagulation occur simultaneously.

Compared with TURP, studies have demonstrated lower transfusion rates and less bleeding.

Particularly useful when bleeding risk matters

GreenLight may be attractive in older patients or men with cardiovascular disease who require antiplatelet or anticoagulant medication.

The EAU guidelines specifically recognise GreenLight PVP as an option in selected patients receiving anticoagulant or antiplatelet therapy, although individual management of these medications still needs to be determined before surgery.

Shorter catheterisation

Many patients can have their catheter removed relatively quickly after surgery.

Shorter hospital stay

GreenLight surgery is frequently suitable for overnight or even day-case treatment in appropriately selected patients.

No external incision

The entire procedure is performed through the urethra.

No TUR syndrome

GreenLight PVP uses saline irrigation and does not carry the classical dilutional hyponatraemia or “TUR syndrome” associated with older monopolar TURP techniques.

Effective symptom improvement

GreenLight PVP can produce substantial improvements in:

  • Urinary flow
  • Bladder emptying
  • IPSS symptom scores
  • Quality of life

Randomised trials of contemporary GreenLight PVP have demonstrated symptom and flow improvements broadly comparable with TURP over short- to medium-term follow-up.

What Are the Side Effects?

Most men experience some temporary urinary irritation during the recovery period.

Burning or stinging when urinating

This is common initially and usually improves as the prostatic urethra heals.

Urinary frequency and urgency

The bladder may remain irritable for several weeks.

It is important to remember that removing the obstruction does not instantly reset a bladder that may have been struggling against that obstruction for many years.

Blood in the urine

Small amounts of bleeding can occur intermittently during healing, despite the excellent haemostatic properties of the laser.

Temporary difficulty urinating

Occasionally swelling after surgery means that the catheter needs to remain in place longer or needs to be reinserted.

Urinary infection

As with any endoscopic urinary procedure, urinary infection can occur.

Retrograde Ejaculation

One of the most important issues to discuss before surgery is ejaculation.

Following conventional GreenLight PVP, semen may travel backwards into the bladder rather than forwards through the penis during orgasm.

This is called retrograde ejaculation.

The orgasm usually remains present, but little or no semen may be produced.

This is particularly important for younger men concerned about fertility or preservation of ejaculation.

GreenLight should therefore not automatically be described as an “ejaculation-preserving” operation.

Does GreenLight Cause Erectile Dysfunction?

For most men, erectile function is preserved.

Current evidence does not demonstrate a major difference in erectile-function outcomes between GreenLight PVP and conventional TURP.

Sexual function, however, is influenced by many factors including age, vascular health, diabetes, medications and pre-existing erectile function.

Less Common Complications

Potential complications include:

  • Significant bleeding
  • Urinary tract infection
  • Temporary urinary retention
  • Urethral stricture
  • Bladder-neck contracture
  • Temporary urinary incontinence
  • Rare persistent urinary incontinence
  • Persistent urgency or overactive bladder symptoms
  • Incomplete removal of obstructing tissue
  • Recurrent prostate enlargement
  • Requirement for further prostate surgery

One Important Limitation: There Is Usually No Tissue for Pathology

This is an important difference between GreenLight PVP and TURP or HoLEP.

With TURP, prostate chips are removed.

With HoLEP, the enucleated adenoma is morcellated and retrieved.

With GreenLight PVP, much of the treated tissue is vaporised.

Consequently, there may be little or no prostate tissue available for histological examination.

For this reason, appropriate assessment for prostate cancer should be undertaken before GreenLight surgery when clinically indicated, using PSA, examination, MRI and/or prostate biopsy where appropriate.

GreenLight vs TURP vs HoLEP vs Robotic-Assisted Simple Prostatectomy

There is no single “best” prostate operation for every man.

The appropriate procedure depends on:

prostate size + prostate anatomy + bleeding risk + bladder function + patient priorities + surgeon expertise.

Feature GreenLight PVP TURP HoLEP Robotic Simple Prostatectomy / Enucleation
Approach Transurethral Transurethral Transurethral Abdominal robotic
Energy 532 nm laser Electrical 2,140 nm holmium laser Robotic dissection ± energy
Tissue treatment Vaporisation Resection Anatomical enucleation Anatomical enucleation
Tissue for pathology Limited/none Yes Yes Yes
Bleeding Very low Low-moderate Very low Low-moderate
Best established size ~30–80 mL ~30–80 mL Virtually size-independent Large/very large prostates
Large prostate >100 mL Possible, but less ideal Less attractive Excellent option Excellent option
Catheter duration Usually short Short Usually short Usually longer
Hospital stay Short Short Short Generally longer
Anticoagulation advantage Good Less favourable Good Less favourable
Learning curve Moderate Familiar technique Significant Significant
Durability in very large glands Less certain Good Excellent Excellent
Incisions None None None Abdominal port incisions

GreenLight vs TURP

TURP has traditionally been regarded as the benchmark operation against which newer BPH procedures are compared.

GreenLight achieves broadly similar improvements in urinary symptoms and flow for appropriately selected prostates.

Its principal advantages over TURP are:

  • Less perioperative bleeding
  • Lower transfusion requirements
  • Shorter catheterisation
  • Shorter hospitalisation
  • Excellent visibility during surgery
  • Potential advantages in patients at increased bleeding risk

Its disadvantages include:

  • Longer operating time in some patients
  • Lack of tissue for histology
  • Potentially higher retreatment rates over longer follow-up
  • Reduced efficiency as prostate size becomes very large

Long-term population data suggest that although reoperations for bleeding are less common after PVP, overall cumulative reoperation may be higher than after TURP.

So GreenLight’s strength is low perioperative morbidity, while TURP retains excellent durability and provides tissue for histology.

GreenLight vs HoLEP

HoLEP is fundamentally different.

GreenLight predominantly vaporises the obstructing prostate.

HoLEP enucleates the adenoma anatomically from the surgical capsule, rather like removing the inside of an orange while leaving the peel behind.

HoLEP uses a pulsed 2,140 nm holmium laser, which is strongly absorbed by water rather than haemoglobin.

The major advantage of HoLEP is that it is essentially prostate-size independent.

A 40 mL prostate can be enucleated.

So can a 100, 150 or even 200+ mL prostate in experienced hands.

The AUA guideline specifically recognises HoLEP as a prostate size-independent surgical option.

HoLEP also removes a larger proportion of the obstructing adenoma and provides tissue for histological examination.

Its principal disadvantages are its technical complexity, significant learning curve and potential for temporary postoperative stress urinary incontinence, particularly following treatment of very large glands.

For very large prostates, HoLEP will generally provide more complete anatomical adenoma removal than conventional GreenLight vaporisation.

GreenLight vs Robotic-Assisted Prostate Enucleation

For very large benign prostates, another option is robot-assisted simple prostatectomy (RASP), sometimes described as robotic prostate adenoma enucleation.

This is very different from a robotic radical prostatectomy performed for prostate cancer.

The entire prostate is not removed.

Instead, the enlarged benign adenoma is dissected away from the remaining prostate capsule.

It essentially achieves the same anatomical objective as HoLEP but approaches the prostate through the abdomen and bladder or prostate capsule rather than through the urethra.

Robotic simple prostatectomy is particularly attractive for very large or anatomically complex prostates, particularly when associated bladder pathology can be addressed simultaneously.

Its disadvantages include:

  • Abdominal surgery
  • Robotic port incisions
  • Longer catheterisation
  • Longer hospital stay
  • Greater surgical invasiveness
  • Higher resource utilisation

Recent comparative evidence suggests that both robotic simple prostatectomy and laser enucleation provide excellent outcomes for prostates ≥80 mL, while endoscopic laser enucleation generally provides faster perioperative recovery.

So Which Operation Is Best?

A useful way of thinking about these procedures is not as competitors, but as different tools for different prostates.

GreenLight PVP

Particularly attractive for:

  • Small-to-moderately enlarged prostates
  • Approximately 30–80 mL glands
  • Patients where minimising bleeding is particularly important
  • Older or medically complex patients
  • Patients requiring rapid recovery and short catheterisation

TURP

Remains an excellent option for:

  • Small-to-moderately enlarged prostates
  • Conventional benign prostatic obstruction
  • Situations where prostate tissue for histology is desirable
  • Centres with extensive TURP experience

HoLEP

Particularly attractive for:

  • Moderate, large and extremely large prostates
  • Men requiring maximal adenoma removal
  • Recurrent BPH after previous surgery
  • Patients where long-term durability is particularly important
  • Patients wishing to avoid abdominal surgery despite a very large prostate

Robotic-Assisted Simple Prostatectomy

Particularly attractive for:

  • Very large prostates
  • Complex prostate anatomy
  • Large intravesical adenomas
  • Patients with associated bladder pathology requiring treatment
  • Situations where endoscopic enucleation expertise is unavailable or a robotic approach offers anatomical advantages

The Bottom Line

GreenLight laser photoselective vaporisation is an effective, minimally invasive surgical treatment for benign prostate enlargement.

Its 532 nm laser is selectively absorbed by haemoglobin, allowing prostate tissue to be vaporised while simultaneously achieving excellent haemostasis.

Its particular strengths are:

less bleeding, short catheterisation, short hospitalisation and rapid recovery.

For appropriately selected men with moderate-sized prostates, symptom improvement is broadly comparable with TURP.

As prostate size increases, however, anatomical enucleation becomes increasingly attractive. HoLEP and robotic-assisted simple prostatectomy remove the adenoma more completely and are particularly effective for very large prostates. HoLEP achieves this endoscopically, whereas robotic surgery achieves it through an abdominal approach.

The choice therefore should not simply be:

“Which operation is newest?”

A better question is:

“Which operation best suits this prostate, this bladder and this patient?”

Prostate size and shape, urinary symptoms, bladder function, bleeding risk, medications, general health, PSA assessment, sexual priorities and the surgeon’s experience should all contribute to the final decision.

This information is intended for general patient education and does not replace individual assessment and discussion with a urologist.

 

Vasectomy: A Guide to Permanent Male Contraception

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Vasectomy is a safe, effective and permanent method of male contraception. It is a relatively minor surgical procedure that prevents sperm from entering the semen by interrupting the vas deferens, the tubes that carry sperm from the testicles.

For men and couples who are confident that their family is complete, vasectomy provides highly reliable contraception without the need for ongoing medication or contraceptive devices.

What Happens During a Vasectomy?

Sperm are produced in the testicles and mature within the epididymis. During ejaculation, sperm normally travel through a tube called the vas deferens, where they ultimately mix with fluid produced by the prostate and seminal vesicles to form semen.

During a vasectomy, each vas deferens is divided and sealed so that sperm can no longer reach the ejaculate.

Importantly, vasectomy does not stop the testicles from producing sperm. The sperm that continue to be produced are naturally broken down and absorbed by the body.

Who Should Consider a Vasectomy?

Vasectomy may be appropriate for men who:

  • Have completed their family and do not want more children.
  • Do not wish to have children in the future.
  • Want a highly effective permanent form of contraception.
  • Have a partner for whom pregnancy would represent a significant health risk.
  • Prefer male sterilisation rather than their partner undergoing a more invasive sterilisation procedure.
  • Wish to avoid the need for long-term hormonal or barrier contraception.

The most important consideration is that vasectomy should be regarded as permanent.

Although vasectomy reversal is possible, successful reversal cannot be guaranteed. Men who are uncertain about future fertility should carefully consider alternative contraception or, in selected circumstances, sperm banking before proceeding.

How Is Vasectomy Performed?

Vasectomy is usually performed as a day procedure, commonly under local anaesthetic, although sedation or general anaesthesia may occasionally be appropriate.

A conventional or no-scalpel technique may be used.

The vas deferens is identified through a small opening in the scrotal skin. A short segment of the vas may be removed, and the divided ends are then sealed using techniques such as cautery, ligation and/or fascial interposition.

The procedure generally takes approximately 15–30 minutes.

Patients are usually able to return home shortly afterwards.

What Should I Expect After the Procedure?

Mild discomfort, bruising and swelling of the scrotum are common during the first few days.

Simple measures can help recovery, including:

  • Wearing supportive underwear.
  • Using simple analgesia as recommended.
  • Avoiding strenuous physical activity and heavy lifting for several days.
  • Keeping the wound clean and dry according to your surgeon’s instructions.
  • Avoiding sexual activity until discomfort and swelling have settled.

Most men can return to sedentary work relatively quickly, while men involved in heavy physical work may require a longer recovery period.

Vasectomy Does Not Work Immediately

This is one of the most important facts to understand about vasectomy.

A man is not sterile immediately after the procedure.

Sperm that were already present beyond the site of the vasectomy may remain within the reproductive tract for a period after surgery.

For this reason, another reliable method of contraception must be used until a post-vasectomy semen analysis confirms that the procedure has been successful.

Your urologist will advise when the semen test should be performed according to the protocol being followed.

Do not stop contraception simply because a certain number of weeks or ejaculations have passed. Wait until appropriate semen testing has confirmed success.

How Effective Is Vasectomy?

Vasectomy is one of the most effective forms of contraception available.

However, no contraceptive procedure can be regarded as absolutely 100% effective. Rarely, the divided ends of the vas deferens can reconnect, a process known as recanalisation.

Recanalisation may occur early after surgery and be detected on semen testing, or very rarely occur later after an initially successful vasectomy.

This is one reason why post-vasectomy semen analysis is an essential part of the procedure rather than an optional extra.

Does Vasectomy Affect Testosterone?

No.

Vasectomy does not remove or damage the testicles, and testosterone production continues normally.

A vasectomy should therefore not cause:

  • Loss of masculinity.
  • Reduced testosterone levels.
  • Loss of facial or body hair.
  • Reduced muscle mass.
  • Premature ageing.

Does Vasectomy Affect Erections or Sexual Function?

Vasectomy does not normally affect the ability to obtain or maintain an erection.

It also does not interfere with orgasm.

The nerves and blood vessels responsible for erections are not interrupted during a routine vasectomy.

Will Ejaculation Be Different?

Most of the volume of semen comes from the prostate and seminal vesicles, rather than from sperm.

Consequently, ejaculation continues after vasectomy and the appearance and volume of the semen are generally essentially unchanged.

The difference is microscopic: once the vasectomy has been successful, sperm are no longer present in the ejaculate.

What Are the Possible Complications?

Vasectomy is generally a low-risk procedure, but complications can occur.

Bleeding and Haematoma

Bleeding into the scrotum can result in swelling, bruising or a collection of blood known as a haematoma.

Small haematomas usually settle with conservative management. Large or expanding haematomas occasionally require further treatment.

Infection

Infection of the skin or deeper scrotal tissues is uncommon but may occur. Symptoms can include increasing pain, redness, swelling, discharge or fever.

Pain and Swelling

Some degree of discomfort and swelling is expected during the initial recovery period and usually settles.

Sperm Granuloma

Sperm may occasionally leak from the divided end of the vas and produce a small inflammatory lump known as a sperm granuloma.

These are often harmless but can occasionally be tender.

Epididymal Congestion

Some men develop aching or discomfort around the epididymis following vasectomy, possibly related to pressure within the sperm-carrying system.

This is usually temporary but can occasionally persist.

Post-Vasectomy Pain Syndrome

A small proportion of men experience persistent or recurrent testicular or scrotal pain lasting for months or longer after vasectomy.

This is known as chronic post-vasectomy pain or post-vasectomy pain syndrome.

Treatment depends upon severity and may include:

  • Anti-inflammatory or pain medication.
  • Pelvic floor or other targeted therapy where appropriate.
  • Nerve-directed treatment.
  • Spermatic cord procedures.
  • Epididymectomy in selected cases.
  • Vasectomy reversal in carefully selected patients.

Further surgery is rarely required, but persistent pain is an important complication to discuss before deciding on vasectomy.

Vasectomy Failure and Recanalisation

Occasionally sperm remain present because the vas deferens has reconnected or the procedure has otherwise failed to achieve sterility.

Persistent sperm on semen analysis may require further testing and, occasionally, a repeat vasectomy.

Very rarely, late recanalisation can occur after a previously satisfactory semen analysis, meaning that pregnancy remains possible even after initial clearance.

Does Vasectomy Increase the Risk of Prostate Cancer?

Vasectomy has been extensively studied in relation to prostate cancer and other long-term health concerns.

Current evidence has not established vasectomy as a cause of prostate cancer, and vasectomy is not generally considered a reason to alter routine prostate cancer screening or assessment.

Men should continue appropriate prostate health checks based on their age, family history, symptoms and individual risk factors.

Can a Vasectomy Be Reversed?

Yes, but reversal is considerably more complex than the original vasectomy.

Vasectomy reversal involves microsurgically reconnecting the reproductive tract, usually with a vasovasostomy or, when necessary, a vasoepididymostomy.

Success depends on several factors, including:

  • The length of time since vasectomy.
  • The condition of the vas deferens and epididymis.
  • The surgical technique required.
  • The experience of the microsurgeon.
  • The fertility and age of both partners.

Successful return of sperm to the semen does not necessarily guarantee pregnancy.

For this reason, a vasectomy should never be undertaken on the assumption that it can simply be reversed later.

Alternatives to Vasectomy

Men who are uncertain about permanent contraception should consider reversible alternatives.

Depending upon individual circumstances, these may include condoms or contraceptive methods used by the female partner, including hormonal contraception, intrauterine devices and contraceptive implants.

The choice should take into account effectiveness, side effects, medical history, personal preference and future fertility plans.

When Should I Seek Medical Attention After Vasectomy?

Contact your doctor or urologist if you develop:

  • Increasing rather than improving scrotal pain.
  • Significant or rapidly increasing swelling.
  • Heavy bleeding.
  • Increasing redness or discharge from the wound.
  • Fever or feeling systemically unwell.
  • Persistent testicular pain.
  • A concerning new scrotal lump.

The Bottom Line

Vasectomy is a highly effective, relatively simple and permanent form of male contraception.

For appropriately selected men who have completed their families, it can remove the need for ongoing contraception while leaving testosterone production, erections, orgasm and ejaculation essentially unchanged.

The key points are to understand that vasectomy should be considered permanent, complications such as chronic scrotal pain and failure can occur, and the procedure does not provide immediate contraception.

Most importantly, continue contraception after vasectomy until your post-vasectomy semen analysis has confirmed that it is safe to stop.

This information is intended for general education and does not replace individual medical advice. Your urologist can discuss whether vasectomy is appropriate for you, the technique used, expected recovery and the post-vasectomy semen-testing protocol.

Caffeine and Health

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In a world fueled by caffeine, questions about its impact on health are more pertinent than ever. As a leading urologist in Brisbane, Dr. Jo Schoeman understands the importance of addressing concerns surrounding common lifestyle choices. We delve into the caffeine conundrum, exploring whether this ubiquitous stimulant is truly detrimental to health and how much is considered safe daily.

 

The Caffeine Conundrum:
Caffeine, found in coffee, tea, energy drinks, and various other beverages, is renowned for its ability to boost alertness and provide that much-needed morning kick. However, its relationship with health is a topic that sparks curiosity and concern alike.

 

 How Much is Enough?

Dr. Jo Schoeman sheds light on the optimal amount of caffeine consumption for maintaining a healthy lifestyle. “Moderation is key,” he advises, emphasising that a moderate intake can contribute to increased alertness without negatively impacting health. Understanding what constitutes a moderate amount is crucial for individuals seeking to strike a balance between enjoying their favorite caffeinated beverages and ensuring overall well-being.

 

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The Safe Daily Limit:
Determining a safe daily limit for caffeine consumption involves considering individual factors such as age, health condition, and sensitivity to caffeine. Dr. Jo Schoeman provides insights into how much caffeine is generally considered safe for most adults and the potential consequences of exceeding these limits. It’s important to note that individual responses to caffeine can vary, and consulting with a healthcare professional is advisable for personalised guidance.

 

Potential Health Impacts:
While moderate caffeine consumption is generally deemed safe, Dr. Jo Schoeman discusses potential health impacts associated with excessive intake. From sleep disturbances to increased heart rate, understanding the risks enables individuals to make informed decisions about their caffeine habits.

 

Personalised Recommendations:
Recognising the need for personalised advice, Dr. Jo Schoeman encourages those with specific health concerns or conditions to seek individualised recommendations. As a urologist in Brisbane, he is well-equipped to provide guidance tailored to the unique health needs of her patients.

 

In the caffeine-driven world we live in, understanding the nuances of its impact on health is essential. Dr. Jo Schoeman, as a trusted urologist in Brisbane, offers valuable insights into the caffeine conundrum, providing a balanced perspective on how much is enough and what is considered safe daily. Remember, moderation and individual considerations are key when navigating the choices surrounding this ubiquitous stimulant.