Tag Archive for: urology brisbane

Blood in the Urine (Haematuria): When Should You See a Urologist Brisbane?

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Discovering blood in your urine can be alarming. While there are many possible causes, blood in the urine should never be ignored. Known medically as haematuria, this symptom can sometimes indicate an underlying condition requiring specialist assessment. Consulting an experienced Urologist Brisbane patients rely on can help identify the cause and provide appropriate treatment.

What Is Haematuria?

Haematuria refers to the presence of blood in the urine. It can occur in two forms:

Visible Haematuria

The urine appears pink, red or brown due to the presence of blood.

Microscopic Haematuria

Blood cells are detected only during laboratory testing and may not be visible to the naked eye.

Both forms should be assessed by a healthcare professional.

Common Causes of Blood in the Urine

There are numerous possible causes of haematuria, including:

Urinary Tract Infections

Infections affecting the bladder, kidneys or urinary tract can cause irritation and bleeding.

Kidney Stones

Kidney stones can damage the lining of the urinary tract, resulting in blood appearing in the urine.

Enlarged Prostate

An enlarged prostate can place pressure on the urinary system and may contribute to urinary symptoms and bleeding.

Vigorous Exercise

In some cases, intense physical activity can lead to temporary blood in the urine.

Kidney Disease

Various kidney conditions may result in haematuria and require specialist management.

Urinary Tract Cancers

Although less common, blood in the urine can sometimes be associated with cancers affecting the bladder, kidney or urinary tract. This is one reason why prompt evaluation by a Urologist Brisbane specialist is important.

Symptoms That May Accompany Haematuria

Depending on the underlying cause, patients may also experience:

  • Pain during urination
  • Frequent urination
  • Lower abdominal discomfort
  • Back or flank pain
  • Difficulty passing urine
  • Fever or chills

These symptoms can provide valuable clues during diagnosis.

How Does a Urologist Brisbane Diagnose Haematuria?

A comprehensive evaluation may include:

Medical History and Physical Examination

Your specialist will discuss symptoms, medical history and risk factors.

Urine Testing

Urinalysis helps identify infection, blood cells and other abnormalities.

Blood Tests

Blood tests may assess kidney function and identify underlying conditions.

Imaging Studies

Ultrasound or CT imaging can help detect stones, tumours or structural abnormalities.

Cystoscopy

A cystoscopy allows a Urologist Brisbane specialist to examine the inside of the bladder using a small camera.

Why Early Investigation Matters

While haematuria can sometimes result from minor conditions, it may also be an early warning sign of a more serious problem. Early diagnosis often leads to more effective treatment and improved outcomes.

Delaying assessment can allow certain conditions to progress and become more difficult to treat.

When Should You Seek Medical Advice?

You should arrange an appointment if:

  • You notice visible blood in your urine
  • Blood is detected during routine testing
  • Haematuria occurs repeatedly
  • You experience pain or urinary symptoms
  • You have a history of smoking or urinary tract conditions

Speak with a Urologist Brisbane Today

If you have noticed blood in your urine or have concerns about your urinary health, our experienced team is here to help. We provide thorough assessments, advanced diagnostic services and personalised treatment plans to identify the cause and protect your long-term health. Contact our clinic today to book a consultation with a trusted Urologist Brisbane specialist.

Urethral Meatal Stenosis: Congenital, Acquired and Correct Management

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The urethral meatus is the opening through which urine leaves the body. Meatal stenosis means that this opening has become abnormally narrow and is interfering with urinary flow. It is most often discussed in boys and men, although narrowing of the female urethral opening can also occur.

An important point is that a meatus can look small without causing obstruction. Treatment should therefore be based on the complete picture, symptoms, the appearance of the opening, the urinary stream and, where appropriate, objective testing, not appearance alone.

What symptoms can it cause?

Typical symptoms include:

  • a thin, forceful or upward-deflected stream;
  • spraying or difficulty aiming the urine;
  • taking longer to pass urine or needing to strain;
  • burning or discomfort during urination;
  • a small spot of blood at the meatus;
  • urinary frequency, urgency or incomplete emptying; and
  • recurrent urinary infection in selected patients.

In toilet-trained boys, an abnormal stream is often the most useful clue. Published patient-reported data show that improvement after meatotomy is most predictable when the preoperative problem is an abnormal or deflected stream. Frequency, urgency, wetting or dysuria may have another cause and should not automatically be attributed to a narrow-looking meatus.

Complete inability to pass urine is uncommon but requires urgent medical attention.

Congenital meatal stenosis

Congenital meatal stenosis is present from birth. True isolated congenital narrowing is uncommon and should be distinguished from normal variation in meatal size. It may also occur as part of another developmental urethral condition, including hypospadias, or following congenital urethral reconstruction.

In a baby or young child, symptoms can be difficult to recognise. The diagnosis becomes more apparent after toilet training, when a persistently narrow, spraying or markedly deflected stream can be observed.

Not every anatomically small meatus needs surgery. An asymptomatic child with a satisfactory stream, no urinary infections and normal bladder emptying can often be observed. Symptomatic obstruction, however, should be assessed by a paediatric urologist.

Acquired meatal stenosis

Acquired stenosis develops after birth. Its causes vary with age.

In boys

Meatal stenosis is recognised after circumcision, although published estimates vary substantially because studies use different definitions and methods of examination. Proposed mechanisms include irritation and inflammation of the exposed meatus, contact with wet nappies, meatal ulceration and subsequent scar formation. It often becomes clinically obvious between early childhood and school age rather than immediately after circumcision.

Other causes include inflammation, trauma, catheterisation and previous surgery, particularly repair of hypospadias. Following hypospadias surgery, narrowing may involve more than the external opening and must be assessed in the context of the reconstructed urethra.

In adolescents and adults

Important causes include:

  • lichen sclerosus (also called balanitis xerotica obliterans or BXO), which can scar the foreskin, glans, meatus and more proximal urethra;
  • repeated urethral instrumentation, catheterisation or endoscopic surgery;
  • prior hypospadias repair or other penile surgery;
  • trauma, infection or chronic inflammation; and
  • previous radiotherapy or treatment affecting the urethra.

In adults, it is essential to determine whether narrowing is confined to the meatus or extends into the fossa navicularis or penile urethra. Treating only the visible opening will fail if more extensive scar disease has been overlooked.

Female meatal or urethral stenosis is uncommon. Symptoms may resemble recurrent urinary infection or other causes of bladder-outlet obstruction. Diagnosis should be made carefully, as urinary symptoms alone do not prove that the urethra is narrowed.

How is it diagnosed?

Assessment may include:

  1. A detailed history: including the direction and calibre of the stream, spraying, pain, infections, prior circumcision, catheterisation, surgery, trauma and skin disease.
  2. Examination: assessing the meatus and surrounding skin for scarring, pallor, inflammation, lichen sclerosus, hypospadias or surgical change.
  3. Observation of the urinary stream, particularly in a toilet-trained child.
  4. Uroflowmetry and post-void residual ultrasound when symptoms are unclear, the patient is older, or more extensive obstruction is suspected.
  5. Urinalysis or urine culture if pain, blood or infection is suspected.
  6. Urethral calibration, cystoscopy or urethrography selectively, especially in adults, recurrent disease, previous urethral surgery or suspected extension beyond the meatus.

Kidney and bladder ultrasound is not required for every straightforward case, but may be appropriate when there are recurrent infections, incomplete emptying, significant obstruction or concern about the upper urinary tract.

What is the correct management?

Management must match the patient’s symptoms, cause, age and extent of narrowing.

1. Observation

Observation is reasonable when the meatus is merely small in appearance but the patient has no relevant symptoms, passes a satisfactory stream and empties the bladder normally. Treating an incidental finding is unlikely to improve unrelated urgency, frequency or wetting.

2. Treat active skin or inflammatory disease

When lichen sclerosus or another inflammatory disorder is present, the underlying disease must be treated as well as the narrowing. Potent topical corticosteroid treatment is commonly used for genital lichen sclerosus under medical supervision. Circumcision may be indicated when the foreskin is affected, but established meatal or urethral scar may also require surgery.

Persistent or suspicious penile lesions may need biopsy. Long-term review can be appropriate because lichen sclerosus can recur, extend into the urethra and is associated with a small but important risk of penile malignancy.

3. Meatotomy or meatoplasty

For a short, symptomatic stenosis confined to the meatus, meatotomy or meatoplasty is usually the definitive treatment.

  • A meatotomy enlarges the opening with a controlled incision.
  • A meatoplasty reconstructs and sutures the edges to create a durable, appropriately shaped opening.

Both can provide excellent relief in appropriately selected children. A large paediatric series reported that meatotomy required more early manual spreading and had a higher reoperation rate than meatoplasty; technique and postoperative care therefore matter. In another study, 95% of families reported their child was at least somewhat improved after meatotomy, with the strongest benefit in boys treated for an abnormal stream.

The operation may be performed under local anaesthesia in selected cooperative patients or under general anaesthesia, particularly in younger children. Expected short-term effects include stinging, minor spotting of blood and temporary spraying while swelling settles. The surgeon may advise ointment and gentle separation of the meatal edges during early healing; instructions vary according to the procedure used.

4. Dilatation

Repeated blind dilatation is generally not a durable solution for dense scar-related meatal stenosis. It may cause further tearing and scarring and can commit a patient to repeated procedures. Carefully selected dilation or self-dilatation may have a role as temporary or palliative management, or as part of a specialist regimen for inflammatory disease, but it should not replace an appropriate reconstructive assessment in recurrent or complex disease.

5. Recurrent, adult or extended distal disease

If narrowing recurs, is associated with lichen sclerosus, or extends into the fossa navicularis/distal urethra, a simple repeat incision may not be sufficient. Options include formal meatoplasty or distal urethroplasty using an oral mucosal graft. The European Association of Urology recommends offering open meatoplasty or distal urethroplasty for meatal and distal urethral strictures; the precise operation should be individualised to stricture length, tissue quality and the patient’s priorities.

In lichen-sclerosus-related urethral disease, genital skin should not be used as a graft because the disease may recur in that tissue. Oral mucosa is generally preferred when graft reconstruction is required.

Follow-up and recurrence

Most patients with an isolated, properly treated meatal stenosis do well. Follow-up should assess:

  • improvement in stream direction and calibre;
  • pain, bleeding, infection or difficulty voiding;
  • bladder emptying when clinically indicated; and
  • restenosis or progression of an underlying condition such as lichen sclerosus.

Prompt reassessment is advisable if the stream narrows again, spraying persists after healing, voiding becomes painful or difficult, infections recur, or new skin changes appear.

The practical message

Meatal stenosis is not simply “a small hole.” Correct care begins by confirming that the narrowing is clinically important and identifying its cause and extent. A symptomatic, short stenosis confined to the meatus is usually treated successfully with meatotomy or meatoplasty. Recurrent stenosis, adult disease, previous hypospadias repair or lichen sclerosus requires a more detailed urethral assessment and sometimes formal reconstruction.

This article provides general educational information and does not replace an individual assessment. Seek urgent care if you or your child cannot pass urine, develops fever with urinary symptoms, or has significant bleeding or pain.

Selected references

  1. European Association of Urology. EAU Guidelines on Urethral Strictures: Disease Management in Males. 2026. https://uroweb.org/guidelines/urethral-strictures/chapter/disease-management-in-males
  2. European Association of Urology. EAU Guidelines on Urethral Strictures: Definition, Epidemiology, Aetiology and Prevention. 2026. https://uroweb.org/guidelines/urethral-strictures/chapter/definition-epidemiology-aetiology-and-prevention
  3. Wessells H, et al. Urethral Stricture Disease Guideline Amendment (2023). Journal of Urology. 2023. doi:10.1097/JU.0000000000003482.
  4. Dothan D, et al. Surgical Treatment of Meatal Stenosis: Lessons Learned from the Pediatric Urology Practice. Urology. 2023;171:220–224. PMID: 35981660.
  5. Varda BK, et al. Minor procedure, major impact: patient-reported outcomes following urethral meatotomy. Journal of Pediatric Urology. 2018;14(2):165.e1–165.e5. doi:10.1016/j.jpurol.2017.11.018.
  6. Godley SP, et al. Meatal stenosis: a retrospective analysis of over 4000 patients. Journal of Pediatric Urology. 2015;11(1):38.e1–38.e6. doi:10.1016/j.jpurol.2014.09.016.
  7. Morris BJ, Krieger JN. Does circumcision increase meatal stenosis risk? A systematic review and meta-analysis. Urology. 2017;110:16–26. doi:10.1016/j.urology.2017.07.027.
  8. Wang MH. Surgical management of meatal stenosis with meatoplasty. Journal of Visualized Experiments. 2010;(45):2213. doi:10.3791/2213.

Prepared for patient education.

Prostate Health and Urology

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When it comes to men’s health, one topic that often takes center stage is prostate health. As a vital part of the male reproductive system, the prostate plays a crucial role in urinary function and overall well-being. We sit down with Dr. Jo Scheoman, a renowned urologist based in Brisbane, to discuss the importance of prostate health and its connection to urology.

 

Meet Dr. Jo Scheoman
Dr. Jo Scheoman is a highly respected urologist with years of experience in diagnosing and treating a wide range of urological conditions. Specialising in prostate health, Dr. Scheoman is dedicated to providing compassionate care and innovative treatments to patients in Brisbane and beyond. With a focus on patient education and empowerment, Dr. Scheoman strives to raise awareness about the importance of proactive prostate health management.

 

Understanding Prostate Health:
The prostate is a small gland located below the bladder and in front of the rectum. Its primary function is to produce fluid that nourishes and protects sperm. As men age, the prostate can undergo changes that may affect urinary function and overall health. Common prostate conditions include:

– Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate gland, which can lead to urinary symptoms such as frequent urination, urgency, and incomplete emptying of the bladder.
– Prostatitis: Inflammation or infection of the prostate gland, often causing pain or discomfort in the pelvic area and changes in urinary habits.
– Prostate Cancer: The most common cancer in men, prostate cancer occurs when abnormal cells develop in the prostate gland. Early detection and treatment are critical for favorable outcomes.

 

The Role of Urology in Prostate Health:
As a specialised field of medicine, urology focuses on the diagnosis and treatment of conditions affecting the urinary tract and male reproductive system, including the prostate. Urologists like Dr. Scheoman play a vital role in assessing prostate health, diagnosing conditions, and recommending appropriate treatment options. From routine screenings and diagnostic tests to advanced surgical procedures, urologists are equipped to address a wide range of prostate-related concerns.

urologist brisbane, urology brisbane,

Maintaining Prostate Health:
While certain risk factors for prostate conditions, such as age and family history, are beyond our control, there are steps men can take to promote prostate health and reduce the risk of developing prostate-related issues. These include:

– Healthy Lifestyle: Adopting a balanced diet rich in fruits, vegetables, and lean proteins, along with regular exercise, can support overall health and reduce the risk of obesity, which is linked to prostate issues.
–  Regular Check-ups: Scheduling routine check-ups with a urologist for prostate screenings and evaluations is essential for early detection and intervention.
– Awareness and Education: Staying informed about prostate health and understanding the signs and symptoms of prostate conditions can empower men to take proactive steps towards their well-being.

 

Prostate health is a critical aspect of men’s overall well-being, and proactive management is key to maintaining optimal health and quality of life. With the expertise and guidance of urologists like Dr. Jo Scheoman, men can take control of their prostate health and enjoy a fulfilling, healthy life. Whether it’s preventive screenings, diagnostic evaluations, or personalized treatment plans, urologists play a crucial role in supporting men’s health every step of the way. If you’re in Brisbane and seeking expert urological care, Dr. Jo Scheoman is here to provide compassionate, comprehensive services tailored to your unique needs.

Phone : (07) 3371 7288

Website : https://www.drjoschoeman.com.au/

WESLEY HOSPITAL

Suite 10, Level 9
Evan Thomson Building
24 Chasely Street
Auchenflower, 4066

Food and urological health: what does the evidence say?

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Food and drink can influence some urinary conditions, particularly recurrent kidney stones. A balanced eating pattern also supports general health. But the evidence does not support calling individual foods “urology-friendly” treatments or claiming that a berry, seed or spice will prevent urinary tract infections (UTIs), prostate enlargement or cancer. The useful advice depends on the diagnosis and the person.[1–4]

 

Start with the whole diet

The Australian Dietary Guidelines recommend a variety of vegetables, fruit, wholegrain foods and suitable protein foods, while limiting foods high in salt.[1] That is a more reliable starting point than a list of purported “superfoods.” People with kidney disease, recurrent stones or other medical conditions may need more specific advice from their treating team.

1. Berries and the cranberry question

Blueberries, strawberries and raspberries can be enjoyed as fruit, but evidence about cranberry products should not be extended to all berries. A Cochrane review of 50 trials found that cranberry juice, tablets or capsules probably reduce symptomatic, culture-confirmed UTIs in women with recurrent UTIs, and found benefit in some other groups. It found little or no clear benefit in several other populations. Product preparations and doses differ, and no standard effective dose has been established.[3]

Cranberry products are a possible prevention measure for selected people, not a treatment for an infection that is already present. Recurrent urinary symptoms also warrant assessment: not every episode of burning or urgency is caused by a bacterial UTI.[3]

2. Watermelon, water and kidney stones

 

Watermelon contributes fluid and can be part of a varied diet, but it has no special “detoxifying” action. The kidneys filter blood continuously; eating watermelon does not flush out a diagnosed infection or stone.

For many people with recurrent stones, adequate fluid intake is one of the better supported preventive measures. European Association of Urology (EAU) guidance recommends enough fluid, preferably water, to produce more than 2.5 litres of urine in 24 hours for stone prevention.[2] This is a urine output target, not an instruction for everyone to drink a fixed amount of water. Fluid needs vary with heat, activity and health conditions. People with a prescribed fluid restriction, including some with kidney or heart disease, should follow individual advice.[2, 8]

3. Leafy greens and oxalate

Vegetables are part of a healthy eating pattern. There is no reason for everyone to avoid spinach or other leafy greens. However, spinach contains substantial oxalate, which can matter for some people with calcium oxalate stones and high urinary oxalate. In that setting, limiting excessive intake of high-oxalate foods may be useful.[2]

Stone prevention is more nuanced than cutting out one vegetable. Stone composition, blood tests and sometimes a 24-hour urine collection can guide advice. EAU guidance generally discourages restricting normal dietary calcium, since adequate calcium intake can help reduce intestinal oxalate absorption; advice on supplements is different and should be individualised.[2]

4. Fish and dietary protein

fatty fish , urology food, urology brisbane,

Fish is one protein choice within the Australian Dietary Guidelines.[1] Oily fish contains omega-3 fats, but there is insufficient clinical evidence to claim that eating it treats bladder inflammation or prevents a particular urological disorder.

For some stone formers, the overall amount of animal protein may be more relevant than selecting one type of fish. Excess animal protein can change urine chemistry in ways that favour stone formation. Any change should fit the person’s nutritional needs and stone risk profile.[2]

5. Pumpkin seeds and prostate health

Pumpkin seeds can contribute nutrients, including zinc, to a varied diet. That does not mean they prevent benign prostate enlargement or prostate cancer, or replace assessment of urinary symptoms. Cancer Council Australia concludes that evidence about specific dietary factors is insufficient to recommend a food or supplement for prostate cancer prevention.[4]

“Natural” supplements are not automatically beneficial. For example, a large prevention trial found an increased prostate cancer risk in men assigned vitamin E alone, illustrating why a plausible biological theory is not enough to justify a prevention claim.[5]

6. Turmeric: food versus supplements

urogolgy food, tumeric

Turmeric is a spice; curcumin is one of its constituents. Laboratory findings about inflammation do not demonstrate that adding turmeric to meals prevents or treats urinary disease. The US National Center for Complementary and Integrative Health says there is not enough evidence to draw firm conclusions about many proposed health benefits of oral turmeric or curcumin.[6]

Concentrated supplements are different from ordinary culinary use. Some formulations designed to increase curcumin absorption have been associated with liver injury. Tell your treating clinician about supplements, particularly before an operation or when taking regular medicines.[6]

Practical steps if you have urinary symptoms

For someone with recurrent kidney stones, the strongest dietary starting points are usually appropriate fluid intake, avoiding excess salt and adjusting diet based on stone type and urine results. EAU guidance recommends a mixed diet and generally advises against restricting normal dietary calcium.[2] For someone with recurrent UTIs, the priority is to confirm the diagnosis and consider the full range of prevention options; cranberry is one possible measure for certain groups, with limits to the evidence.[3]

Diet cannot replace assessment of blood in the urine, persistent pain, fever with urinary symptoms, difficulty passing urine or repeated infections. If you have these symptoms, speak with your GP or treating clinician. Advice can then be tailored with input from a urologist or accredited practising dietitian where needed.

This is general educational information, not an individual treatment plan. No food or supplement discussed here is presented as a cure or as a substitute for appropriate medical care.

References

  1. National Health and Medical Research Council. Australian Dietary Guidelines.
  2. European Association of Urology. Guidelines on Urolithiasis: Metabolic Evaluation and Recurrence Prevention.
  3. Williams G, et al. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews, 2023.
  4. Cancer Council Australia. Prostate cancer prevention.
  5. US National Cancer Institute. Selenium and Vitamin E Cancer Prevention Trial (SELECT).
  6. US National Center for Complementary and Integrative Health. Turmeric: Usefulness and Safety.
  7. Kidney Health Australia. Kidney stones.
  8. Healthdirect Australia. Drinking water and your health.

 

“Beat the Leak”: The Team Behind the Surgery

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The Steam, Laser-Beam, Dream-Stream, Uro-Team

People often ask what happens behind the theatre doors. They usually know the surgeon’s name, but the work is done by a team.

I’m fortunate to work regularly with a group of theatre nurses, anaesthetists and support staff who know one another’s routines and are comfortable speaking up. Before an operation starts, we check the plan, the equipment and the details that matter for that particular patient. During the procedure, each person has a job to do, and clear communication helps us respond when a plan needs to change.

Our team has a motto: “Beat the Leak.” It makes us smile, but it also captures a serious part of my work as a urologist. For someone living with urinary incontinence, a leak can mean planning every outing around a toilet, avoiding exercise or worrying about an embarrassing moment. It is easy to underestimate how much that can affect daily life.

“Beat the Leak” is our reminder to listen closely to that experience and work towards better bladder control. The right approach depends on the cause of the leakage. It may involve pelvic floor physiotherapy, changes to daily habits, medication or a procedure. Surgery is appropriate for some people, but no operation can promise a dry outcome for everyone. We discuss the likely benefits, risks and alternatives with each patient before deciding on a plan.

The care continues after the operation. The recovery team helps patients through the first hours, explains what to expect at home and makes sure concerns reach the right person. Follow-up matters too: it gives us a chance to check healing, assess whether treatment has helped and decide if anything else is needed.

I value the skill and kindness of the people I work with in theatre. Our motto may be light-hearted, but the aim behind it is simple: to help each patient feel heard, well cared for and more confident in everyday life.

Dr Joseph “Jo” Schoeman

                     

Cool Hey! Keep an eye out for us at St Andrews War Memorial hospital and the Wesley Hospital

Test the strength of your urine flow

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Do I have the toy for you guys! Ever wondered how fast you urinate? When seeing foam in the bowl is not enough… Remember those days when we could see who urinated the furthest… I am obviously referring to your childhood, out in the bush or garden with your mates, and on the odd occasion of taking a leak at the same time, it would always end in a competition (boys will be boys). Hopefully you have outgrown this as it is probably not socially acceptable to do this anymore. We do experience a bit of this in public toilets occasionally with younger blokes urinating next to you, taking you back down memory-lane to the good-old days.

I generally ask the guys how fast their flow is. I occasionally get a puzzled look… My response would be: “Can you still wee over the fence, or do you wet your shoes? Can you still put foam in the bowl?” There is purpose in the question: A flow rate reveals a lot about a man’s lower urinary tract health. This forms part of the assessment your LUTS (lower urinary tract symptoms). LUTS consist of voiding symptoms and storage symptoms. A slow flow, interrupted flow, stop-start and inability to empty completely are your voiding symptoms. The storage symptoms are urgency, frequency, urge incontinence and urinating more than once a night. These are more prevalent with a bladder issue (overactive bladder) or significant outflow obstruction irritating your bladder. You could also have an overflow incontinence caused by the longstanding obstruction, whether it’s your prostate or a neurological (nerve) issue.

Pre-requirements for a Flowrate is a full bladder with a minimum of 150 cc present in the bladder. For this test, you will urinate into a special funnel that is connected to a measuring device. The device calculates the amount of urine, rate of flow in seconds, and the length of time until all urine has been passed. This information helps evaluate how well the lower urinary tract is working. It also helps figure out if there is a blockage of normal urine outflow. I look at the shape of the curve created on a graph. There a many tell-tale signs in this one examination. Once the flow rate is completed, I do an ultrasound to check how much urine remains in your bladder. I then have a wealth of information regarding the function of your bladder. This assists in decision making in the management of your urological issue.   

A Normal flow rate averages between 11-20ml/s. As you age over 50 your flow rate deteriorates. The flow rate should have a nice bell-curve. Usually, you would empty your bladder in less than 60 seconds. The average bladder volume is 600cc. Residual urine volumes vary with age and gender and should be as low as possible. A value between 100-150 cc is acceptable over the age of 60.

Results from a study published in the Indian Journal of Urology. Flow rates (Qmax values) in adult males were significantly higher than in the elderly and Qmax values in young females were significantly higher than in young males. Qmax values in males increased with age until 15 years old; followed by a slow decline until reaching 50 years old followed by a rapid decline after 50 years old even after correcting voided volume. Qmax values in females increased with age until they reached age 15 followed by decline in flow rate until a pre-menopausal age followed by no significant decline in post-menopausal females. Qmax values increased with voided volume until 700 cc followed by a plateau and decline.  (Age, gender, and voided volume dependency of peak urinary flow rate and uroflowmetry nomogram in the Indian population – PMC (nih.gov)

 

Mean maximum and average flow rate parameters in different age group.

Male population Maximum flow rate Average flow rate
16-50 years old 22.8 ml/sec 13.22ml/sec
>50 year 17.04 ml/sec 8.9ml/sec
Female population Maximum flow rate Average flow rate
Pre-menopausal 21.8 ml/sec 12 ml/sec
Post-menopausal 17.59 ml/sec 10.2 ml/sec
Pediatric population Maximum flow rate Average flow rate
Girls 19.33 ml/sec 11.25 ml/sec
Boys 16.9 ml/sec 9.6 ml/sec

 

Factors influencing your flow rate:

  • Benign prostatic hypertrophy (BPH). This is enlargement of the prostate gland. It is not caused by cancer and often happens in men over age 50. The prostate wraps around the urethra. When it is enlarged, it can narrow the urethra and interfere with normal passage of urine from the bladder. If left untreated, the enlarged prostate can block the urethra completely.
  • Cancer of the prostate or bladder
  • Urinary blockage. A urinary tract blockage can happen for many reasons along any part of the urinary tract, from the kidneys to the urethra. It can lead to a urine backup. This can cause infection, scarring, or even kidney failure if untreated.
  • Neurogenic bladder dysfunction. This is trouble with bladder function due to a nervous system problem, such as a spinal cord tumor or injury.
  • Frequent urinary tract infections. These can cause scarring and damage in the urinary tract.
  • Urine Flow Test | Johns Hopkins Medicine

 

What do I use it for:

  • Diagnosis of an outflow obstruction.
  • Assess the outcome of interventions: medical or surgical.
  • With addition of Urodynamic studies, functional and neurogenic bladder issues can be managed appropriately.

 

So, guys come see me with your full bladders at the Wesley Hospital in Brisbane. Let’s see how well and effective you urinate, and then discuss how we can get you back to care-free urinating. The good old days.

16 DOT ‘Nesbitt’ Plication

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Correction of penile chordee / curvature.

Why is it done?

  • To treat an acquired deviation of an erect penis.
  • Usually occurs in males 55-65 years of age.
  • Can be associated with previous penile trauma, usually no associated history.
  • A dorsal (up) curvature is more common than a ventral (down) one. Can also deviate to the side.
  • Pain is usually the presenting symptom with a gradually worsening curvature.
  • The curvature may be so bad that penetration becomes impossible.
  • Associated with the connective tissue disorder: Dupuytren’s Contracture, which is an auto-immune disease.
  • Worse cases may require a penile prosthesis.

Pre-requirements

  • An informed consent is required from the patient/ parents.
  • Patients are informed that this may shorten the penis to the length of the shorter side of the penis, usually 2-3 cm.
  • In patients who wish to preserve penile length, a lengthening technique using buccal mucosa may be indicated and will be referred to a colleague.
  • Patients may not eat or drink from 6-8 hours prior to surgery according to age.
  • Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery. Clexane injections may be substituted.
  • Be prepared for an overnight stay.

How is it done?

  • This procedure is done under general anesthetic.
  • Supine position.
  • The foreskin is loosened proximal to the glans with a circumferential incision and the whole penile skin is retracted to the base of the penis.
  • An artificial erection will be induced by injecting a sterile saline solution into the penile corpora cavernosa with a tourniquet around the base.
  • Non-dissolvable sutures will be placed on the sides opposite to the diseased areas in an attempt to pull the erect penis into a straight alignment.
  • Occasionally a circumcision may result due to complications with this technique, yet foreskin preservation is attempted.
  • If there is a dorsal curvature, ventral sutures are laced and the penis pulled in upright position, therefore sutures are always placed on the opposite site avoiding vital structures such as.
  • An indwelling catheter will be inserted until you are awake.
  • A dressing is then applied, which should be removed after 72 hours.
  • A local anesthetic is injected at the base of the penis as a penile block thus giving post-operative pain relief for the next 4-6 hours.

What to expect after the procedure?

  • Any anesthetic has its risks, and the anesthetist will explain such risks.
  • Bleeding is a common complication.
  • A hematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible. Bruising is normal.
  • Sutures may tear loose with vigorous use of erect penis, and the procedure may then require revision.
  • An infection of the wound may occur and requires immediate attention.
  • Necrosis of the foreskin and some penile skin can occur in rare circumstances. This may require skin-grafting.
  • DANGER SIGNS: A wound that swells immediately, fever, and puss. Contact Dr Schoeman or the hospital immediately as this occurs in up to 15–20% of all cases.

What next?

  • Dressings should be kept dry for the initial 72 hours after surgery and soaked off in a bath thereafter.
  • The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
  • The catheter will be removed as soon as you are awake, or if there are concerns, the following morning.
  • On discharge, a prescription may be issued for patients to collect.
  • Patients should schedule a follow-up appointment with Dr Schoeman 2 weeks after the procedure.
  • There will be signs of bruising for at least 10 days.
  • Refrain from using your erect penis for 6 weeks.
  • The suture-line will be hard and indurated for at least 8-10 weeks.
  • Sick leave will be granted for 10 days.
  • Please direct all further queries to Dr Schoeman’s rooms.
  • PLEASE CONTACT THE HOSPITAL DIRECTLY WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Wes 16 Dot Nesbitt Plication

Artificial Urinary Male Sphincter – AUS

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Why is it done?

  • Male Stress incontinence/ Incontinence
  • Usually after a TURP/TUVP, Radical Prostatectomy in 2% of cases as pre-described complication of surgery

How is it done?

  • ·This procedure is done under a spinal /general anesthetic, as decided by the anesthetist.
  • The legs will be elevated into the lithotomy position.
  • A 7cm incision is made on the perineum space between scrotum and anus).  Or penoscrotal junction. You will also have a small suprapubic incision.
  • The silicone inflatable cuff is placed around the upper end of the corpora cavernosa of the penis under the muscle.
  • The reservoir is placed behind the pubic bone
  • The access port is placed in the scrotum; make sure it is on the side of your dominant hand.
  • The cuff will only be activated 6 weeks after the surgery
  • The wounds are closed with dissolvable sutures and/or skin glue.
  • A local anesthetic is given for pain relief.
  • A urinary catheter is placed for 24hrs.
  • The catheter will be removed early the next morning.
  • Prophylactic antibiotics will be given to prevent infection.

 

Complications

  • Any anesthetic has its risks, and the anesthetist will explain all such risks.
  • Complications: hemorrhaging, requiring blood transfusion <1%.
  • Patients will wake up with a catheter in the urethra and bladder. This will remain in the bladder for 24 hrs.
  • Pelvic pain for 10-14 days may occur, making it difficult to sit.
  • You will be incontinent until the cuff is activated
  • This may be less effective in irradiated patients

NB! Each person is unique and for this reason, symptoms may vary

 

What next?

  • Patients will have a trial of void without catheter the next day. You will be incontinent until the device is activated in 6 weeks
  • Patients will be discharged as soon as they can completely empty the bladder.
  • Patients may initially suffer from urge incontinence, but this will improve within the next 6 weeks.
  • Allow 6 weeks for symptoms to stabilize.
  • Initial period of pelvic pain is expected.

 

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Wes AUS Male Sphincter

Copyright 2019 Dr Jo Schoeman