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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.

PSA Screening for Prostate Cancer in Australia: Should You Have a PSA Test?

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Prostate cancer is one of the most commonly diagnosed cancers in Australian men. One of the difficulties with prostate cancer is that early prostate cancer usually causes no symptoms. By the time symptoms develop, some cancers may already have progressed beyond the prostate.

A simple blood test called the prostate-specific antigen (PSA) test can help identify men who may be at increased risk of prostate cancer. However, PSA testing is not a perfect cancer test and deciding whether to have regular PSA testing involves balancing the potential benefits of early diagnosis against the risks of unnecessary investigation and treatment.

In Australia, there is currently no national population-based prostate cancer screening program. Instead, PSA testing is based on an informed discussion between a man and his doctor, taking into account age, family history, overall health, life expectancy and personal preferences.

What is PSA?

PSA, or prostate-specific antigen, is a protein produced by prostate cells. A small amount normally enters the bloodstream and can be measured with a simple blood test.

An elevated PSA does not automatically mean that you have prostate cancer.

PSA can rise because of:

  • prostate cancer
  • benign enlargement of the prostate (BPH)
  • inflammation or infection of the prostate
  • urinary infection
  • recent ejaculation or sexual activity
  • recent instrumentation of the urinary tract
  • manipulation of the prostate.

Conversely, some men with prostate cancer can have a PSA within the expected range. PSA is therefore best considered a marker of prostate activity and prostate cancer risk rather than a test that diagnoses cancer.

Who Should Consider PSA Testing in Australia?

Current Australian guidance supports informed, individualized PSA testing rather than universal population screening.

For men at average risk who have been informed about the potential benefits and harms and decide to undergo regular testing, current RACGP guidance recommends offering PSA testing every two years between the ages of 50 and 69 years.

Men with a significant family history may be advised to start earlier. Depending on the strength of the family history, testing may begin from approximately 40–45 years of age and continue every two years to age 69.

A stronger family history includes having a father, brother or multiple close relatives diagnosed with prostate cancer, particularly when prostate cancer occurred at a younger age.

Other factors, including ancestry, genetic predisposition and an individual’s general health and life expectancy, may also influence the decision about when to begin testing.

Importantly, these recommendations apply to men without symptoms. Men with symptoms or clinical findings that raise concern about prostate cancer require individual assessment rather than simply entering a screening program.

What Does an Elevated PSA Mean?

An elevated PSA is not a diagnosis of prostate cancer.

For men aged 50–69 undergoing early detection testing, a PSA above 3.0 ng/mL generally prompts further assessment under current Australian guidance. An abnormal result will often be repeated because PSA levels can fluctuate and temporary elevations are common.

Depending on the PSA level, age, prostate size, family history and other risk factors, further assessment may include:

Repeat PSA → assessment of PSA trend and other risk factors → specialist review → prostate MRI → possible prostate biopsy

Modern prostate cancer assessment has changed substantially. An abnormal PSA no longer necessarily means proceeding directly to a prostate biopsy. Multiparametric MRI (mpMRI) can help identify suspicious areas within the prostate and assist the urologist in deciding whether biopsy is necessary.

The Potential Benefits of PSA Screening

The principal advantage of PSA testing is straightforward:

It may detect a significant prostate cancer while it is still curable.

Aggressive prostate cancer can spread to lymph nodes, bones and other organs. Once metastatic prostate cancer develops, treatment is generally aimed at controlling rather than curing the disease.

Regular PSA testing provides an opportunity to identify some clinically important cancers years before they would otherwise become apparent.

Large screening trials have produced differing results, which is one reason PSA screening remains controversial. European screening data have demonstrated a reduction in prostate cancer mortality associated with PSA-based screening, while other trials have shown less convincing mortality benefits.

For an individual man, therefore, the potential benefit is significant: early detection may identify an aggressive cancer at a stage when curative treatment remains possible.

What Are the Downsides of PSA Screening?

The difficulty is that prostate cancer is not one disease.

Some prostate cancers are aggressive and potentially life-threatening. Others grow extremely slowly and may never cause symptoms during a man’s lifetime.

PSA testing can detect both.

False-positive PSA results

An elevated PSA may lead to anxiety, repeat blood tests, MRI scans and sometimes biopsy even when no cancer is ultimately found.

Overdiagnosis

PSA testing can identify a prostate cancer that would never have caused illness or shortened the man’s life.

This is known as overdiagnosis.

Overtreatment

If an insignificant cancer is diagnosed and subsequently treated, the man can potentially experience treatment complications without gaining a meaningful survival benefit.

Potential consequences of prostate cancer treatment include:

  • erectile dysfunction
  • urinary incontinence
  • urinary symptoms
  • ejaculatory changes
  • bowel symptoms following some forms of radiotherapy.

This is one of the major reasons Australia does not currently have a universal PSA population-screening program.

Importantly, however, diagnosing prostate cancer does not automatically mean treating it.

Many men with low-risk prostate cancer are now managed with active surveillance, involving PSA monitoring, MRI and selective repeat biopsy. Treatment is reserved for evidence that the cancer is becoming more significant.

What Are the Implications of Not Having PSA Screening?

Choosing not to undergo PSA testing is also a legitimate decision, particularly after considering the benefits and disadvantages.

The advantage is avoiding the potential cascade of:

PSA testing → abnormal result → anxiety → MRI → biopsy → diagnosis of an insignificant cancer → possible unnecessary treatment.

However, there is another side to this decision.

Because early prostate cancer frequently produces no symptoms, a man who does not undergo PSA testing may remain unaware that he has prostate cancer.

For most men who never develop clinically significant disease, this causes no harm.

For a smaller group who develop aggressive prostate cancer, however, the first indication of the disease may occur after the cancer has grown substantially or spread beyond the prostate.

At that stage, the opportunity for curative treatment may have been reduced or lost.

The decision is therefore not simply:

“Do I want to know whether I have prostate cancer?”

A more useful question is:

“Given my age, health, family history and personal priorities, do the potential benefits of finding a significant prostate cancer early outweigh the potential harms of investigating and possibly diagnosing a cancer that may never affect me?”

This is why shared decision-making with your GP or urologist is important.

What About a Digital Rectal Examination?

The digital rectal examination, or DRE, involves a doctor gently inserting a gloved, lubricated finger into the rectum to examine the back surface of the prostate.

The doctor assesses the prostate for abnormalities such as:

  • unusual hardness
  • nodules
  • asymmetry
  • irregularity
  • loss of the normal contour of the gland.

Historically, DRE was routinely combined with PSA testing for prostate cancer screening.

This has changed.

DRE is no longer recommended as a routine screening test in asymptomatic men

Current Australian guidance states that DRE should not routinely be added to PSA testing for early detection in asymptomatic men in primary care.

There are several reasons.

A finger can examine only part of the prostate. Small cancers may not be palpable, and cancers in areas of the prostate that cannot be reached during examination can be missed. A normal DRE therefore does not exclude prostate cancer.

Conversely, benign prostate enlargement and other abnormalities can sometimes produce an abnormal examination.

Does DRE Still Have a Role?

Yes.

Not recommending DRE as a routine screening test does not mean that the examination has become obsolete.

A urologist may perform a DRE when assessing a man with:

  • an elevated or rising PSA
  • urinary symptoms
  • suspected prostate disease
  • an abnormal MRI
  • concern about locally advanced prostate cancer
  • other pelvic or rectal symptoms.

Occasionally, a prostate cancer may produce a distinctly hard or irregular prostate even when the PSA is not dramatically elevated. An abnormal DRE can therefore remain clinically important and may prompt further investigation. Cancer Council Australia notes that urologists will commonly perform DRE as part of prostate assessment even though GPs no longer routinely use it for screening asymptomatic men.

The key distinction is:

DRE has a role in clinical examination and investigation, but it is not recommended as a routine population-screening test in an otherwise well man undergoing PSA testing.

PSA Screening Is About Risk, Not Just a Number

One of the most important changes in modern prostate cancer detection is moving away from treating PSA as simply “normal” or “abnormal.”

A PSA result should be interpreted in context.

Your doctor or urologist may consider:

your age + PSA level + change in PSA over time + family history + prostate size + symptoms + examination findings + MRI findings + overall health

Together, these provide a much more meaningful assessment of prostate cancer risk than a single PSA result.

Should I Have a PSA Test?

There is no single answer that is appropriate for every man.

For a healthy man in the appropriate age group, particularly someone with a family history of prostate cancer, the potential benefit of identifying an aggressive cancer while it remains curable may be important.

For an older man with substantial medical problems or limited life expectancy, the likelihood that PSA screening will provide meaningful benefit becomes considerably smaller. Current Australian guidance advises against PSA testing in men whose life expectancy is likely to be less than approximately seven years because a mortality benefit from early detection is unlikely to occur within that period.

The decision should therefore be individual rather than automatic.

The Bottom Line

PSA testing can save lives by detecting clinically significant prostate cancer at an earlier and potentially curable stage, but it can also detect cancers that would never have caused harm.

Australia therefore does not currently operate a universal PSA screening program. Instead, men are encouraged to make an informed decision about PSA testing after discussing their individual risk and the potential benefits and harms with their doctor.

For men who choose screening, current Australian guidance generally supports PSA testing every two years from age 50–69 for men at average risk, with earlier testing considered for men with a significant family history.

A digital rectal examination is no longer recommended as a routine addition to PSA screening in asymptomatic men, but it remains an important component of specialist prostate assessment in selected circumstances.

Concerned about your prostate cancer risk?

If you are considering PSA testing, have a family history of prostate cancer, have noticed a change in your PSA, or have urinary symptoms, discuss your individual risk with your GP or urologist.

Early detection should not simply be about finding more prostate cancers. The goal is to identify the cancers that matter, at a time when something useful can still be done about them.

This information is intended for general education and does not replace individual medical advice. Recommendations may differ according to your age, family history, medical conditions and previous PSA results.

Further information

Australian patient information and guidance are available from Cancer Council Australia: Prostate cancer screening and early detection and the RACGP Guidelines for preventive activities in general practice.

Fascia Lata Allograft as a Mid-Urethral Sling for Female Stress Urinary Incontinence

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A “new/revamped” kid on the block – Fascia Lata Allograft: A biological alternative to synthetic mesh

Stress urinary incontinence (SUI) is one of the most common forms of urinary incontinence in women. It occurs when urine leaks with activities that increase abdominal pressure, such as coughing, sneezing, laughing, exercising, lifting or running.

For women whose symptoms remain troublesome despite pelvic floor muscle training and appropriate conservative treatment, surgical treatment can provide substantial and durable improvement.

For many years, the mid-urethral sling has been one of the most effective minimally invasive surgical treatments for SUI. Synthetic mesh mid-urethral slings remain available in Australia and have extensive evidence supporting their effectiveness. However, concerns surrounding synthetic mesh have led many women to ask whether there is a biological alternative.

One such option is a fascia lata allograft, including the fascia lata allograft supplied by Samson Medical Technologies in Australia.

The important distinction is that the Samson product is not a synthetic mesh. It is human donor fascia lata, processed for use as a biological graft. Samson describes its current fascia lata allograft as 100% human-derived, without storage media, non-irradiated and processed using Super Critical CO₂ technology.

However, there is an important caveat: the published clinical evidence for fascia lata allografts in SUI largely relates to earlier cadaveric fascia products and pubovaginal sling techniques, rather than Samson’s current specific product. Therefore, the historical allograft results should not be presented as if they were Samson-specific clinical trial results.

What is an allograft sling?

An allograft is tissue obtained from a human donor rather than from the patient herself.

Traditional biological pubovaginal slings have commonly used the patient’s own rectus fascia or fascia lata. This provides a strong, durable biological support but requires an additional incision to harvest the patient’s tissue.

An allograft avoids this donor-site surgery.

The fascia lata is positioned beneath the urethra and secured to provide a supportive platform. During coughing, sneezing or physical exertion, the urethra is compressed against this support, helping prevent urine leakage.

The concept is therefore quite different from a synthetic polypropylene mid-urethral sling. Instead of leaving a permanent synthetic mesh implant, the surgeon is using processed human connective tissue.

Samson currently supplies fascia lata allografts in several dimensions, including 20 × 100 mm and 20 × 120–140 mm configurations.

How effective are fascia lata allografts?

This is where the evidence requires some careful interpretation.

There is a substantial historical literature examining cadaveric fascia lata as a sling material, but the results have been inconsistent.

Early studies

Some early studies reported excellent short-term results.

One study of 26 women treated with solvent-dehydrated cadaveric fascia lata reported that 77% were completely dry and 92% used one pad or fewer per day at a mean follow-up of 15 months.

Another series of 31 women reported complete resolution of SUI in 93% at approximately one year.

A larger series of 104 women using freeze-dried, non-irradiated cadaveric fascia lata demonstrated substantial reductions in pad use, although the study’s follow-up was relatively short.

These studies created considerable enthusiasm for allograft tissue because it offered the advantages of a biological sling without the morbidity of harvesting the patient’s own fascia.

But there was also a warning signal

Other studies produced considerably less encouraging results.

A study of 18 women using solvent-dehydrated, gamma-irradiated fascia lata found that 27.8% experienced significant failure, with recurrent incontinence occurring within 3–6 months. The authors concluded that this particular allograft material was unreliable.

A subsequent comparative study of 71 women found a concerning difference in objective urodynamic recurrence: urodynamic stress incontinence was present in 41.7% of women who received Tutoplast allograft compared with none of those receiving autologous fascia lata at follow-up. Patient-reported outcomes, however, were more favourable.

Other series have reported much better results. In a 134-patient comparison, 63 women received allograft fascia and 71 received autologous fascia. There was no statistically significant difference in overall cure of stress and urge incontinence at approximately two years, while the allograft group experienced less postoperative pain and disability.

What does this mean?

The historical evidence suggests that allograft fascia can work well, but the durability and consistency of older allograft products were variable.

This variability is important when discussing the Samson allograft. There is currently insufficient published comparative evidence to state that the Samson product has a specific cure rate such as 80%, 90% or 95%.

The more scientifically defensible statement is:

Samson fascia lata provides a contemporary biological allograft option for sling surgery, but Samson-specific long-term comparative clinical outcome data are still developing.

That distinction is important when counselling patients.

How does Samson allograft differ from older allografts?

The earlier allograft literature predominantly involved freeze-dried, solvent-dehydrated and/or gamma-irradiated cadaveric fascia lata.

The Samson product currently described by the manufacturer is different in its processing. Samson reports that its fascia lata is:

  • 100% human-derived
  • non-irradiated
  • supplied without storage media
  • processed using Super Critical CO₂ technology
  • available in several sizes.

The rationale behind modern tissue processing is to preserve the structural characteristics of the collagenous tissue while making the graft suitable for implantation.

Nevertheless, a different processing technology does not automatically establish superior clinical continence outcomes. Laboratory characteristics, tensile strength and histological appearance are not substitutes for long-term clinical trials.

This is one of the areas where future Australian outcome data will be particularly valuable.

How does an allograft compare with synthetic mid-urethral mesh?

Synthetic mid-urethral slings have the largest evidence base of any minimally invasive SUI operation.

A Cochrane review including 81 trials and more than 12,000 women found that more than 80% of women were cured or significantly improved following mid-urethral sling surgery, with good results maintained for up to five years.

Retropubic and transobturator approaches have broadly comparable effectiveness, although their complication profiles differ.

For example, retropubic slings have a higher risk of bladder perforation, whereas transobturator procedures have more groin pain. Vaginal mesh exposure is uncommon but recognised with both approaches.

The Australian situation

It is important to distinguish mid-urethral slings from transvaginal mesh used for pelvic organ prolapse.

The Australian TGA has removed certain transvaginal mesh products from the market, particularly mesh used for prolapse and single-incision mini-slings. However, mid-urethral sling devices for SUI remain approved in Australia.

Indeed, a 2026 Australian Government review concluded that mid-urethral sling devices should remain on the Prescribed List, with their existing listing unchanged.

Therefore, synthetic MUS should not simply be described as “banned mesh” in Australia. It remains an accepted treatment for appropriately selected women.

Potential advantages of an allograft

A biological fascia lata sling potentially offers:

Advantages

  • No synthetic polypropylene mesh
  • No fascial harvest from the patient’s abdomen or thigh
  • Avoidance of donor-site pain
  • Biological rather than permanent synthetic material
  • Potentially useful where avoidance of synthetic mesh is an important patient preference

Potential disadvantages

  • Less robust long-term evidence than synthetic MUS
  • Historical allograft studies have shown variable durability
  • It is still a surgical sling and can cause obstruction, urinary retention, infection, bleeding or pain
  • It requires more extensive dissection than a conventional MUS
  • It should not currently be marketed as proven superior to synthetic MUS

What about the Burch colposuspension?

The Burch colposuspension is the classic non-mesh surgical treatment for SUI.

Rather than placing a sling beneath the urethra, sutures are placed beside the bladder neck and proximal urethra and attached to supporting pelvic tissues.

It can be performed by open or laparoscopic surgery.

Long-term studies demonstrate that Burch colposuspension can be highly effective. One classic study found an 81.6% cure rate at 5–10 years.

More contemporary comparative data are reassuring. In a large study with more than 1,300 women and long-term follow-up, the proportion reporting no ongoing SUI was 83.0% after Burch colposuspension compared with 85.0% following retropubic MUS, with no significant difference.

However, Burch surgery is more invasive than a mid-urethral sling and is generally no longer the first surgical option for uncomplicated primary SUI.

It can nevertheless be an attractive option in selected women, particularly when avoiding synthetic mesh is important.

What about peri-urethral bulking agents?

Urethral bulking agents occupy a completely different part of the treatment spectrum.

A material is injected into the urethral wall around the bladder neck or proximal urethra to increase coaptation and improve continence.

In Australia, polyacrylamide hydrogel such as Bulkamid is an established example.

The major attraction is that it is substantially less invasive than sling surgery.

It can often be performed under local anaesthesia or sedation and has a relatively favourable safety profile.

The trade-off is effectiveness and durability.

A 2024 study of Bulkamid reported that at 12 months 69% of women described themselves as cured or improved, with 40% reporting cure, while 23% underwent subsequent treatment, including repeat Bulkamid injection or MUS.

Longer-term data are more modest. In a cohort of 357 women followed for a median of approximately 2.5 years, subjective cure was 30.9%, while 52.1% reported improvement. Minor adverse events occurred in 21%, with no serious adverse events attributed to the procedure.

Current guideline evidence therefore generally considers bulking agents less effective than MUS, Burch colposuspension or autologous fascial sling surgery, and repeat injections may be necessary.

Putting the options together

Treatment Approximate effectiveness Main advantages Main disadvantages
Samson fascia lata allograft sling Samson-specific long-term cure rate not yet established; historical allograft studies range widely Biological tissue; no synthetic mesh; no tissue harvest Limited contemporary comparative evidence; historical allograft durability concerns; surgical sling risks
Synthetic mid-urethral sling Generally >80% cure/improvement in medium-term evidence Minimally invasive, rapid recovery, extensive evidence Mesh-specific complications including exposure, pain and voiding dysfunction
Burch colposuspension Approximately 70–85% long-term continence in many series No vaginal mesh; durable native-tissue operation More invasive; longer recovery; risk of prolapse and voiding problems
Autologous fascial sling Generally high effectiveness, comparable with other established sling procedures No synthetic mesh; patient’s own tissue Requires tissue harvest; more postoperative morbidity
Bulking agent Lower cure rate, but meaningful improvement for many women Minimally invasive; useful for frail/high-risk patients or those avoiding sling surgery Less durable; repeat injections commonly required

The Australian Government’s own review of MUS specifically considered colposuspension, native-tissue pubovaginal slings and urethral bulking agents as important comparators.

Who might consider an allograft sling?

A fascia lata allograft may be particularly attractive for a woman who:

  • has objectively demonstrated SUI;
  • has failed appropriate conservative treatment;
  • wishes to avoid a permanent synthetic mesh implant;
  • does not want an abdominal or thigh incision to harvest her own fascia;
  • understands that the long-term evidence base for contemporary allograft products is smaller than that for synthetic MUS;
  • accepts that biological tissue does not eliminate the risks associated with sling surgery.

It may also have a role in selected women with recurrent SUI, particularly where previous synthetic mesh surgery makes another synthetic procedure unattractive. However, recurrent SUI is a more complex clinical situation and requires individual assessment.

The important question: is Samson allograft better than synthetic mesh?

At present, there is not enough evidence to say that it is.

The strongest evidence remains with synthetic mid-urethral slings. Their effectiveness has been demonstrated in thousands of women and across multiple randomised trials and systematic reviews.

The potential attraction of Samson fascia lata is different.

It offers a biological alternative for women who would prefer to avoid synthetic mesh while also avoiding the morbidity of harvesting their own fascia.

That makes it an interesting addition to the surgeon’s toolbox rather than a replacement for the established mid-urethral sling.

The key unanswered question is long-term durability.

Historical cadaveric allograft studies demonstrate that some allografts performed extremely well, while others experienced substantial early failure.

Consequently, contemporary prospective data specifically evaluating Samson’s processing technology, clinical continence outcomes, complications and durability would be valuable.

What should a woman expect from the procedure?

As with any continence operation, the goal is not simply to make a stress test negative. The aim is to improve the woman’s quality of life while preserving normal bladder emptying and sexual function.

Potential complications of sling surgery include:

  • temporary or persistent difficulty emptying the bladder;
  • urinary retention requiring catheterisation;
  • urinary tract infection;
  • bleeding or haematoma;
  • pain;
  • de novo urgency or worsening overactive bladder;
  • recurrent or persistent SUI;
  • vaginal wound problems;
  • infection;
  • rarely, injury to the bladder, urethra or surrounding structures.

Synthetic mesh has additional mesh-specific risks, including vaginal exposure/erosion and chronic pain. The TGA specifically requires information regarding complications such as severe chronic pain, groin pain and bladder perforation in the instructions for use of Australian MUS devices.

An allograft avoids synthetic mesh exposure, but it does not make the operation risk-free.

The bottom line

For a woman with bothersome stress urinary incontinence, there is no single operation that is right for everyone.

Synthetic mid-urethral slings remain the most extensively studied minimally invasive surgical treatment and have excellent success rates.

Burch colposuspension remains a durable non-mesh alternative, although it is more invasive.

Bulking agents offer the least invasive surgical option but generally have lower and less durable success rates.

Fascia lata allograft represents an intriguing middle ground: a biological sling that avoids both synthetic mesh and the need to harvest the patient’s own fascia.

The Samson allograft is particularly interesting because its contemporary processing differs from several of the older cadaveric fascia products that generated the historical literature. Samson describes its current graft as non-irradiated human fascia lata processed using Super Critical CO₂ technology.

However, the enthusiasm should be matched by scientific caution. The historical literature demonstrates that allografts can achieve good continence outcomes, but it also demonstrates that not all allograft materials have behaved identically over time.

For patients considering this option, the most accurate discussion is therefore not “this is a better sling than mesh.” It is:

“This is a biological alternative to synthetic mesh, with encouraging historical experience but less mature long-term clinical evidence for the contemporary product.”

As further Australian experience and prospective follow-up accumulate, Samson fascia lata allograft may become an increasingly useful option in the treatment of female stress urinary incontinence.

Important note

This article is intended for general information and does not replace an individual assessment by a urologist or uro-gynaecologist. The choice between conservative management, bulking agent, synthetic MUS, biological or autologous sling and Burch colposuspension depends on the type and severity of incontinence, previous surgery, urethral function, pelvic anatomy, patient preference and overall health.

Post-Prostatectomy Urinary Incontinence

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When urine leakage persists after prostate surgery

Urinary leakage after prostatectomy is common, particularly in the first few weeks and months following surgery. For most men, bladder control progressively improves as the urinary sphincter and pelvic floor recover.

For some men, however, leakage persists and can become a significant physical, social and emotional burden.

The good news is that persistent post-prostatectomy urinary incontinence is treatable, and there are several options ranging from pelvic floor rehabilitation through to highly effective surgical treatments.

What is post-prostatectomy incontinence?

Post-prostatectomy urinary incontinence (PPI) refers to involuntary leakage of urine following surgery to remove the prostate, most commonly radical prostatectomy for prostate cancer.

The most common form is stress urinary incontinence (SUI).

You may notice leakage when:

  • Coughing or sneezing
  • Standing up
  • Walking or exercising
  • Lifting something heavy
  • Getting out of a chair or car
  • Bending over
  • Playing sport
  • During sexual activity or orgasm

Some men also experience urgency urinary incontinence, where a sudden compelling desire to urinate is followed by leakage.

Others have a combination of stress and urgency incontinence.

Why does this happen?

The prostate sits immediately below the bladder and surrounds the urethra. The urinary sphincter mechanism is therefore intimately involved with prostate surgery.

After prostatectomy, continence depends on the remaining external sphincter, pelvic floor muscles and the way the bladder stores and releases urine.

Recovery is a process rather than an on/off switch.

Most men experience substantial improvement during the first year, although the rate and extent of recovery varies between individuals. A small proportion of men continue to have bothersome leakage that requires active treatment.

How severe is the leakage?

The first step is to understand exactly what type of leakage you have and how much urine you are losing.

A consultation should look at:

1. Your symptoms

We want to know:

  • When did the leakage begin?
  • Is it improving, stable or getting worse?
  • Does it occur with coughing, movement or exercise?
  • Do you experience urgency?
  • How frequently do you urinate?
  • Do you get up at night?
  • Do you have difficulty emptying your bladder?
  • Do you leak during sexual activity or orgasm?
  • How much does the problem interfere with your lifestyle?

A validated questionnaire such as the ICIQ-UI Short Form can provide a standardised measure of symptoms and their impact.

Objective assessment

It is useful to measure your incontinence rather than relying solely on how many pads you use.

Different men use different numbers of pads, and a pad that is changed for comfort may contain very little urine.

Pad weight testing

A pad weight test provides a more objective measurement of urine loss.

The principle is simple:

1 gram increase in pad weight ≈ 1 mL of urine.

Depending on the clinical question, testing can be performed over a defined period or as a 24-hour pad weight assessment during normal daily activities.

For example:

Dry pads: 250 g
Used pads: 650 g

Urine loss = 400 g ≈ 400 mL

Pad testing can help:

  • Quantify the severity of leakage
  • Establish a baseline
  • Monitor improvement
  • Compare the result before and after treatment

Pad weight testing is recommended as one of the objective tools for assessing male urinary incontinence.

Why pad weight can be more useful than “number of pads”

One man’s “three pads a day” may represent a few drops on each pad.

Another man’s three pads may be completely saturated.

The number of pads therefore tells only part of the story.

The weight tells us how much urine is actually being lost.

Bladder diary

A 3-day bladder diary can be remarkably informative.

You record:

  • What and how much you drink
  • Time of each drink
  • Time of each urination
  • Volume passed
  • Urgency
  • Episodes of leakage
  • Activity associated with leakage
  • Pad changes
  • Night-time urination

The diary helps identify patterns that may not be obvious during a consultation.

It can distinguish, for example, between:

“I am leaking because my sphincter is weak”

and

“I am leaking because my bladder is filling rapidly and becoming overactive.”

Bladder diaries are an established method for objectively assessing frequency, voided volumes, urine production and urinary leakage.

Ultrasound assessment

An ultrasound examination can provide important additional information.

A particularly useful measurement is the post-void residual (PVR).

This tells us how much urine remains in the bladder after you have urinated.

Why does this matter?

Persistent urine in the bladder may indicate:

  • Poor bladder emptying
  • Bladder outlet obstruction
  • Reduced bladder contractility
  • Dysfunctional voiding

Ultrasound may also be used to assess the urinary tract and, where clinically appropriate, investigate other anatomical abnormalities.

Measurement of PVR is recommended in the assessment of male urinary incontinence.

Urodynamic testing

Sometimes the bladder and sphincter need to be examined in considerably more detail.

This is where urodynamics can be extremely useful.

Urodynamic testing measures how the bladder and urethra behave during filling and emptying.

It can assess:

  • Bladder capacity
  • Bladder sensation
  • Bladder compliance
  • Detrusor overactivity
  • Bladder pressure
  • Urinary flow
  • Bladder emptying
  • Sphincter function
  • Stress leakage
  • Bladder outlet obstruction

Why is this important?

Not all post-prostatectomy leakage is caused by the same problem.

A man may have:

Sphincter weakness

or

Overactive bladder

or

Poor bladder compliance

or

Impaired bladder contractility

or a combination of these.

Urodynamics can help distinguish bladder dysfunction from sphincteric insufficiency and can be particularly useful when the diagnosis is uncertain, bladder emptying is abnormal, or invasive treatment is being considered.

Urodynamics is not necessarily required for every man with straightforward stress incontinence.

It should be used selectively when the results are likely to influence diagnosis, counselling or treatment.

Pelvic floor muscle training

The pelvic floor is part of your continence mechanism

Pelvic floor muscle training (PFMT) is an important component of recovery after prostatectomy.

The pelvic floor muscles help support the urethra and contribute to urinary control.

The aim is not simply to perform hundreds of random “Kegels”.

Effective rehabilitation involves learning to:

  1. Identify the correct muscles
  2. Contract them correctly
  3. Hold the contraction
  4. Relax completely
  5. Coordinate the contraction with movement and changes in abdominal pressure
  6. Use the muscles appropriately during activities that trigger leakage

A specialised pelvic floor physiotherapist can be extremely helpful.

Timing matters

Pelvic floor exercises can be started before prostatectomy and should be continued after surgery.

Following catheter removal, pelvic floor muscle exercises or formal pelvic floor muscle training should be offered to men recovering from radical prostatectomy. Evidence suggests that they can accelerate the return of continence, particularly during the earlier stages of recovery.

However, pelvic floor exercises are not a magic switch.

If significant stress incontinence persists despite appropriate rehabilitation, it is important to reassess the situation rather than simply continuing exercises indefinitely.

When should surgery be considered?

Continence often continues to improve during the first year after prostatectomy.

For men with bothersome stress urinary incontinence who are not improving despite conservative treatment, surgical treatment can be considered from around six months, particularly when the incontinence is severe.

For persistent bothersome incontinence, surgical treatment should generally be offered by approximately 12 months rather than waiting indefinitely for further spontaneous improvement.

The exact timing should be individualised.

Surgical treatment

There is no single operation that is right for every man.

The choice depends on:

  • Severity of leakage
  • Pad weight
  • Time since prostatectomy
  • Previous radiation therapy
  • Urethral anatomy
  • Bladder function
  • Previous continence surgery
  • Manual dexterity
  • Patient expectations and preferences

The major surgical options include:

1. Male sling

A male sling supports and/or repositions the urethra to improve urinary control.

It is generally most suitable for mild to moderate stress urinary incontinence.

A sling may be particularly attractive to men who:

  • Have relatively low-volume leakage
  • Have not received pelvic radiation
  • Have good bladder function
  • Prefer a treatment without a mechanical pump

However, male slings are not routinely recommended for severe stress incontinence, where outcomes are generally less reliable than with an artificial urinary sphincter.

2. Artificial urinary sphincter

For significant or severe post-prostatectomy stress incontinence, the artificial urinary sphincter (AUS) remains the benchmark surgical treatment.

The device consists of:

  • A cuff around the urethra
  • A small control pump in the scrotum
  • A pressure-regulating balloon

When the cuff is inflated, the urethra is closed.

When you want to urinate, you squeeze the pump.

The cuff temporarily opens, allowing urine to pass.

It then automatically closes again.

Who is an AUS suitable for?

An AUS can be considered for men with mild through severe stress urinary incontinence, particularly when conservative treatment has failed.

Before implantation, the patient needs sufficient manual dexterity and cognitive ability to operate the device.

What are the disadvantages?

An AUS is a mechanical implant.

Potential complications include:

  • Infection
  • Urethral erosion
  • Mechanical failure
  • Persistent or recurrent leakage
  • Urethral atrophy
  • Need for revision or replacement

The device can provide excellent long-term continence, but patients should understand that it is not necessarily a “fit it and forget it” solution. Reoperations become more common as the device ages.

3. Adjustable continence devices

Adjustable balloon systems are another option in selected men.

These devices provide external compression around the urethra and can be adjusted following implantation.

They may be considered in selected patients, particularly those with mild incontinence and appropriate anatomy.

The evidence base is less extensive than that for the AUS, and device complications and explantation need to be discussed carefully.

4. Urethral bulking injections

Injectable bulking agents have historically been used to try to improve urethral closure.

They are minimally invasive, but their effectiveness in men following prostatectomy is limited.

Patients should understand that cure is uncommon and durability is poor compared with established surgical treatments.

They are therefore not generally considered the preferred treatment for significant post-prostatectomy stress incontinence.

What if you have urgency as well?

Not every leak after prostatectomy is caused by the sphincter.

Some men develop overactive bladder symptoms, including:

  • Urgency
  • Frequency
  • Nocturia
  • Urgency-associated leakage

This may require treatment directed at the bladder rather than the sphincter.

Treatment may include:

  • Bladder training
  • Fluid modification
  • Pelvic floor rehabilitation
  • Medication
  • Selected minimally invasive treatments for overactive bladder

If urgency is the dominant problem, it should be treated as an overactive bladder rather than assuming that an operation on the sphincter will solve everything.

What about men who have had radiotherapy?

Previous pelvic radiotherapy is particularly important when choosing surgery.

Radiation can affect the tissues and urethral blood supply and may increase the risk of complications and treatment failure.

For men with stress incontinence following radiotherapy, an artificial urinary sphincter is generally preferred over a male sling or adjustable balloon device.

This is one reason why your previous prostate cancer treatment is an important part of the surgical decision.

The decision is about more than pads

The goal of treatment is not simply:

“How many pads can we get you down to?”

It is about getting you back to the life you want to live.

That might mean being able to:

  • Exercise without worrying about leakage
  • Play golf or tennis
  • Go out without carrying spare pads
  • Travel confidently
  • Sleep without constantly worrying about leakage
  • Wear the clothes you want
  • Be intimate with your partner without anxiety

The appropriate treatment depends on both the objective severity of the incontinence and how much it affects your quality of life.

A practical assessment pathway

Step 1

Understand the symptoms

Stress leakage? Urgency? Mixed symptoms? Night-time leakage?

Step 2

Measure the problem

Validated questionnaire + bladder diary + pad weight.

Step 3

Check bladder emptying

Ultrasound and post-void residual.

Step 4

Assess pelvic floor function

Pelvic floor assessment and physiotherapy where appropriate.

Step 5

Look deeper when necessary

Urodynamics, and additional investigations such as cystoscopy when clinically indicated.

Step 6

Treat the cause

Bladder-directed treatment for urgency/detrusor dysfunction.

Sphincter-directed treatment for genuine stress incontinence.

Step 7

Consider surgery when appropriate

  • Mild–moderate SUI: male sling may be appropriate in selected men
  • Moderate–severe SUI: artificial urinary sphincter is often the preferred option
  • Severe SUI: AUS generally favoured over sling
  • Previous radiotherapy: AUS generally preferred
  • Failed sling: AUS is usually the most effective subsequent option

Don’t just put up with it

Urinary leakage after prostatectomy is common, but persistent incontinence should not simply be accepted as the price of prostate cancer treatment.

If leakage is interfering with your life, there is a structured pathway to determine exactly what is happening and what can be done about it.

A combination of symptom assessment, bladder diary, pad weight measurement, ultrasound, pelvic floor assessment and, where appropriate, urodynamics can provide a much clearer picture.

From there, treatment can be tailored to the individual, ranging from rehabilitation through to reconstructive continence surgery.

The aim is simple: better bladder control, greater confidence and getting you back to doing the things that matter to you.

When should you seek specialist assessment?

Consider seeing a urologist specialising in male continence if:

  • Significant leakage persists beyond the early recovery period
  • You are still using multiple pads several months after surgery
  • Leakage is affecting exercise, work, travel or intimacy
  • You have both urgency and stress leakage
  • You have difficulty emptying your bladder
  • You have previously had pelvic radiation
  • Your incontinence is getting worse rather than better
  • You are considering surgical treatment

Medical disclaimer

This information is intended for general educational purposes and does not replace an individual medical assessment. The appropriate investigation and treatment of urinary incontinence depends on your medical history, previous prostate treatment, bladder function, urethral anatomy and individual circumstances.

Men’s Guide to Lower Urinary Tract Symptoms: What’s Causing Them and What Can Be Done?

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Men’s Guide to Lower Urinary Tract Symptoms: What’s Causing Them and What Can Be Done?

Getting up at night to pee? A weaker stream? Feeling like your bladder never quite empties?

If you are a man over 40, there is a reasonable chance you have experienced one or more of these symptoms:

  • Getting up several times during the night to urinate
  • A weak or slowing urinary stream
  • Difficulty getting started
  • Having to strain or wait for the urine to start
  • Urgency or rushing to the toilet
  • Going to the toilet frequently
  • Dribbling after urination
  • Feeling that your bladder has not emptied
  • Stopping and starting during urination
  • Occasionally leaking urine

Collectively, these are called lower urinary tract symptoms, or LUTS.

The important thing to understand is that LUTS are symptoms, not a diagnosis.

And while an enlarged prostate is a common culprit, it isn’t the only one.

Your bladder, prostate, urethra, medications, fluid intake, sleep, diabetes, neurological conditions and even certain lifestyle factors can all contribute.

The good news? There is a surprisingly large toolbox available to treat bothersome urinary symptoms.

First things first: it isn’t always “just the prostate”

The prostate sits underneath the bladder and surrounds the urethra, the tube through which urine leaves the body.

As men get older, the prostate commonly enlarges. This is known as benign prostatic enlargement (BPE) and is part of the condition commonly referred to as benign prostatic hyperplasia (BPH).

An enlarged prostate can narrow the urinary channel and create bladder outlet obstruction (BOO).

But there is a twist.

A man can have a large prostate and relatively few symptoms. Another man can have a modestly enlarged prostate and significant symptoms.

And sometimes the prostate isn’t the main problem at all.

The bladder may become overactive, underactive or less compliant. A urethral stricture may narrow the urinary passage. Infection, stones, neurological disease, diabetes, excessive evening fluid intake and sleep disorders can also contribute.

This is why simply saying, “Your prostate is enlarged, let’s treat the prostate,” isn’t always the right answer.

So how do you investigate LUTS?

The aim of the assessment is not simply to measure the size of your prostate.

The real question is:

Why are you having these symptoms, and which treatment is most likely to help you?

Current European guidelines recommend a structured assessment that includes symptoms, examination and appropriate testing.

1. Your story matters

Your doctor will ask about:

  • What symptoms you have
  • How long you’ve had them
  • How much they bother you
  • How often you urinate
  • How many times you get up at night
  • Your urinary stream
  • Urgency and leakage
  • Previous urinary problems or operations
  • Medications
  • Fluid, caffeine and alcohol intake
  • Medical conditions such as diabetes or neurological disease
  • Sexual and ejaculatory function

You may be asked to complete a questionnaire such as the International Prostate Symptom Score (IPSS).

This is useful because your perception of the problem matters. A slightly abnormal test with minimal bother doesn’t necessarily require treatment, whereas quite modest objective abnormalities can be very troublesome for another man.

2. Examination

This generally includes an abdominal and genital examination and, where appropriate, a digital rectal examination (DRE) to assess the prostate.

Yes, it is brief.

No, it isn’t anyone’s favourite part of the consultation.

But it can provide useful information.

3. Urine testing

A urine dipstick or microscopy can look for:

  • Infection
  • Blood
  • Glucose
  • Protein
  • Other abnormalities

Blood in the urine should not simply be blamed on an enlarged prostate. It may require further investigation.

4. PSA

A prostate-specific antigen (PSA) blood test may be appropriate.

PSA is not simply a “prostate enlargement test.” It can contribute to assessment of prostate cancer risk and can also provide information relevant to prostate enlargement and the risk of future progression.

Whether you should have a PSA depends on your age, risk factors, symptoms and whether the result would change management.

5. Bladder scan

An ultrasound scan can measure the amount of urine left in the bladder after you have urinated.

This is called the post-void residual (PVR).

A large residual may indicate significant obstruction, poor bladder contraction or a combination of the two.

6. Uroflowmetry

This is one of my favourite simple urological tests because it is essentially a sophisticated way of answering:

“How fast does this man actually pee?”

You urinate into a special machine that measures the flow rate.

It provides information about the strength and pattern of the urinary stream and is particularly useful when interpreted alongside the PVR and symptoms.

Guidelines recommend performing uroflowmetry before treatment when possible.

7. Ultrasound

Ultrasound can assess:

  • Prostate size
  • Prostate shape
  • Median lobe enlargement
  • Bladder abnormalities
  • Residual urine
  • Kidneys and upper urinary tract where indicated

Knowing the size and shape of the prostate becomes particularly important if surgery or a minimally invasive procedure is being considered.

8. Bladder diary

If your main complaint is frequency or getting up repeatedly at night, a three-day bladder diary can be extremely useful.

You record:

  • When you drink
  • How much you drink
  • When you urinate
  • How much you pass
  • How many times you get up at night

This can reveal whether the problem is actually prostate obstruction, an overactive bladder, excessive nighttime urine production or something else.

9. Cystoscopy

A small camera can be passed through the urethra to look directly at the urethra, prostate and bladder.

It isn’t necessary for every man with LUTS.

It becomes particularly useful when there is concern about a urethral stricture, bladder pathology, haematuria, previous surgery, or before certain procedures where the findings could influence treatment selection.

10. Urodynamics

Sometimes the most important question is:

Is the prostate obstructing the bladder, or is the bladder itself struggling to push urine out?

Urodynamic testing can distinguish conditions such as bladder outlet obstruction, detrusor overactivity and impaired bladder contractility.

It isn’t necessary for everyone. It is generally reserved for selected men when the diagnosis is uncertain or when the result could change the treatment decision, particularly before invasive treatment in certain circumstances.

Treatment: there is no single “best” treatment

Treatment should be tailored to the man, not simply to his prostate.

The options range from doing nothing for now, through lifestyle measures and medication, all the way to minimally invasive procedures and major surgery.

The right treatment depends on:

  • Your symptoms
  • How much they bother you
  • Prostate size and anatomy
  • Flow rate
  • Residual urine
  • Bladder function
  • Your general health
  • Your priorities
  • Your attitude toward medication and procedures
  • Whether preservation of ejaculation is important to you

1. Watchful waiting and lifestyle changes

Not every man needs a procedure.

If symptoms are mild and aren’t significantly affecting your quality of life, monitoring may be entirely appropriate. Many men remain stable for years.

Simple measures can help:

Things worth trying

  • Reduce large amounts of fluid before bed
  • Moderate caffeine intake
  • Reduce evening alcohol
  • Avoid deliberately “holding on” for excessive periods
  • Treat constipation
  • Review medications that may worsen urinary symptoms
  • Manage diabetes and other medical conditions
  • Maintain a healthy weight
  • Stay physically active

For some men, these seemingly boring interventions make a surprisingly large difference.

2. Medication

If symptoms are bothersome, medication is often the first active treatment.

Alpha-blockers

Examples include:

  • Tamsulosin
  • Silodosin
  • Alfuzosin
  • Doxazosin
  • Terazosin

These medications relax smooth muscle around the prostate and bladder outlet, making it easier for urine to pass.

They often work relatively quickly.

Potential side effects include:

  • Dizziness
  • Low blood pressure
  • Nasal congestion
  • Ejaculatory changes

The different drugs have different side-effect profiles, so the choice can be individualised.

One important point: if you are taking an alpha-blocker and are planning cataract surgery, tell your ophthalmologist because of the association with intraoperative floppy iris syndrome.

5-alpha-reductase inhibitors

These include:

  • Finasteride
  • Dutasteride

They work differently from alpha-blockers.

Rather than simply relaxing the prostate, they reduce the hormonal stimulation responsible for prostate growth and can gradually shrink the prostate.

They are particularly useful in men with larger prostates and a higher risk of progression.

The downside?

They take considerably longer to work.

They can also reduce libido and ejaculatory volume and may affect erectile function in some men.

They also lower PSA, which needs to be taken into account when interpreting PSA results.

Combination therapy

For some men with significant symptoms and an enlarged prostate, an alpha-blocker can be combined with a 5-alpha-reductase inhibitor.

This gives relatively rapid symptom relief from the alpha-blocker while the 5-alpha-reductase inhibitor works more slowly on the underlying prostate enlargement.

Medication for an overactive bladder

Not every man with urinary urgency and frequency needs his prostate treated.

If the bladder is overactive, medications such as:

  • Antimuscarinic drugs
  • Beta-3 agonists such as mirabegron

may be appropriate.

These treatments target the bladder rather than the prostate.

Tadalafil

Interestingly, a medication better known for treating erectile dysfunction can also improve LUTS.

Tadalafil, a PDE5 inhibitor, can be useful in men who have both urinary symptoms and erectile dysfunction.

This is one of those pleasing examples where treating two problems with one tablet is possible.

3. Minimally invasive treatments

If medication isn’t working, causes side effects, or simply isn’t something you want to take indefinitely, there is now a growing middle ground between tablets and conventional surgery.

These treatments aim to relieve obstruction while generally reducing the surgical burden and, in some cases, preserving sexual or ejaculatory function.

UroLift / Prostatic Urethral Lift

Small implants are placed to pull prostate tissue away from the urethra and open the urinary channel.

The attraction is that there is no tissue removal and sexual and ejaculatory function are generally well preserved.

It is particularly suited to selected men with relatively small prostates and appropriate anatomy.

The trade-off is that symptom improvement may be less than with TURP, and retreatment rates are higher. Current EAU guidance recommends it for selected men with prostate volumes under about 70 mL and without a middle lobe.

Rezūm / water-vapour therapy

Steam is delivered into the prostate.

The heat destroys targeted prostate tissue, which subsequently shrinks, opening the urinary channel.

The procedure can be performed without conventional tissue resection and has the advantage of generally preserving sexual function.

The downside is that improvement is not immediate. There can be a period of urinary irritation, frequency and discomfort while the prostate settles.

Aquablation

Aquablation is a fascinating newer technology.

Instead of cutting the prostate with a conventional electrosurgical instrument or laser, a computer-guided high-pressure water jet removes precisely targeted prostate tissue.

Real-time imaging helps guide the treatment.

It can be particularly attractive to men who want effective tissue removal while placing a high priority on preservation of ejaculation.

Current EAU guidance supports Aquablation as an alternative to TURP in appropriately selected men with prostate volumes around 30–80 mL, particularly where preservation of ejaculatory function is important. Long-term data also support its use in selected larger prostates.

Aquablation is available in Australia, although access varies between centres.

Prostatic artery embolisation

This is performed by an interventional radiologist.

The blood supply to the prostate is selectively reduced, causing the prostate to shrink over time.

It avoids transurethral surgery and can be attractive to selected men who strongly prefer a minimally invasive approach.

However, outcomes are generally less predictable than established surgical procedures, and patient selection is important. Current EAU guidance emphasises collaboration between urologists and appropriately trained interventional radiologists.

4. Traditional surgery: still very much alive and kicking

Sometimes the best solution is simply to remove the obstruction.

And despite the arrival of a parade of newer technologies, conventional surgery remains extremely effective.

TURP

Transurethral resection of the prostate, or TURP, has been the benchmark against which many newer procedures are compared.

A telescope is passed through the penis into the prostate and obstructing tissue is removed from inside the prostate.

There is no abdominal incision.

TURP provides excellent, durable improvement in urinary flow and symptoms.

Potential complications include bleeding, infection, urethral stricture, bladder neck contracture, temporary or persistent urinary leakage and sexual side effects.

One of the most common long-term effects is retrograde ejaculation, where semen travels into the bladder rather than out through the penis during orgasm.

The orgasm can still occur, but fertility and the visible ejaculation of semen may be affected.

5. Laser prostate surgery

Laser technology has transformed prostate surgery.

Rather than using a conventional electrical cutting loop, lasers can vaporise, resect or enucleate prostate tissue.

HoLEP

Holmium Laser Enucleation of the Prostate, or HoLEP, is one of the most important modern surgical options.

The surgeon uses a laser to separate the obstructing prostate adenoma from the surrounding prostate capsule. The tissue is then removed from the bladder and sent for pathological examination.

Think of it as shelling the obstructing prostate out from inside its capsule.

HoLEP has several advantages:

  • Excellent symptom improvement
  • Excellent improvement in urinary flow
  • Suitable for small and very large prostates
  • Durable results
  • Excellent haemostasis
  • Less bleeding than some traditional approaches
  • Can be performed in men taking certain blood-thinning medications in appropriately selected circumstances

Current EAU guidelines strongly recommend HoLEP as an alternative to TURP or open prostatectomy for appropriate men with moderate-to-severe LUTS due to benign prostatic obstruction.

HoLEP does, however, have a learning curve. The experience of the surgeon matters.

Thulium laser enucleation

Another laser-based option is ThuLEP, or thulium laser enucleation of the prostate.

It follows similar principles to HoLEP and can provide comparable symptom and flow improvements.

The precise technology available varies between hospitals and surgeons.

GreenLight laser / laser vaporisation

Laser vaporisation uses laser energy to vaporise obstructing prostate tissue.

It can be particularly useful in selected men with smaller or medium-sized prostates and has favourable bleeding characteristics.

Laser vaporisation has also been used extensively in men taking antiplatelet or anticoagulant medications, although individual assessment is essential.

6. Very large prostates

When the prostate becomes very large, treatment choices change.

Historically, the answer was an open simple prostatectomy, where the obstructing inner portion of the prostate is surgically removed through an abdominal approach.

It remains effective, but it is considerably more invasive.

Today, endoscopic enucleation procedures such as HoLEP can often achieve similar long-term results without an open operation.

For very large glands, the choice may therefore come down to:

HoLEP or another enucleation procedure versus robotic/open simple prostatectomy, depending on anatomy, surgeon expertise and available technology.

The EAU currently recommends open prostatectomy primarily when endoscopic enucleation is unavailable for men with very large prostates.

So which treatment is best?

There isn’t one answer.

A useful way of thinking about it is:

Situation Possible approach
Mild symptoms, little bother Lifestyle + observation
Moderate symptoms Medication
Enlarged prostate with progression risk Alpha-blocker ± 5-alpha-reductase inhibitor
Urgency/frequency from overactive bladder Bladder-directed medication
LUTS + erectile dysfunction Consider tadalafil
Small/medium prostate, want minimally invasive treatment UroLift, water-vapour therapy or other selected MIST
Want tissue removal with potential preservation of ejaculation Aquablation in suitable patients
Standard durable surgical treatment TURP
Medium/large prostate TURP, laser or enucleation depending on anatomy
Large prostate HoLEP/ThuLEP or simple prostatectomy
Very large prostate Enucleation or robotic/open simple prostatectomy

The important point is that prostate size alone should not dictate the treatment.

Anatomy, bladder function, symptoms, medical history and your personal priorities all matter.

When should you stop taking tablets and consider surgery?

There is no prize for remaining on medication forever.

If medication works well and you are happy with it, excellent.

But surgery or an intervention becomes increasingly reasonable when:

  • Symptoms remain troublesome despite medication
  • Medication causes unacceptable side effects
  • You develop recurrent urinary retention
  • You have recurrent urinary tract infections
  • You develop bladder stones
  • There is significant bleeding attributed to prostate enlargement
  • There is significant residual urine or deterioration of bladder function
  • The upper urinary tract becomes affected
  • Your quality of life is being significantly affected

These are recognised indications for surgical intervention in appropriate patients.

And what about sex?

This deserves a proper conversation.

Urinary symptoms and sexual function frequently coexist, but treating the prostate can sometimes affect sexual function.

Depending on the treatment, there may be effects on:

  • Ejaculation
  • Erectile function
  • Libido
  • Orgasm
  • Fertility

For some men, preservation of ejaculation is a major priority.

For others, the priority is simply being able to empty their bladder properly and sleep through the night.

Neither priority is wrong.

The important thing is to tell your urologist what matters to you before choosing a procedure.

Different procedures have different sexual side-effect profiles, and this should form part of the decision rather than being discovered afterwards.

Don’t automatically blame everything on your prostate

One of the biggest mistakes men make is assuming:

“I’m getting older, my stream is weaker, therefore my prostate is enlarged.”

Perhaps.

But perhaps not.

LUTS can arise from several different mechanisms, and the treatment that works beautifully for one man may do very little for another.

A good assessment should answer three questions:

1. What symptoms am I actually experiencing?

2. What is causing them?

3. What treatment gives me the best balance between improvement, side effects, durability and quality of life?

Once those questions are answered, the treatment options become much clearer.

When should you see a doctor urgently?

Seek prompt medical assessment if you develop:

  • An inability to pass urine
  • Significant blood in the urine
  • Fever or chills with urinary symptoms
  • Severe pain
  • Recurrent urinary infections
  • New kidney problems
  • Significant deterioration in your urinary function

Acute urinary retention, in particular, is not something to simply wait out at home.

The bottom line

Lower urinary tract symptoms are common in men, but putting up with them is not an inevitable part of ageing.

There is an increasingly sophisticated range of treatments available, from lifestyle changes and medication through to minimally invasive therapies, TURP, laser procedures, Aquablation and advanced enucleation techniques such as HoLEP.

The trick is not finding the best treatment.

It is finding the best treatment for you.

And that starts with a proper assessment rather than simply assuming that every urinary problem is caused by “the prostate.”

If your bladder is running the night shift, your stream has become a garden hose on low pressure, or you are planning your day around finding toilets, it may be time to have it properly assessed.

Medical note: This is patient education rather than individual medical advice. The investigation and treatment approach should be tailored to the individual, particularly where there is haematuria, urinary retention, recurrent infection, neurological disease or concern about prostate cancer. The treatment information above reflects contemporary EAU guidance, including the 2026 guideline update.

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.

Kidney Stones: Symptoms, Causes and Treatment Options Explained

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Kidney stones: symptoms, treatment and prevention

Kidney stones can cause sudden, intense pain, but some are discovered by chance and cause no symptoms. The right treatment depends on where a stone sits, its size, whether urine can drain, whether infection is present and how well the kidneys are working. If you have suspected stone pain, an assessment can establish which approach is safest for you.

What is a kidney stone?

A kidney stone forms when substances in urine crystallise and grow. Calcium-based stones are common; other types include uric acid, infection-related (struvite) and cystine stones. A stone may remain in the kidney or move into the ureter, the tube carrying urine to the bladder. A ureteric stone can obstruct urine flow and cause renal colic.

Symptoms to recognise

  • Severe pain in the side or back that may travel towards the lower abdomen or groin, often in waves
  • Blood in the urine, which may be visible or detected on a test
  • Nausea or vomiting
  • Urgency, frequent urination or discomfort passing urine, particularly when a stone is near the bladder

Cloudy urine, fever or chills may indicate infection. These symptoms also have other possible causes, so imaging and tests are important.

Seek urgent care at an emergency department if you have fever or chills with suspected stone pain, cannot pass urine, cannot keep fluids down, have pain that cannot be controlled, or have a single functioning kidney or known kidney disease with possible obstruction. An infected, obstructed kidney is a urological emergency: antibiotics and urgent drainage with a ureteric stent or nephrostomy may be needed before definitive stone treatment.

Why do stones form?

Low fluid intake, heavy sweating, a high-salt diet, previous stones and family history can increase risk. Other contributors include certain medicines and conditions such as gout, bowel disease or recurrent infection. The causes differ by stone type. Finding the type matters when planning prevention.

How are kidney stones diagnosed?

Assessment usually includes your symptoms and medical history, urine testing for blood and infection, and blood tests to check kidney function when appropriate. A low-dose CT scan without contrast is often used for adults with suspected renal colic because it shows the size and position of a stone and signs of obstruction. Ultrasound may be preferred first in pregnancy and some other circumstances. If you pass or have a stone removed, laboratory analysis can guide future prevention.

What are the treatment options?

Observation and pain relief. Many small ureteric stones pass without a procedure. This is reasonable when pain is controlled, there is no infection or concerning obstruction, and kidney function is safe. Your clinician will arrange follow-up to confirm that the stone has passed or the obstruction has resolved. Pain relief is tailored to your health; anti-inflammatory medicines may be useful but are unsuitable for some people, including those with impaired kidney function. Drink normally and avoid dehydration; forcing large amounts of water during acute colic does not push a blocked stone through.

Medication to help passage. An alpha blocker may improve passage for selected stones in the lower ureter, especially those around 5–10 mm. This use is off-label and should be discussed alongside possible adverse effects, such as dizziness. It is not suitable as a substitute for urgent treatment if infection, uncontrolled pain or worsening kidney function develops.

Shock wave lithotripsy (SWL or ESWL). Shock waves delivered from outside the body break a suitable stone into fragments. Its success depends on factors including stone size, position and density; further treatment can sometimes be needed.

Ureteroscopy and laser treatment. A fine telescope passes through the urethra and bladder into the ureter or kidney. The stone can be removed or fragmented with a laser. A temporary ureteric stent is sometimes placed and can cause urinary discomfort until removal.

Percutaneous nephrolithotomy (PCNL). For some large or complex kidney stones, instruments are passed through a small opening in the back to remove the stone. This is more invasive than ureteroscopy or shock wave treatment and has its own bleeding and infection risks.

Your urologist will discuss the expected chance of clearing the stone, anaesthetic needs, recovery, possible stenting and risks of each appropriate option.

Reducing the chance of another stone

For most people, drinking enough fluid to keep urine dilute is a useful starting point, particularly in Queensland heat. If you have heart failure or kidney disease, follow your treating team’s fluid advice instead of increasing intake on your own. Reduce excess salt, maintain a balanced diet and avoid unnecessarily restricting normal dietary calcium. Further dietary advice or preventive medication should be based on the stone’s composition and, for recurrent or higher-risk stones, blood and 24-hour urine testing. Follow-up imaging may be recommended to check for residual or new stones.

When should you see a urologist in Brisbane?

Arrange an assessment if you have a diagnosed stone that has not passed, recurrent stones, persistent pain, blood in the urine, or concerns about kidney function. If you are acutely unwell or have fever with stone symptoms, go to an emergency department rather than waiting for a routine appointment.

This article is general information and does not replace individual medical advice.

References

  1. European Association of Urology. EAU Guidelines on Urolithiasis (2026).
  2. National Institute for Health and Care Excellence. Renal and ureteric stones: assessment and management (NG118).
  3. Healthdirect Australia. Kidney stones: symptoms, diagnosis and treatment.
  4. Kidney Health Australia. Kidney stones.

Management Options for Benign Prostate Hyperplasia

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What is BPH?

Benign Prostate Hyperplasia

(BPH) is a non-cancerous enlargement of the prostate gland that commonly affects men as they age.

As the prostate grows, it can press on the urethra and cause urinary symptoms such as:

  • Frequent or urgent need to urinate
  • Difficulty starting urination
  • Weak urine stream or dribbling
  • Getting up multiple times at night
  • Feeling the bladder hasn’t fully emptied

Watchful Waiting & Lifestyle Changes

Active Monitoring

  • Annual check-ups with your doctor
  • Symptom tracking using validated scores
  • Prostate size monitoring
  • ~79% of patients remain stable over 5 years

Lifestyle Adjustments

  • Reduce fluids before bedtime
  • Limit caffeine and alcohol
  • Avoid decongestants & antihistamines
  • Practice timed voiding
  • Stay active and maintain healthy weight

Medications

Alpha-Blockers

             Fast-acting relief
  • Relax prostate & bladder neck muscles
  • Improve urine flow within days
  • Examples: tamsulosin, alfuzosin
  • May cause dizziness or low blood pressure

5-Alpha Reductase Inhibitors

            Long-term shrinkage
  • Shrink prostate over 6-12 months
  • Best for larger prostates (>40 cc)
  • Examples: finasteride, dutasteride
  • Can be combined with alpha-blockers

PDE5 Inhibitors (Tadalafil)

          Dual benefit
  • Daily low-dose relaxes smooth muscle
  • Also treats erectile dysfunction
  • Newer AUA guidelines support combos
  • Preserves ejaculatory function

Minimally Invasive Procedures

  1. Rezum – Steam Therapy
  2. UroLift – Prostatic Lift
  3. iTIND – Temporary Implant

Surgical Options

  1. TURP
  2. HoLep
  3. Greenlight Vaporization (PVP)
  4. Robotic Simple Prostatectomy

TURP remains the traditional gold standard. HoLEP and RSP offers the best long-term durability, especially for larger prostates.

HoLEP: Lowest retreatment rate (2% at 10 years), works for all prostate sizes. GreenLight: Same-day discharge, safe on blood thinners.

Choosing the Right Treatment

Treatment depends on several individual factors. Discuss these with your doctor:

  1. Symptom severity and how much they bother you
  2. Prostate size (small, medium, or large)
  3. Whether medications have been tried already
  4. Recovery time and return-to-activity goals
  5. Sexual function priorities (ejaculation, erections)

Key Takeaways

  1. BPH is very common and not cancerous — effective treatments are available at every stage
  2. Mild symptoms often improve with simple lifestyle changes and regular monitoring
  3. Medications can significantly reduce symptoms; newer combinations offer added benefits.
  4. Minimally invasive procedures preserve sexual function with quick recovery times.
  5. Surgery provides the most durable results for larger prostates or severe symptoms.

Talk to your  urologist about which option is right for you

 

How Diet & Lifestyle Can Support Prostate Health

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Prostate health: food, movement and informed testing

The prostate is a small gland below the bladder that contributes fluid to semen. It surrounds the first part of the urethra, so changes in the prostate can affect urination. Prostate enlargement, inflammation and cancer are different conditions; urinary symptoms alone cannot tell us which, if any, is present.[1, 2]

A healthy diet and regular activity support overall wellbeing. They may help some people manage weight and cope with treatment, but no food or exercise programme has been shown to guarantee prevention of prostate enlargement or prostate cancer. Similarly, a “check-up” is not the same thing as screening everyone for cancer: the decision to have a PSA blood test should take account of age, individual risk, preferences and the possible harms of testing.[3, 4]

What can affect the prostate?

Benign prostate enlargement (BPH) becomes more common with age. It may cause a weak stream, hesitancy, more frequent urination or waking at night. Similar symptoms can come from bladder conditions, medicines or other causes. Treatment depends on the degree of bother and any complications, and can range from monitoring and practical changes to medicines or a procedure.[1]

Prostatitis describes inflammation of the prostate and has several forms. Pain, urinary symptoms or fever require assessment; diet alone will not diagnose or treat the cause.[1]

Prostate cancer often causes no symptoms in its early stages. Some cancers grow slowly and may never need treatment; others are more aggressive. An abnormal PSA result does not by itself establish a cancer diagnosis.[2, 4]

Is there a “prostate-friendly” diet?

It is reasonable to use this phrase for a varied, balanced eating pattern, but it should not imply that a particular menu protects the prostate. The Australian Dietary Guidelines recommend vegetables, fruit, mostly wholegrain cereals, appropriate protein foods and water as a usual drink, while limiting foods high in added salt and saturated fat.[5] Food choices should also fit a person’s other conditions and cultural preferences.

The foods often promoted for prostate health can fit into that pattern, with important limits to the evidence:

Food What it offers What remains unproven
Tomatoes A vegetable source of lycopene and other nutrients Eating tomatoes or taking lycopene supplements has not been established as a way to prevent or treat prostate cancer.[3, 6]
Broccoli and cauliflower Vegetables that add variety and fibre Laboratory theories about their compounds do not prove that they prevent prostate disease in people.[3]
Salmon and sardines Protein and, in oily fish, omega-3 fats Fish is not a proven prostate cancer treatment or prevention strategy.[3, 5]
Green tea A beverage some people enjoy Antioxidant content does not establish a clinical benefit for prostate cancer; caffeine may aggravate urinary urgency in some people.[3, 7]
Chia and flaxseeds Fibre and unsaturated fats Eating these seeds is not proven to prevent BPH or prostate cancer.[3, 5]

No supplement should be assumed to be beneficial because it is sold as “natural” or “prostate supporting.” The SELECT trial, for example, found increased prostate cancer risk among men assigned vitamin E alone. Discuss supplements with your clinician, particularly if you are receiving treatment or taking medicines.[6]

A practical meal might include vegetables, a wholegrain food and fish, beans, eggs, tofu or another suitable protein. Add fruit or unsalted nuts and seeds according to preference. The value is in the overall pattern, not a particular “superfood.” If cancer treatment is affecting appetite or weight, an accredited practising dietitian can tailor the plan.[5, 8]

Movement, weight and everyday habits

Physical activity helps cardiovascular health, strength, mood and weight management. Australia’s current adult movement recommendations encourage activity on most days, including moderate to vigorous movement for at least 30 minutes on most days, strength activities twice a week, and mobility or balance activities on several days.[9] A walk, cycling, swimming or a manageable strength routine can be a starting point; build gradually if you have been inactive.

Excess body weight is associated with some adverse health outcomes, and Cancer Council Australia reports evidence linking overweight and obesity with prostate cancer risk. That association does not mean that weight loss prevents every prostate cancer, or that a person’s weight explains an individual diagnosis.[3]

For urinary symptoms, it can help to note when and how much you drink, whether caffeine or alcohol worsens urgency, and whether constipation is present. Drinking enough is important, but forcing large volumes can make frequency worse. These measures may ease symptoms for some people; they should not delay assessment of persistent or concerning changes.[1, 7]

If you are undergoing prostate cancer treatment, exercise may support fitness and help with treatment-related effects. The safest type and intensity depend on treatment, fatigue, bone health and other conditions. Ask your treating team or an accredited exercise physiologist for an individual plan when needed.[8]

What about PSA testing and “regular check-ups”?

A PSA test measures a protein made by the prostate. PSA may rise for reasons other than cancer, and testing can find slow-growing cancers that would never have caused harm. Further investigation and treatment can carry physical and emotional burdens. Testing may also identify a cancer at a stage when treatment can help. These benefits and harms should be discussed before testing.[2, 4]

The 2026 Australian guidelines for early detection recommend, after an informed discussion, PSA testing every two years for people aged 50–69 who choose testing. Routine testing at 45–49 is generally not recommended for average-risk people, although an interested person may be offered an initial test. People at higher risk, including those with certain family histories, Black sub-Saharan ancestry or a BRCA2 mutation, may be advised to start two-yearly testing at 45. For people aged 70 or older, the decision is individualised according to health, life expectancy and preferences.[4]

These are recommendations for people without symptoms. New difficulty passing urine, blood in the urine, persistent pain or other concerning symptoms call for assessment regardless of age or a planned PSA testing schedule. A GP is a sensible first contact and can arrange testing or referral when indicated.[2, 4]

A sustainable approach

Eat a varied diet, move regularly in ways you can sustain, and talk with your GP about symptoms and whether PSA testing makes sense for your age and risk. Healthy living is valuable in its own right, while medical decisions remain individual. There is no guarantee that these steps will prevent prostate disease, and a diagnosis does not mean someone has failed to look after their health.

General information only. This article does not replace personal medical advice or a discussion of the benefits and harms of PSA testing.

References

  1. Healthdirect Australia. Prostate problems.
  2. Cancer Council Australia. Early detection of prostate cancer.
  3. Cancer Council Australia. Prostate cancer prevention: evidence on lifestyle and diet.
  4. Prostate Cancer Foundation of Australia. 2026 Guidelines for the Early Detection of Prostate Cancer in Australia.
  5. National Health and Medical Research Council. Australian Dietary Guidelines.
  6. US National Cancer Institute. Prostate cancer, nutrition and dietary supplements; SELECT trial results.
  7. Healthdirect Australia. Benign prostatic hypertrophy: lifestyle measures.
  8. Cancer Council Australia. Life during and after prostate cancer treatment.
  9. Australian Government Department of Health. 24-hour movement recommendations for adults.

Microbiome of the Male Reproductive System: The Hidden Factor in Men’s Health

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When most people think about the microbiome, they imagine gut bacteria affecting digestion and immunity. But did you know that the male reproductive system also has its own unique microbiome? This hidden ecosystem of microorganisms plays a surprising role in fertility, hormone balance, and overall sexual health.

What Is the Male Reproductive Microbiome?

The male reproductive microbiome refers to the community of bacteria and other microorganisms living in the penis, testes, prostate, and semen. While it’s less studied than the gut microbiome, research shows that these microbes are crucial for maintaining reproductive health.

A balanced microbiome supports sperm quality, prevents infections, and even influences the immune environment of the reproductive tract. On the other hand, imbalances sometimes caused by antibiotics, poor hygiene, infections, or lifestyle factors can lead to fertility issues and other complications.

How the Microbiome Affects Fertility

Studies suggest that an unhealthy male reproductive microbiome may contribute to:

  • Reduced sperm motility: making it harder for sperm to reach the egg.

  • Decreased sperm count: fewer sperm can lower the chance of conception.

  • DNA fragmentation: damaged sperm DNA can affect embryo quality.

  • Inflammation: chronic inflammation in the reproductive tract can impair fertility and sexual health.

Even small changes in microbial balance can have a measurable impact on reproductive outcomes, highlighting why men’s microbiomes deserve attention.

Factors That Influence the Male Microbiome

Several lifestyle and environmental factors can disrupt the delicate balance of microbes:

  • Antibiotic use: kills both harmful and beneficial bacteria.

  • Diet: processed foods, sugar, and alcohol can negatively impact microbial health.

  • Hygiene: poor genital hygiene can allow harmful bacteria to thrive.

  • Sexual activity: sexually transmitted infections can alter microbial balance.

  • Chronic stress: stress hormones can influence bacterial populations and immunity.

Maintaining healthy habits is essential for keeping the microbiome in check.

Supporting a Healthy Male Microbiome

Here are practical ways men can support their reproductive microbial health:

  1. Balanced diet: Include fiber-rich fruits, vegetables, fermented foods, and lean protein.

  2. Probiotics: Supplements or natural sources (like yogurt or kefir) can help maintain beneficial bacteria.

  3. Safe sexual practices: Use protection and get regular STI screenings.

  4. Gentle hygiene: Avoid harsh soaps; washing with mild cleansers is best.

  5. Lifestyle management: Reduce alcohol, quit smoking, manage stress, and exercise regularly.

Why It Matters

The male reproductive microbiome is more than just a scientific curiosity, it’s a critical component of sexual and reproductive health. By understanding and supporting this hidden ecosystem, men can improve fertility, reduce infection risk, and even support hormone balance and overall wellness.

Conclusion:
Men’s health isn’t just about testosterone, erections, or sperm count, it’s also about the microscopic world living inside the reproductive system. Paying attention to the male reproductive microbiome is a small step with potentially big benefits for fertility, sexual function, and overall health.