Urology - Oncology, Laparoscopy, General Urology Mischel Neill - BHB MBCHB FRACS - Urology - Oncology, Laparoscopy, General Urology Urology - Oncology, Laparoscopy, General Urology
 
 
Patient Info

Men's Health

Men's health :: Female Urology :: Paediatric Urology

Infections :: Haematuria :: Erectile Dysfunction :: Urinary Incontinence
Urinary Stones :: Vescico Ureteral Reflux :: Benign Prostatic Hyperplasia :: Cancer :: Epididymo Orchitis

Epididymo ľorchitis

Erectile Dysfunction (Impotence)

The erection mechanism is complex involving nerves, arteries bringing blood to the erectile structures and veins taking it away.

Many different disease processes may effect any or all of these components and cause the mechanism to fail.

As men get older it may become more difficult for them to achieve and/or maintain an erection. Up to 50% of men between the ages of 40-70 suffer from erectile dysfunction. The anxiety that results may compound the problem.

Common conditions that may contribute to erectile dysfunction include cardiovascular disease; neurological disease (such as stroke or Parkinson’s syndrome); medication side effects (including recreational drug use, smoking and excessive alcohol consumption); endocrine disease (such as Diabetes and thyroid disorders); Peyronie’s disease (a penile scarring condition); trauma; psychological issues and cancer or cancer treatments. In prostate and bladder cancer treatment, damage to the erectile nerves due to the effects of radiation therapy or during surgery may cause a temporary or permanent loss of erectile function. Nerve sparing surgery exists that can lessen the impact on erectile function, however the suitability of such surgery depends on a number of factors including the stage and extent of the tumour.

Erectile Dysfunction Treatment

Management of erectile dysfunction is usually approached in a stepwise fashion.

Conservative management

Conservative options initially include general lifestyle modification by stopping smoking, regular exercise, moderation of diet and alcohol intake as well as stress management and weight loss. As a rule of thumb, if it’s recommended as healthy for the heart, it will be helpful for erectile dysfunction. Treatment of other medical problems such as uncontrolled hypertension or diabetes is also important as may be modifying/changing medications already being taken.

Vacuum pumps are a plastic cylinder with a hand or battery operated pump used to draw blood into the penis. A constriction band is then placed around the base of the penis to keep blood in the internal penile spaces. The ring is removed after 30 minutes to prevent tissue damage. This is a generally well tolerated treatment and is used when medical management fails. Side effects are few but ejaculation may be painful and temporary numbness or bruising can occur.

Medical management - oral

PDE5 inhibitor tablets can increase blood flow to the penis, thus achieving an erection. The most common forms of this drug group are Viagra (Sildenafil), Cialis (Tadalafil) and Levitra(Vardenafil).
Common side effects of this method include hot flushes, nausea, visual disturbances and headaches for some men. These medications are not able to be taken in certain situations. These include severe heart disease, men taking nitrate medications for heart problems and retinitis pigmentosa (a rare inherited condition causing degeneration of the retina at the back of the eye).

Medical management – penile injections

This involves injecting a combination of medications into the side of the penis that dilates the blood vessels enabling them to fill with blood and thus creating an erection. This method is successful for most men, but it is essential to work out an accurate dosage to prevent the erection lasting too long (known as priapism this can cause damage to the penile tissue). Other side effects may include pain, bruising and scar tissue formation at the injection site.

Surgical management

Surgical implants can be used to help create an erection. Implants are permanently implanted into the penis with an operation under general anaesthetic; they can only be removed through another operation. There are two main types of implant, the Semi-Rigid implant or the Inflatable implant.

Semi-Rigid implants involve placing a firm but bendable rod into the penis. After having this operation there is a permanent erection, although this will not be as firm as previous erections, it is adequately suitable for sexual intercourse. It is also flexible enough to be pulled down and tucked away when clothed, thereby avoiding any unwanted attention or embarrassment.

Later generation penile implants have an inflation/deflation mechanism. Inflatable implants involve the insertion of two cylinders into the penis and a reservoir of 60-100mls of saline deep behind the pubic bone. A pump and valve are inserted into the scrotum allowing the saline to be pumped into the cylinders in the penis, thus producing an erection. When an erection is no longer needed the valve can be released allowing the saline to drain back into the reservoir and the penis to become flaccid (soft).

The main drawbacks of surgically implantable prostheses are the risk of infection, erosion through the tissue and mechanical failure. In each case the prosthesis may need to be surgically removed.

Premature Ejaculation

Premature ejaculation is defined as recurrent or persistent ejaculation with minimal stimulation before, during or shortly after penetration. The mechanism for this condition is not well understood however both psychological and physical factors are thought to contribute.

The treatment of premature ejaculation is evolving but includes psychotherapy, behavioural techniques (stop-start and squeeze techniques), topical treatments (local anaesthetic applied in a condom) and medications (PDE5 inhibitors or SSRIs).

What is Cancer? - A brief definition

Cancer is a disease that results from abnormal growth and division of cells that make up the body's tissues and organs. Under normal circumstances, cells reproduce in an orderly fashion to replace old cells, maintain tissue health and repair injuries. However, when growth control is lost and cells divide too much and too fast, a cellular mass -or "tumour" -is formed. If the tumour is confined to a few cell layers and it does not invade surrounding tissues or organs, it is considered benign. By contrast, if the tumour spreads to surrounding tissues or organs, it is considered malignant, or cancerous. In order to grow further, a cancer develops its own blood vessels and this process is called angiogenesis. When it first develops, a malignant tumour may be confined to its original site. If cancerous cells are not treated they may break away from the original tumour, travel, and grow within other body parts, the process is known as metastasis.

Click on the below links to find more about the individual cancers

Psychological and Emotional Issues

Most people when diagnosed with cancer, experience a combination of new and confusing emotions during what may be a highly stressful period. A diagnosis of cancer can also affect family members such as a spouse or children, who may often find dealing with the diagnosis even more stressful than the patients themselves. This can often add to the burden of anxiety and so is important to address and understand.

Cancer affects each individual and their family in different ways and often people need to find their own way of coping. The process of coping can often be one of trial and error, before finding what works best for you.

Following are a number of suggestions that may be useful to some people to help them cope with their experience of cancer.

Talk to others family, friends, your family doctor, nurses, counsellors or a religious leader.

Information

Finding information about your illness and treatment and the help available will add to your understanding of what you are dealing with. Fear of the unknown may create uncertainty and increase stress. A very good source of information is The Cancer Society of New Zealand. The Auckland branch phone number is (09) 308 0160 and the website is www.cancernz.org.nz

Support Groups

Joining a support group will allow you to meet with other people coping with their illness and can be a valuable source of support and helpful ideas. Information on support groups can be obtained through the Cancer Society at (09) 308 0168. There are also groups for carers, contact (09) 308 0162.

Attitudes

Our thoughts and attitudes have a great impact on how we feel about things. We may not always be able to change the things that happen to us, but we can influence the impact they have on our lives. It is important to acknowledge the positive as well as negative aspects of a situation. Be realistic and try to avoid jumping to conclusions, talking to others may give you a different perspective on circumstances. Family and friends are often very upset and fear that their emotions may further exacerbate the situation. Try not to be afraid of your emotions and the emotional reactions of others, try to be available to talk about the issue with loved ones.

Listen to Others

Try to accept how your close family and friends are feeling, you don't have to solve their problems, just be there to listen. They may also be going through a tough time, so getting upset and crying are natural reactions. Not wanting to talk is also a normal reaction and may be a way of coping for some people. If you are particularly concerned with how a person is coping it may be useful talk to someone to find out how best to help.

Routine

Many people find it beneficial to continue with life's daily routines. It is important to try to cheer yourselves up and take your mind off things, an outing or chat about future plans may provide some stress relief.

Manage Stress

Be aware of your stress levels and try to manage these. Signs of stress can include; restlessness, fear panic, racing thoughts, forgetfulness, muscle aches, irritability and a loss of enjoyment in activity and life. There are many ideas and methods that can assist with relaxation, including breathing exercises or gentle activities such as Yoga. Get to know your body and its normal reactions so that you can recognise the signs and symptoms of stress. Try to allow yourself regular time for relaxation so that it becomes part of your daily routine; stress relievers such as breathing exercises can be performed anywhere. These routines can be enjoyable and may have lasting effects throughout the day.

Find out what is best for you.

Most people find that coping with the diagnosis and treatment of cancer is a difficult time. However, with time, most are able to cope and get on with their lives. Some people may need extra help, especially if there are other stresses in their lives. If you need further information or advice, talk to your treating team, the hospital Social worker or psychologist or The Cancer Society about what services might be helpful and available in your area.

Suggestions for Patients

You may have many questions about your care, your treating team will be guided be how much you want to know and the questions that you ask.

Make a list of questions to take to your appointment and perhaps take someone with you so that you don't miss anything. Don't be afraid to ask a number of questions or even to ask the same one twice. There are a number of good sources that can help answer questions, available through The Cancer Society of New Zealand. Hospital and Community services may offer emotional support either individually or through support groups and networks. Sharing feelings, experiences and ideas can be valuable, spiritual belief may also bring comfort.

Ill health can disrupt family life, and the roles and responsibilities of family members may change. Family members may have different needs at different times, some may discuss issues openly and others may not. This requires patience and understanding and you as the patient should let people know what you are prepared to talk about, with whom and when.

It may be helpful to examine your lifestyle and responsibilities and to reassess your priorities and make adjustments accordingly. Learn to pace yourself and to listen to your body, accept offers of help from family and friends. The side effects of treatments can also take their toll on your mind and body. Your energy levels and self-esteem may be affected, so continue to recognise your strengths and remind yourself that your loved ones still recognise these traits in you. Try to maintain a healthy diet and good sleeping patterns in order to maintain your strength and assist your recovery from treatment.

Suggestions for Family and Friends

Avoid trying to keep things from the patient. Often trying to 'protect' the patient makes their fears even worse. Patients appreciate the opportunity and have a right to make important decisions that affect their lives. Continue to involve the patient in activities you shared and enjoyed in the past. Make specific offers of help that may be easy for the patient to accept, such as a lift or help with heavy bags etc.

It is important to allow the patient to take the lead in talking about issues, so try to be a good listener. Don't feel that it is up to you to make everything better, no matter how much you wish you could. Offer encouragement and convey affection, try to take time off from talking about the illness, physical contact and laughter are often excellent ways to help people cope.

Try to involve everyone concerned when dealing with important issues such as family matters. Children also need to have information about what is happening within the family unit or to their parents. Always remember, that even when ill, people are still the same person inside as they were before the problems began.

Family and friends are also affected by a cancer diagnosis; so don't forget to look after yourself too. Be realistic about what you can offer and do, if everyone can do a little, it make life easier all round.

PSA (Prostate Specific Antigen)

Prostate cancer does not usually cause symptoms early in the course of the disease. Most prostate cancers when symptomatic are locally advanced, may have spread beyond the prostate and have become incurable. In an attempt to detect prostate cancer at an earlier point the prostate specific antigen (PSA) was developed. It is measured as a routine blood test and is specific to the prostate. Unfortunately elevations of PSA are not specific to prostate cancer and other conditions such as benign prostatic hyperplasia (BPH), infections and inflammation may be responsible. To distinguish between these sources, samples of tissue are taken from the prostate for examination under the microscope.

Transrectal ultrasound guided (TRUS) biopsy of the prostate

The process of TRUS biopsy takes around 10 minutes to perform. It involves a finger based examination of the prostate followed by insertion of an ultrasound probe into the rectum. Local anaesthetic is injected through the front wall of the rectum using a small needle to reduce sensation. This is often not felt. Prostatic measurements are taken however imaging alone is not accurate enough to distinguish the source of PSA evelation. A guide attached to the probe allows control of the biopsy device. When the biopsy device is activated it makes a clicking noise delivers a short lived “thud” in the rectal area. The biopsies have been likened to being flicked with a rubber band.

12 biopsy cores are taken on a “random” basis from the prostate. In reality these cores are directed using ultrasound imaging in a systematic fashion. These biopsies are designed to provide a representative sample however they do not remove the entire prostate.

Because the biopsies are taken through the rectal wall there is a small risk of either bleeding or infection. Antibiotics are given routinely to reduce the risk, starting the day prior to biopsy and continuing for one day afterwards. The risk of side effects significant enough to require admission to hospital is in the order of 1%. Blood thinners such as warfarin, clexane and clopidogrel should be stopped prior to the procedure however this process should be discussed first as alternative therapy may be required to avoid complications. Aspirin at a moderate dose (300mg/day) is usually OK to continue for the biopsy. Other preparation such as bowel cleansers is unnecessary.

Following the biopsy, strenuous exercise is avoided for the first week. Pathological results generally take at least a week to become available as various staining processes need to be undertaken. A follow-up urology visit is routine to discuss the results of the biopsy and what these will mean in terms of either treatment or the need for future screening.

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Urology - Oncology, Laparoscopy, General Urology Mischel Neill - BHB MBCHB FRACS Royal Australasian College of Surgeons Urological Society of Australia and New Zealand