Prostate cancer surgery

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Local template perineal biopsies have changed completely the approach towards diagnosis prostate cancer. It carries less risk of infection, better access to all the areas of the prostate and is extremely well tolerated.

Robotic Radical Prostatectomy is prostate cancer robotic surgery for prostate cancer that is localised or locally advanced prostate cancer utilising robotic technology. This is associated with faster recovery, and less complications. Robotic prostatectomy can be done with the intention to spare the erectile nerves or not depending on the stage and aggressiveness of the cancer. If there is a very aggressive cancer with high risk of spread lymph node dissection is performed.

There are various ways how bladder outflow obstruction can be addressed. This includes medications like alpha blockers (Tamsulosin / Alfuzocin / Silodosin) or 5 alpha reductase inhibitors (Finasteride / Dutasteride). When these fail one has to explore surgical options. Nowadays there are various options like Bladder Neck Incision (BNI), Transurethral resection of the prostate (TURP), UroLift, Aquablation, Holium Laser Enucleation of the Prostate (HoLeP), Green Light laser (KTP), REZUM,  Prostate Arterial Embolisation. Not everyone is eligible to all treatments. A workup has to be done a priori.

Bleeding with urine (haematuria) is the commonest referral to the urology department that leads to investigations that include an ultrasound / CT scan for the kidneys however the bladder is best seen with a camera test (flexible cystoscopy / rigid cystoscopy). If there is anything abnormal in the inner lining of the bladder, it may be biopsied or resected. 

To decrease risk of reoccurrence of non muscle invasive bladder cancers you may be given chemotherapy or immunotherapy (BCG) in the bladder. There are different protocols and depends on your health and type of bladder cancer.

For those people that they are experiencing urinary frequency and urgency not responding to medications, they can be offered Botulinum Type A (BOTOX) that is given into the bladder to calm it down. 

Circumcision is the surgical removal of the foreskin and by far is the oldest and most common procedure performed either for medical or socio-religious reasons. It leads to better hygiene , less occurrence of balanitis (inflammatory changes to the head of the penis) and may help in decreasing the risk of HIV transmission.

Penile cancer is very rare, and if there are changes over the head of the penis or penile skin not resolving with ointments in less than two weeks then a biopsy is always merited to exclude penile cancer.  

Vasectomy is a common procedure that men ask for in order not to conceive further. The absolute majority are done under local anaesthetic. An indepth conversation re complications and when it safe to engage in unprotected intercourse is a must. There are many men who due to life changes will ask for this to be reversed. The success rate of the reversal depends how long has the vasectomy is performed. If more than 8 years have passed unlikely it will be successful.

Varicocoele are dilated veins of the testicular cord. Men report the feeling of 'bag of worms' or heaviness  or dull ache. They can lead to abnormal sperm parameters. If that is so, treatment of the varicocoele is indicated even though its not a guarantee to resolution or improvement to sperm parameters.  There are various ways how they can be addressed interventional radiology or laparoscopic or open approach. Discuss with your urologist.

Torsion of the testicle presents with acute severe pain, and this is a medical emergency as there is a tangible risk that the testicle may die as its blood supply is compromised. Typically if one presents within 4 hours of the symptoms most testicle can be saved, if one presents at 24 hours from the onset chances of saving the testicle is less than 5%.

 If you had one stone, you have a 50% risk of developing another in the next five years. Once a stone former always a stone former. 80% of stones are made of calcium.  The earlier you have them in your life and if you have multiple stones than your risk of forming stones in the future is very high. Warm climate, lack of drinking, high salt intake, high protein intake, family history of kidney stones, certain medical conditions and other factors are all risk factors for kidney stone formation. Treatment is tailored according to your level of fitness, number of stones, and their location.