General Urology

General Urology conditions and services may include:

Haematuria

Haematuria means blood in the urine.  It can be macroscopic, visible to the naked eye, or microscopic, not visible to the naked eye. It is only detectable on testing.  Haematuria should never be accepted as normal and should always be investigated to find the cause of the bleeding.  The bleeding can arise from an abnormality anywhere in the urinary tract from the kidneys to the tip of the urethra.

For further information on Haematuria please click here.

Bladder Cancer

The most common symptom of bladder cancer is blood in the urine.  The tests that are used to diagnose bladder cancer include:  a urine test, a CT scan, a cystoscopy and biopsy.

Most bladder cancer can be managed by local measures where the bladder is retained.  Local measures include removing or destroying the tumours via a cystoscope. In cases where the cancer is aggressive or invades into the wall of the bladder the entire bladder may need to be surgically removed.  This operation is called a Radical Cystectomy.  There are a number of options for managing the urine after this procedure;

The most common method is to construct an ileal conduit using a small segment of the patient’s bowel to carry the urine to the skin on the surface of the abdomen where it runs into a bag. It will be necessary for the patient to wear a bag permanently.

Select patients may be suitable for a neobladder.  A neobladder is a type of bladder replacement made from a segment of the patient’s own bowel which is formed into a pouch and positioned inside the body where the original bladder was located.  The pouch is joined to the patient’s urethra.  With this procedure the patient can pass urine normally.  There is usually a period of urinary leakage until the pouch stretches up and the patient strengthens the sphincter muscle that holds in the urine.  For this operation to be successful the patient must have good kidney and liver function and must not have cancer in the urethra.  Many patients prefer a neobladder to an ileal conduit because they can pass urine normally and do not need to wear a bag.

Dr Lazzaro has considerable experience in performing radical cystectomies, ileal conduits and neobladders.  For more information please contact his office.

Laparoscopic Urology

Laparoscopic surgery is also known as keyhole surgery or minimally invasive surgery.  Laparoscopic surgery is performed using a thin telescope with built in magnification and a number of long thin surgical instruments, each inserted through a small incision no larger than one centimetre.  This allows the surgeon to carry out minimally invasive surgery on a variety of urological conditions.    Many urological surgical procedures that were traditionally performed through large abdominal incisions can now be carried out in this way. Compared to traditional open surgery usually requiring a large incision, patients who have laparoscopic surgery often experience less pain, require a shorter hospital stay, will be able to return to work or physical activities earlier and will have less scarring.

Laparoscopic surgery can be used to treat conditions in the kidney, adrenal gland and prostate. Laparoscopic surgery has now become the most common way that kidneys are removed for the treatment of kidney cancer.

Erectile Dysfunction (ED)

                                                                                  

Erectile Dysfunction (ED) is the persistent inability to achieve and maintain an erection that is firm enough to have sexual intercourse.  ED usually has a physical cause such as poor circulation, hormone problems, or the side effects of medications.  Diseases such as diabetes, hypertension, and heart disease cause the majority of cases.  ED is also a side effect of treatments for prostate cancer. 

The treatment of ED is usually with tablets or penile injection therapy.  The medications work by increasing the blood flow to the erectile tissue in the penis and are very effective in treating ED.  In instances where the medications are not effective the surgical insertion of a penile prosthesis can be considered.  The most popular penile prosthesis is a three part fluid filled device comprising a reservoir placed in the abdomen, a pump placed in the scrotum and two cylinders placed in the erectile spaces in the penis.  The whole device is implanted through a small (five cm) incision in the scrotum. No part of it is visible from outside.

Post Prostatectomy Urinary Incontinence

Incontinence is a well recognised complication of surgical procedures to remove the prostate. Fortunately most cases improve with pelvic floor exercises and the passage of time. When incontinence does not improve surgical options can be considered to treat the incontinence including;

The placement of a urethral sling. A synthetic mesh tape, which elevates and puts pressure on the urethra. It is inserted through a small incision behind the scrotum and specially designed needles are used to position the sling so it forms a hammock under the urethra. A sling works best in cases where there is a mild to moderate degree of incontinence.

When the incontinence is more severe an artificial urinary sphincter  is more likely to control the incontinence.  An artificial urinary sphincter is a surgically implanted devise comprised of three parts;

  • A cuff placed around the urethra. In the resting state the cuff is inflated with fluid and squeezes the urethra to hold the urine in the bladder 
  • A small pump placed in the scrotum that is used to deflate the cuff to allow the passage of urine. The cuff automatically reinflates a few minutes after urination.
  • A small pressurised balloon reservoir placed in the abdomen reinflates the cuff after urination.

This device is implanted through a small incision behind the scrotum. It requires a general anaesthetic and 24 to 48 hours in hospital.

Dr Lazzaro is an accredited implanter of prosthetic devices for the management of erectile dysfunction and urinary incontinence.

Vasectomy

A vasectomy is a safe and effective operation performed on a man to prevent him from fathering more children. It is usually performed on a man when he and his partner consider their family is complete and they do not want to have any more children. It works by obstructing the flow of sperm from where it is produced in the testis from joining the seminal fluid. The vasectomy does not affect a man’s sex drive, sexual performance or his hormone levels.  He will still ejaculate seminal fluid, which will appear normal but will contain no sperm. 

For more information on Vasectomy please click here.