Robotic kidney surgery is particularly useful for performing the operation of partial nephrectomy.Patients suitable for partial nephrectomy are those who have a kidney cancer of a relatively small size which is located in the upper or lower pole of the kidney. Traditionally partial nephrectomy is performed via a large flank incision that necessitates an in-patient stay of 7 to 10 days. Robotic kidney surgery is also suitable for performing minimally invasive pyeloplasty, this is for repair of an obstructed pelvic ureteric junction which controls the outflow of urine from the kidney. Localized prostate cancer is cancer that is confined within the prostate and has not spread to other sites, which is to be distinguished from prostate cancer that has spread beyond the prostate to other parts of the body. As men grow older, they experience the normal age-related, noncancerous enlargement of the prostate (also known as benign prostatic hyperplasia, or BPH).
Prostate cancer, when it first begins and is in its early stages, may not cause any symptoms. Current patterns of practice include two tests to screen for prostate cancer, the digital rectal exam and PSA. The PSA is a blood test done to measure the level of PSA, prostate specific antigen, which is a protein made by the prostate. If there is a concern that prostate cancer may be present, for example if there is an abnormal digital rectal exam or an elevated PSA, then further evaluation is carried out with transrectal ultrasound (TRUS) and prostate biopsy.
Grade is a term used to describe the microscopic appearance of the prostate cancer, and can help predict the potential aggressiveness of prostate cancer. From a practical point of view, clinical experience shows that most patients with prostate cancer have Gleason scores between 6 and 10. Furthermore, those cancers confined to the prostate can be more successfully treated than those that have spread beyond the prostate. Life expectancy, rather than patient age, is important to keep in mind when choosing a treatment. An assessment of a patient’s health status includes review of their current medical problems, including consideration of the seriousness of any coexisting diseases, and evaluation of the family history of medical problems.
The three most common treatments for localized prostate cancer are expectant management, which includes active surveillance and watchful waiting, radiation therapy and surgery.
Active surveillance or watchful waiting is based on the recognition that some prostate cancers follow a nonaggressive course, and tend not to spread outside the prostate or become life threatening. Radiation therapy, includes two types: interstitial prostate brachytherapy and external beam radiation therapy. Other treatments, such as cryotherapy, have been used for the treatment of localized prostate cancer, but have not been widely used.
Watchful waiting and active surveillance have two main advantages – low cost and no immediate complications.
In watchful waiting, the prostate cancer is left as is, and treatment is initiated if there are signs that the prostate cancer is causing clinical problems. Active surveillance may be a favorable choice in men who have low risk disease, including those who have longer life expectancies. The main disadvantage of watchful waiting and active surveillance is that over time the cancer may become worse and even untreatable. Interstitial prostate brachytherapy is a therapy that places radiation seeds within the prostate. External beam radiotherapy uses carefully directed radiation directed at the prostate in an effort to kill the prostate cancer cells. Both forms of radiation (prostate brachytherapy and external beam radiotherapy) may cause urinary or bowel difficulty, and can predispose to erectile dysfunction.
The main benefit of this operation is that it offers the potential to remove all the cancer.
The main disadvantages of radical prostatectomy are the hazards associated with the procedure.
Urinary incontinence (unwanted loss of urine) after radical prostatectomy occurs in a subset of men, but usually lessens or stops with time. If non-surgical management is not effective to treat Erectile Dysfunction, there is another very effective option: a penile prosthesis.
A penile prosthesis or a penile implant, is a device that can be used to effectively treat Erectile Dysfunction (ED) and if implanted by an experienced surgeon, can last at least 15 years with regular robust use. The technology and engineering over the last 30 years has come a very long way indeed and have gone under numerous engineering advancements. The three-piece device features a fluid-filled inflatable prosthesis that consists of two inflatable cylinders placed in the penis, a pump implanted in the scrotum and a fluid-filled reservoir placed in the lower abdomen. The entire implant is concealed within the body and it is not visible virtually undetectable to the naked eye. After a man has recovered from penile implant surgery, which is 4-6 weeks, when an erection is desired, the pump in the scrotal pump which transfers fluid from the reservoir into the cylinders.
If penile implants are right for you post diagnosis with an experienced urologist, there are a number of important benefits many other treatments such as pills and injection therapy just don’t feature. Firstly, penile implants are the most reliable form of managing erectile dysfunction which means sexual spontaneity is always possible. Intimacy and growth in a relationship, both sexually and emotionally is heavily reliant on a couple’s ability to enjoy intimate sex whenever the desire arises. Reliability is also a key factor and can have a considerable effect on a man’s confidence knowing a penile implant will work every time. Finally, and likely most importantly for most men, performance anxiety and fear of embarrassment is no longer a factor. You will find most private health insurance providers will cover either partially or completely the cost of the implant.
There are many tools available to urologists including cystoscopy, ultrasound scanning to image the prostate and bladder, urodynamic testing to evaluate the cause of urinary problems and urinalysis.
Urology places special emphasis on the urinary tracts of males and females as well as the reproductive system of males. Our physicians put particular emphasis on the urinary tracts of males and females, as well as the reproductive system of males, and their primary focus is to diagnose, treat, and control urological disorders.


Click here to learn about our oncology care center that helps patients with prostate cancer return to active healthy lives. BPH is treated with medications (Flomax and Proscar) as well as with minimally invasive surgical therapy.
Please bring with you results of any prior studies, tests, surgeries or procedures you have had. Male Pelvic Floor Problems also arise from time to time, it’s not just women who benefit from pelvic floor muscle training, as men can also suffer from problems with their waterworks.
Research shows that physiotherapy can help men to strengthen their pelvic floor muscles and improve bladder control, reduce leakage, avoid ‘after dribble’ and, in some cases, also help improve sexual function. These problems are often linked to weak pelvic floor muscles, although it is best to be assessed by a specialist therapist to see if pelvic floor muscle training is appropriate. I am a chartered physiotherapist specialising in pelvic floor muscle exercises for both men and women.
If you would like to discuss any of the above, please contact me for a free telephone consultation either via this website or at Hallamshire Physiotherapy on 0114 267 1223.
Partial nephrectomy enables the amputation of the affected part of the kidney whilst generally preserving between 60 to 80% of normal kidney tissue. Robotic partial nephrectomy generally facilitates discharge after 2 to 3 days and early return to work and other activities. It is about the size of a walnut and is located below the bladder and in front of the rectum. It is the second most common type of cancer found in American men and the second leading cause of cancer death among American men. As the prostate enlarges, it can crowd the urinary pathway and make urination more difficult. Urinary symptoms may be present but they are usually due to the prostatic enlargement described above.
The digital rectal exam is a physical exam performed by a medical practitioner to feel the surface of the prostate (a lubricated, gloved finger is placed in the rectum to feel the prostate). PSA elevation is nonspecific, and an elevated PSA may be a due to prostate enlargement, inflammation (which can include urinary infection), or may be the first sign of prostate cancer. Grade can be used as a measure to assess how likely a prostate cancer is to grow and spread.
Cancers that have spread beyond the prostate to the lymph nodes or bone have less favorable outcomes with treatment. A man’s health may also help predict how likely he is to experience hazards related to treatment.
Some men want their cancer removed, without consideration of age, grade or stage, and are willing to face potential hazards of surgery for the chance of complete resolution of their cancer.
PSA and a digital rectal exam need to be checked on a regular basis, and repeat prostate biopsies should be carried out at regularly scheduled intervals. With interstitial prostate brachytherapy, small radioactive “seeds” are planted in the prostate. Watchful waiting is used in men who have a short life expectancy, due to their other health problems, so they can avoid hazards related to treatment. Factors which predict low risk disease include low Gleason score (6 or less), PSA level less than 10, and low volume disease (less than half the biopsies positive, and no more than 50% of any one biopsy core positive). It is not always possible to predict when a prostate cancer progresses and spreads beyond the prostate. The advantage of brachytherapy is that it is a single outpatient anesthesia-based procedure. Irritative urinary tract symptoms can include urinary frequency, urgency, and pain or burning with urination. Treatment by radical prostatectomy offers the man with cancer that has not spread outside the prostate the possibility of freedom from the disease for the rest of his life. Other problems associated with radical prostatectomy include irritation of the bladder, gastrointestinal symptoms, bladder infection, and blockage of the urine flow from the bladder. These have made implants an effective permanent solution for the sexual satisfaction for a man and his partner.
Essentially two cylinders are inserted side-by-side into the corpora cavernosa in the shaft of the penis.
For instance, randomly in the early hours of a morning when taking a pill take is not immediate would not be ideal.
Often, urology problems and disorders show many different signs and symptoms and many urology diseases and disorders have similar symptoms.
It is important to detect male health problems early and to modify lifestyles to live longer. From bladder problems to kidney disorders, to urinary tract infections, we devote a great deal of time and energy to investigating and treating these urological problems and others. Alex Shteynshlyuger is a fellowship trained board certified urologist with expertise in treating men with enlarged prostate, BPH and related prostate problems. Men experiencing problems initiating the flow of urine, or who have to strain to empty their bladder, or have blood in their urine or pain on emptying their bladder, should always seek professional help.
I am qualified to teach men how to do pelvic floor exercises correctly and to develop an individual training programme tailored to help them regain control. It forms the first part of the urethra, the tube that carries urine from the bladder through the penis. Once men reach the age of 40, they may start to notice changes in urination, which can include slowing of the urinary stream and increased frequency of urination both day and night. The best way to detect prostate cancer at its early stage is with screening, which currently includes an annual digital rectal exam (also called a DRE) and a PSA blood test. The prostate can be assessed to determine if there may be a hard spot, or an area of asymmetry, which may be a sign of prostate cancer. Furthermore, PSA is not always elevated when prostate cancer is present and there may be prostate cancer even with a normal PSA (which is why the DRE needs to be done too).


Needle (core) biopsy of the prostate is taken in a grid-like systematic fashion to obtain samples of the prostate. The grading system most commonly used is called the Gleason score, which ranges on a scale from 2 to 10. Higher Gleason scores (8 through 10) indicate more aggressive tumors which have the potential to have spread beyond the prostate. When the cancer is low volume, and confined to a small area of the prostate, treatment outcomes are improved compared to those situations where the prostate cancer involves a significant portion of the prostate gland. For prostate cancer that is confined to the prostate, it may take several years until it spreads beyond the prostate and several more years after that before those areas of cancer spread can cause clinical problems. Younger men are less likely to experience treatment-related changes in urinary or sexual function.
Others may be worried about the effect of treatment on their quality of life, and choose their treatment to minimize the risk of developing unwanted hazards of treatment, such as urinary leakage or erectile dysfunction. If during the monitoring period the cancer shows signs of growth or of becoming a more aggressive tumor, then treatment with surgery or radiation can be initiated. The seeds deliver radiation energy to the prostate over the course of four to six months which can “kill” the prostate cancer cells. The term “radical” means that the entire prostate and nearby tissues are removed through surgery. Studies show that men with localized, low grade prostate cancer have a reduced risk of the cancer spreading in the first ten years after diagnosis. In men who have chosen active surveillance, and on follow-up are noted to have signs of progression of their prostate cancer, treatment can be initiated at that point, which can include radical prostatectomy or radiation to the prostate.
Hazards associated with treatment include urinary incontinence and erectile dysfunction, which may happen less frequently with radiation when compared with radical prostatectomy. As with other radiotherapy treatments, erectile dysfunction and urinary incontinence may develop. Radiation treatments are given on a daily basis, five days a week, for a seven- to eight-week treatment period. Patients are in the hospital for one to three days postoperatively and are sent home with a catheter (urinary drainage tube in the bladder) which is removed after one to two weeks. If the cancer has already spread beyond the prostate, then removing the prostate may not lead to cancer cure and additional therapy may be needed. The chance of having erectile dysfunction depends on a man’s age and health, his sexual function before treatment, the stage of the cancer, and the ability to save the nerves that control erection during the surgery.
Rarely, scarring may occur at the junction of the bladder and the urethra and may require an outpatient procedure to address.
If you or someone you know has been diagnosed with prostate problem, make an appointment to take advantage of Dr. The risk increases with age, although men of all ages can suffer from incontinence or erectile dysfunction. The ultrasound does not specifically show areas in the prostate that are suspicious for prostate cancer. In general terms, there are five different recognized patterns of prostate cancer (five different ways it can look under the microscope). With the recognition that there may be a long timeframe for prostate cancer to cause trouble, older men who have other serious health problems may be less likely to suffer ill effects from advancing prostate cancer and so may not require treatment. However, the potential exists that the disease may have already spread beyond the prostate, and if so there is the potential for those men to suffer from progressing prostate cancer. Changes in urination may include increased frequency and urgency, and more frequent urination at night.
Current technology allows radiation to be delivered to the prostate while minimizing exposure to adjacent structures, such as the bladder and rectum. Younger men (those under 60 years of age) are less likely to have problems with their erections than are older men.
Stress urinary incontinence, for example, is a common problem experienced by many men following prostate surgery (prostatectomy or TURP*). However, for men who have a long life expectancy, who are likely to live for at least 10 more years, they are more likely to benefit from treatment, particularly if their prostate cancer is in a medium or high risk category of aggressiveness. External beam radiation therapy uses radiation delivered from an external source (an x-ray beam) to treat prostate cancer. Fortunately, current radiation therapy techniques are designed to minimize trauma to adjacent structures.
On a side note, men who have underlying bowel disease, such as Crohn’s disease or ulcerative colitis, may be less suitable candidates for radiation therapy because of the increased potential for bowel difficulty. If erectile dysfunction does occur after surgery, erections may return to normal over time. Once the samples are removed, a pathologist can look at the prostate biopsies under a microscope to determine if cancer is present. One disadvantage of radiation therapy is the prostate remains, so it is possible for some cancer to persist and potentially progress in the future. Erectile dysfunction is less likely to develop in the period immediately after treatment but is more likely to develop over time. Hazards of biopsy include blood in the urine, stool or semen; infection and inability to urinate. In most cases, there is more than one pattern present, so the two most common patterns are identified. The Gleason score is a summary of the two most common patterns (for example, if there are some areas of Gleason grade 3 and other areas of Gleason grade 4, the cancer may be assigned a Gleason score of 7).



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