Conditions treated
Patient centred LUTS/BPH treatments
Minimally invasive prostate cancer treatment
Patient centred LUTS/BPH treatments
Prostate Diagnostics
Minimally invasive prostate cancer treatment
Patient centred LUTS/BPH treatments
Minimally invasive prostate cancer treatment
Minimally invasive prostate cancer treatment
Minimally invasive prostate cancer treatment
Foreskin and frenular problems
Erectile Dysfunction and Male Infertility
Minimally invasive prostate cancer treatment
Erectile Dysfunction and Male Infertility
Erectile Dysfunction and Male Infertility
Erectile Dysfunction and Male Infertility
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Erectile Dysfunction and Male Infertility
Erectile Dysfunction and Male Infertility
1. Patient centred LUTS/BPH treatments
Almost half of all men will seek treatment for urinary problems at some time.
We have for many years offered one stop clinics in both the private sector and at King’s to try to make a speedy diagnosis and wherever possible give choices and control to men deciding how to manage their waterworks issues. Many options exist, from lifestyle changes and herbal therapies., to long lasting surgical treatments. Almost every man can be helped to have a normal quality of life, and almost every man will have a number of options to choose from.
Until only a few years ago, most men with prostate problems would have been offered the choice of medication or one type of operation. While surgery in the form of TURP is a very effective treatment which has stood the test of time, it is an operation which does require a few days in hospital and which does have a risk of significant bleeding and where a significant majority of men will develop a permanent dry orgasm and a small number of men will develop erectile dysfunction (with an even smaller chance of surgical incontinence. )
Over the last 5-10 years the landscape has changed almost beyond recognition in terms of the choices available to men although sadly a study my group published last year showed that most urologists do not even consider sexual side effects of their patients when offering treatment for benign prostatic obstruction. (World Journal of Urology [21 Apr 2018, 36(9):1449-1453)
2. Prostate diagnostics
A problem with prostate cancer is that it is often talked of as a non-lethal condition. This isn’t true –around 12,000 men a year die in the UK. However, most men with early prostate cancer will not dieof it. This means we need to get better at diagnosing the men who need to have their cancerdetected, and either not picking up or not giving harmful treatment for those men with lessaggressive disease.
While for some men the decision to go for radical treatment, or for active monitoring is easy, thereare many men with small cancers for whom we cannot predict exactly what is likely to happen.Interest is growing in the possible place of focal treatment in this area – if a man has a cancerconfined to one part of the prostate it may be possible to kill the cancer without damaging the restof the prostate or the organs around it. We are gaining experience in which men are suitable forthese treatments and they are now acceptable to most prostate cancer experts.
3. Minimally invasive prostate cancer treatment
Mr Muir has been active in researching and publishing in focal prostate cancer for some years,
offering day case treatments which have low rates of side effects compared to radical options such
as surgery or radiotherapy. While time is needed to know the very long term results of focal therapy,
current data suggests that for suitable men results for cancer control can be similar to other
treatments with low side effect profiles. We are also getting more certain that if a focal therapy does not get rid of a cancer there are good surgical and radiotherapy options waiting in the wings.
Mr Muir currently offers focal therapy using Cryotherapy (freezing) and the Nanoknife (irreversible
electroporation), Treatments are done as a day case and no incisions are used. For each individual an
estimate is given as to likely cure rates and any complications. Al patients’ data is entered into long
term research databases.
Not all men are suitable, and working with World experts in both radical prostatectomy and
radiation therapy means we try to give men as unbiased and honest an opinion as possible.
We are very happy to have a brief look at case summaries to give an idea as to whether focal
therapy is a possible for you.
The cancer is frozen to extreme temperatures which kills cancer cells preferentially to normal ones.
4. Foreskins, frenulum problems and small penis anxiety
Foreskin:
Probably around three per cent of men will have a foreskin problem requiring treatment in adulthood. Of course many boys are circumcised for social or religious reasons. In general, if a man wants to keep connected to his foreskin then we can usually help, although for some men the presence of intractable scarring may mean circumcision is the best option. Gordon has described the operation and technique of frenuloplasty, with success rates of 95%, and sees men from all over the World for this procedure.
When the foreskin is tight but not scarred many men (and the great majority of boys) will find that steroid cream and stretching can avoid surgery. When this fails there is a choice between surgery to widen the foreskin or circumcision. This is often a tricky choice and it is one for a man to make having been fully informed.
While a circumcised penis may be less sensitive than an uncircumcised one with a normal foreskin, almost all men with foreskin problems will be better off having sex without pain or the small worry of long term cancer formation. It is the individual’s right to look at all the options here and make his own choice.
It is worth pointing out that those men who do have a circumcision in adulthood, if well counselled and with the operation expertly done, usually say the discomfort is very much less than they had feared.
We are happy to offer general advice to men with queries about their foreskin problems on receipt of a good quality set of images. This cannot of course replace a full examination.
Penile Size Problems:
Mr Muir has been involved in research looking at men who are unhappy with the size of their penis for almost two decades and has published many research papers. While penis size varies from individual to individual, many men worry about the penis being too small.
It is interesting to note that men do not usually come to a specialist asking for their feet to be made bigger, although this is a similar situation! It is possible to increase the size of the penis in men who have a genuinely small penis due to developmental abnormalities or injury, but the surgery is difficult and has risks. I feel that if the penis works and is long enough for penetration no surgery should be considered.
Indeed many men in this position who worry about penile size will benefit from sympathetic counselling and my recommendation is that initially they should see an experienced psychosexual counsellor. We have recently presented research showing that the majority of men asking for penile enhancement have a distorted image of what they believe a "normal penis" to be and of course they are unlikely to be helped by any such intervention.
What is at least as important, is that men with this worry may be very vulnerable to less scrupulous clinics and the results are inevitably poor. My recommendation is that patients should not ever consider penile enhancement surgery without at least one experienced second opinion.
Reputable surgeons will be able to give clear details of their complication rates and successes for these procedures, but a recent review we carried out showed that very few men are happy with such operations and they can almost never be recommended by reputable doctors.
Our nomogram of over 15,000 penis measurements – 12.5cm (just over 5 inches) is average.
https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/bju.13010
This is a sympathetic and easy to understand video from the USA https://www.youtube.com/watch?v=sEYEUhtXkWs&ab_channel=TheDoctors
5. Erectile Dysfunction and Male Infertility
Almost all men will have some problems with erections at some time in their lives, but a persistent inability to get or keep an erecetion is never normal, and we can almost always help.
Erectile dysfunction is the term now used for the consistent inability to get or maintain an erection of sufficient rigidity for satisfactory sexual intercourse. The lay term for this problem, now regarded by some as of suspect political correctness, is impotence. Indeed this term any give a better idea as to how a man with ED feels, as the loss of manhood, power and status make a man feel generally impotent.
Despite ill-advised comments in the media, it is a serious condition and one that affects both partners in a relationship. There are measurable adverse events which occur as a result of ED and measurable benefits associated with its successful treatment.
It is often not realised that many men presenting with ED have potentially serious underlying medical conditions, leading to the prospect of early intervention for such conditions as diabetes, cardiovascular disease and depressive illnesses. The attention of the patient to his erection is also a powerful aid to reinforcing advice on general lifestyle changes!
Erectile dysfunction is common in all age groups, with the incidence increasing as men get older.
Over five per cent of men in their forties will report complete impotence. It is of course important to realise what is meant when men report erection difficulties: almost all men will have transient failures associated with life events, but if the problem is persistent reassurance alone will not do as treatment.
In contrast to the commonly held belief that ED is more common in older men due to decreasing androgen levels, impotent aged men do not seem to have significantly lower serum androgens than potent age matched controls.
Men with impotence have a significantly increased risk of suffering form heart and other arterial disease, diabetes, depression and smoking. It is therefore impossible to propose that these patients, who represent a poorly attending group in primary care, should not at least be seen for examination and screening of underlying disease.
Physical or psychogenic?
Most men with erectile dysfunction will present a mixed picture of physical and psychogenic origin. We do not refuse to treat patients with chronic pain syndromes for which no physical cause is obvious! The important thing for a man and his partner is to work out the problem and get things going again.
Treatment
Most men can be helped by simple medication taken by mouth – lifestyle changes such as improving fitness and stopping smoking are also important.
For men who need more, treatments ranging from drugs applied to the penis, vacuum devices and even surgical treatment mean that no man needs to suffer this problem forever.
Peyronie’s Disease
A little known but common problem, this is scar tissue inside the penis which makes one side of the penis less elastic, causing a bend.
We do not know what causes Peyronie’s disease: in many men an injury to the penis when erect (which may pass unnoticed) causes an exaggerated inflammatory response causing the scar tiissue. It probably affects about 10% of men to some degree.
If the problem causes a minor bend, no treatment may be needed.
For man who are bothered by the bend, a number of options starting with self stretching through to surgery are commonly used if needed. While a conservative approach is usually recommended, nearly all men can expect a straight working penis.
