Vasectomy is one of the safest, simplest and most effective methods of contraception. The intention of a vasectomy is to render a man sterile and no longer capable of fathering further children.
A vasectomy is usually carried out under local anaesthetic as a day case (patients can go home on the same day). The procedure entails the removal of a portion of the tube (vas deferens) that carry sperm from each of the testicles to the penis. This means that sperm are no longer able to travel from the testicles to the penis, and the man is no longer able to conceive children.
Follow-up specimens for semen analysis will be required. The patient will still need to use alternative methods of contraception until they provide a semen sample 12 to 16 weeks later. The vasectomy only becomes effective when the ‘sperm reservoirs’ become depleted, after which we will give you the ‘all clear’.
Benign Scrotal lumps
Epididymal cysts are collections of fluid in the epididymis (a structure at the back of men’s testicles). These cysts can be surgically removed if they are causing pain. Cysts are quite common and not harmful. They do not need treatment if they are small or cause no significant symptoms.
Your consultant will examine you and will palpate (feel) the mass. You may be offered a scan to determine the exact nature of your cyst. The results of the examination and images will guide your consultant to offer suitable treatment.
The following are some of the options that you may be offered:
- Observation – no intervention if your cyst is small or does not bother you.
- Aspiration (drainage) with a needle – this removes the fluid, but it will re-accumulate very quickly and is not an effective curative treatment.
- Surgical removal – Large or painful cysts can be removed surgically. Your operation will be done as a day case. This means that you come into hospital on the day of the operation and go home the same day.
After surgery to remove the cyst, your testicle may feel slightly “bulkier” than it was before. Surgery to remove an epididymal cyst may affect your fertility.
The patient will be given scrotal support following the surgery. They can expect to go home on the same day, but sometimes, it is necessary to stay for one night. They may feel some discomfort following the surgery, but this can be managed with simple painkillers.
A hydrocele is a collection of fluid in the scrotum that causes a swelling which is soft but often painless. It is a common condition in new-borns but can occur in people of all ages. The swelling may be uncomfortable because it makes the scrotum bigger and can be unsightly but is often painless and is generally not considered to be dangerous. If the hydrocele becomes too large or causes a level of discomfort, then surgery may be recommended to remove the hydrocele. Usually, the cause of a hydrocele is unknown. Sometimes hydroceles can result from an injury or infection or, very rarely, because of testicular cancer.
The consultant will examine the scrotum and may offer you an ultrasound to confirm the diagnosis.
In some cases, the hydrocele will go away on its own within six to 12 months. Sometimes, the fluid can be removed with a needle and syringe, but this does not offer a permanent cure.
A persistent hydrocele can be removed with surgery (hydrocelectomy) to ensure it does not come back. Hydrocele surgery is usually done using a general anaesthetic as a day case (with no overnight stay). This procedure usually lasts about 20 to 30 minutes. The patient will be given scrotal support following the surgery. They can expect to go home on the same day. They may feel some discomfort following the surgery, but this can be managed with simple painkillers.
Phimosis (tight foreskin) is a condition where the foreskin does not pull back (retract) over the glans. This is common in young boys. Phimosis can occur at any age but particularly in young men after puberty. Phimosis is not a problem unless it causes difficulties such as urinary obstruction, haematuria or local pain. However, it can cause major discomfort. It can also cause severe pain and splitting of the foreskin on erection. You are more likely to develop balanitis (swelling and inflammation of the foreskin or head of the penis) if you have phimosis.
Paraphimosis occurs when a tight prepuce is retracted and then is unable to be replaced as the glans swells. A tight constricting band or scar in the skin of the foreskin may prevent the foreskin being retracted back over the head of the penis. This is a urological emergency. Always check there is no encircling foreign body constricting venous return, such as a ring, rubber band or hair.
What are the treatments?
Male circumcision is the removal of the foreskin (the retractable fold of skin that covers and protects the penis). Circumcision can be carried out due to religious, cultural or medical reasons. Circumcision can be carried out as a day case (go home on the same day), under either a local or general anaesthetic. The penis can be swollen for 4 to 5 days afterwards, and it can take 2 to 3 weeks for the skin to fully heal. The stitches will dissolve within 2-3 weeks, and sexual intercourse should be avoided during this period.
Patients who have lower urinary tract symptoms have symptom associated with poor emptying of the bladder (poor/weak flow, incomplete emptying), urgency (the need to rush to pass urine), frequency (going to pass urine often), nocturia (needing to get up at night to pass urine) and occasionally urinary urge incontinence (urine leakage).
Poor emptying of the bladder may be due to an enlarged prostate (in men) while an overactive bladder (OAB) is a common condition affecting women and men, caused by the bladder muscle contracting too readily, often at inconvenient times. All these symptoms can have a significant impact on a patient’s (and partner’s) quality of life.
The consultant will examine take a history and examine you. You may be sent for blood tests and further investigations including a flow rate and post void residual scan before treatment is started.
Treatment is usually in a step wise fashion, starting with the most straightforward, least invasive treatment first, and only moving on to more complex treatments after initial treatments have not worked. Treatments include Lifestyle changes and behavioural regimens have been shown to improve symptoms. The most straightforward is decreasing caffeine or alcohol intake. Others include losing weight and stopping smoking. Behavioural regimens range from simple manoeuvres such as timed or prompted urination and fluid management to biofeedback. Pelvic muscle exercises (Kegel exercises) may also help.
Depending on your symptoms, tablets can be given to help empty your bladder or reduce bladder overactivity. Other treatments include injection of Botox (botulinum toxin) into the bladder muscle or surgery to your prostate (dependent on symptoms).
Patients who have lower urinary tract symptoms associated with poor emptying of the bladder (poor flow, incomplete emptying) due to an enlarged prostate may benefit from having a TURP. Benign enlargement of the prostate is common as men get older. A TURP is recommended in those with:
- Urinary symptoms that have not improved with medication.
- Kidney failure due to incomplete emptying of the bladder
- Recurrent urinary tract infections due to incomplete emptying of the bladder
- The Presence of bladder stones
This is a procedure is performed with either a general or spinal anaesthetic. It involves removing fragments of the central part of the prostate gland in order to improve the flow of urine and the process of emptying the bladder. On average the procedure takes about 1 hour.
After the procedure most people stay in the hospital for 1 to 2 days. A catheter is placed in the bladder at the time of surgery and is removed after 1 to 2 days. The patient may go home once they have passed urine. For the next 1 to 2 weeks, there may be burning and stinging when passing urine. Patients will be able to return to work after 2 to 3 weeks.
common side effects include (more than 1 in 10 chance):
- Mild burning or bleeding. This is normal.
- Blood clots in your bladder and urethra. This is normal and you will need a temporary catheter to flush out your bladder.
- Dry ejaculation at orgasm. This occurs in 75% of men undergoing a TURP (called retrograde ejaculation). The semen is still produced but may go into your bladder rather than out of your penis. When you first urinate after a dry orgasm your urine is likely to be cloudy as it contains semen.
- Poor quality erections (10%)
- Infection of the bladder or kidneys.
- The need for further resection or procedures to manage narrowing of the waterpipe (urethra) in the future.
Less common but more serious complications include:
- Finding unsuspected cancer in the removed tissue which may lead to further treatment.
- The possibility of needing to self-catheterise.
- Incontinence which may be temporary or permanent (4%).