General Urology Consultations
Bladder dysfunction – poor voiding, irritability, incontinence. Prostate screening / disease including prostate cancer. Urinary stone disease. Haematuria investigation, vasectomy, erectile dysfunction, scrotal problems, groin pain and chronic pelvic pain.
General Urology Consultations
The emphasis at Urology Now is on QUALITY Urological care delivered with local after care. We offer insured and self-funding patients an integrated range of fast, easy and affordable services from my clinics conveniently located Caboolture, Redcliffe and the Gold Coast.
- Bladder dysfunction – poor voiding, irritability, incontinence (male and female)
- Prostate screening / disease including prostate cancer
- Urinary stone disease (bladder and Kidney stones)
- Haematuria (Blood in the urine) investigation
- Vasectomy
- Erectile dysfunction
- Scrotal problems / groin pain
- Chronic pelvic pain
For more details contact our office on 07 3522 5719 or email info@urologynow.com.au.
ED is defined as the persistent “inability to achieve or maintain an erection sufficient for satisfactory sexual performance.” While ED is not life threatening, the condition may result in withdrawal from sexual intimacy and reduced quality of life.
Causes
The cause of erectile dysfunction is inadequate rigidity of the blood filled cylinders (corpora cavernosa) of the penis. This may be due to a lack of nerve signals initiating blood flow into the penis, impairment of the arteries filling the penis, ineffective closure of veins required for appropriate storage of blood within the erect penis, psychological factors, and hormonal deficiencies. A combination of physical and psychological factors is often present. Secondary problems related to erectile dysfunction can include loss of sexual desire (loss of libido), premature ejaculation, or inability to reach orgasm.
The physical causes of ED can be further divided into nervous system problems, artery and vein damage, and hormonal causes. Nervous system causes may be due to brain or spinal cord disease (e.g., spinal cord injury, multiple sclerosis) or due to injury to smaller peripheral nerves (e.g. previous pelvic surgery and diabetic nerve damage). Artery or vein damage may be related to the build-up of obstructive cholesterol deposits in arteries, high blood pressure, diabetes, smoking, or trauma. Low testosterone levels can interfere with normal erectile function however this is not considered to be a principal cause of ED in the majority of patients.
Risk Factors
The prevalence and severity of ED increase with age. By the time men reach their seventies, 70% will have ED to some extent (Figure 1). Other risk factors include high blood pressure, diabetes, smoking, high cholesterol, vascular disease.
Treatment
Treatment options for ED have increased over the past decade to include oral treatment, intracavernosal injection therapy, vacuum constriction devices, hormone replacement and surgery. The goal of treatment is to restore satisfactory erections with minimal adverse effects. Men have demonstrated a strong preference for oral treatments even if they have low efficacy.
Oral phosphodiesterase type-5 inhibitors (PDE5 inhibitors) such as Viagra, Cialis and Levitra are first line therapy for ED.
The efficacy of sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are very similar. Because efficacy is very similar amongst the three agents, side effects and time-to-onset will be the main distinguishing factors. Viagra and Levitra feature rapid-onset of action, whereas Cialis has a long window of opportunity for use. Maximum levels in the bloodstream are reached within 45 minutes with Levitra, an hour and 10 minutes with Viagra, and 2 hours with Cialis. Conversely, the half-life of Viagra is 4 hours, for vardenafil 4 to 5 hours, and for Cialis 17 to 21 hours.
Cardiovascular diseases may be a contraindication to treatment with these medicines. Severely impaired patients may run the risk of a cardiac complication related to vigorous sexual activity. Likewise, patients actively taking nitrates, including nitroglycerine and other agents, are contraindicated from receiving prescriptions for PDE5 inhibitors.
Visual disturbances can be seen with sildenafil (blue haze to the visual field; this effect is temporary and is not dangerous).
A very rare but more serious visual complication is shared by all PDE5 inhibitors. This is non-arteritic anterior ischemic optic neuropathy (NAION). A number of cases have been reported and generally risk factors for this very rare form of blindness are severe cardiovascular conditions.
Intra-cavernosal Injection(ICI)
Intra-cavernosal injection is the most effective non-surgical treatment for erectile dysfunction. Alprostadil (prostaglandin E-1) phentolamine and papavarine are the medications used in the injection.
ICI is a very effective way to generate an erection in the early post operative period following radical prostatectomy. Using ICI improves the rate of recovery of normal erectile function following prostate surgery.
Intracavernosal injection has the highest potential for priapism (prolonged painful erection). For this reason the initial trial dose of intra-cavernosal injection therapy is administered under the supervision. An erection lasting more than four to five hours may lead to long term erectile problems and needs to be treated urgently. If an erection lasts for four hours then patients should initially try to repeat the ejaculation, take a cold shower and go for a brisk 15 minute walk. If the erection is still present at five hours then urgent medical treatment at a hospital is required. The erection may need to be surgically drained of blood.
With age the incidence of bladder symptoms increase across both males and females. The problems can be related to obstruction, storage problems or a mixture of both. The management of these symptoms can often be simple, however, it is wise to investigate the bladders function to ensure that there is not an obstruction to the bladder emptying.
This can be performed by voiding into a Uroflow machine which measures the rate at which the urine comes out and the total volume passed. An ultrasound scan of the bladder is then performed to detect any residual urine left behind. More complex tests can be arranged if required.
Blood in the urine is often of benign cause, however, there are serious conditions that can lead to blood being present. Blood may be macroscopic (visible to the eye) or microscopic (invisible to the eye). It can be caused by infection, urinary tract stones, trauma and malignancies of the urinary tract.
All patients with blood in the urine should have an ultrasound of their kidneys and a small telescopic examination of the bladder (flexible cystoscopy) to assist in their diagnosis. If necessary a CT scan is required.
Urology Now can perform and arrange the investigation of blood in the urine and also treat the causes that may be found.
We offer prostate screening to provide a rapid diagnosis for patients with prostate problems, worried it could be cancer. The Consultant Urologist, who will assess you initially and if necessary, may then refer you for further tests. It is important to remember that no two patients are the same and the investigation of each patient will be tailored to suit.
You will then see the consultant for a second time and whenever possible, the results will be available for them to discuss with you and, if necessary, discuss the options and recommend any further course of treatment needed.
Scrotal lumps and bumps are common and most often ignored by men worried that there may be something wrong. Most times there is little to worry about and reassurance is all that is required.
During the consultation the pt will be examined and an ultrasound scan of the testes organised to diagnose and reassure the pt. If there are any abnormalities detected these are often easily treated with surgery.
Chronic pelvic pain is often poorly understood and managed badly by a lot of health care professionals. Pts have often been treated with multiple courses of antibiotics for presumed infection to no effect.
At Urology Now we understand the need for the pt to be assessed fully with careful history and examination. Often rehabilitation of the pelvic floor and lower back is necessary and we will be able to arrange this for our pts.
Other more serious issues can be investigated and the input of a multidisciplinary group is vital. If you are bothered with this then a consultation may the first step taken to improved symptoms.
Urinary tract stones are common and can cause renal/ureteric colic. This is a severe colicky pain which classically goes from the loin area into the groin as a stone works its way from the kidney to the bladder. Many stones will pass on their own, however, if they get stuck or block the kidney damage can occur to the kidney if left untreated.
At Urology Now we are skilled in the diagnosis and management of stones both medically and surgically. Subsequent screening and investigation into the cause of the stones can be organised.