General urology



We offer general urology services for conditions such as urinary stones, hematuria (blood in urine), hematospermia (blood in semen), prostate symptoms, urinary incontinence, erectile dysfunction, vasectomy, and circumcision where medically indicated.

Patients can choose between St Andrews and St Vincent’s hospital for their surgery.

We offer the procedures listed below:

Day case procedures

  • Cystoscopy
  • Vasectomy
  • Circumcision where medically indicated
  • Prostate biopsy
  • Intravesical treatments

Other general procedures

  • Laser surgery for urinary stones
  • Surgery for benign enlargement of prostate
  • Greenlight laser treatment
  • Hydrocele surgery
  • Testicular surgery

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TURP


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PCNL


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Ureteroscopy

Stones


  • What is risk of developing kidney stones?
What is risk of developing kidney stones?

Stone disease is very prevalent. It is estimated that 10% of the population will develop stone disease in their lifetime. A person who develops a kidney stone has a 50% risk of developing another stone in the next 10 years.


  • Are there different type of kidney stones?
Are there different type of kidney stones?

Yes. There are various types of stones – calcium oxalate, uric acid, triple phosphate, calcium phosphate and cystine stones.


  • Can some stones be dissolved with medication?
Can some stones be dissolved with medication?

Uric acid stones that are small can be dissolved with medication if they do not cause obstruction (pain, fever).


  • What if I have recurrent stones?
What if I have recurrent stones?

Recurrent stone formers should get their stone analysed to evaluate the type of stone. They must also get a 24 hour urine analysis to evaluate why they are forming recurrent stones.


  • What diet do I need to follow to prevent recurrent stones?
What diet do I need to follow to prevent recurrent stones?

General advice is to drink plenty of water, reduce salt in the diet and reduce animal protein. It is important to have a normal intake of calcium.

A high intake of animal protein can increase stone formation. Avoid large quantities of meat, eggs and dairy products.

Do not add salt to your food at the table.

Tips to help you increase your fluid intake:

  • Drink water at regular intervals
  • Keep a bottle of water with you
  • Add slices of lemon, lime or orange to make it more palatable
  • Eat more fruit and vegetables – as they contain more water

Specific advice for certain stone types –

  1. Calcium oxalate stones – avoid excessive consumption tea, coffee, nuts (almonds), seeds (peanuts), cocoa, chocolate, certain fruits (figs, plums, berries, tangerines, currants), rhubarb, vegetables (beetroot, celery, spinach, leeks, parsley, okra), soy products and fizzy drinks with high quantities of oxalates such as Coca cola, other aerated beverages.
  1. Uric acid stones – avoid excessive consumption of animal protein such as red meat, fish (crab, mackerel, anchovies, sardines, shrimps), yeast extracts, beer, spinach, mushrooms, asparagus, legumes and cauliflower.

Individuals who are overweight also have high production of uric acid, therefore losing weight is beneficial.

  1. Triple phosphate stones – these are usually due to urinary tract infection with bacteria such as Proteus, E coli, Pseudomonas and needs treatment of infection and stone removal.
  1. Calcium phosphate stones – occur in those with Renal tubular acidosis and requires consultation with a nephrologist.
  1. Cystine stones – these occur in patients who have a genetic disorder called Cystinuria. The patient and their family members need to be tested and counseled.

  • What are the available options to treat urinary stones?
What are the available options to treat urinary stones?

There are three treatment options –

Stones can be treated provided patients do not have a concurrent infection. If there are signs of infection (fever, chills, etc) then drainage of the kidney as a temporary measure is necessary followed, at a later date, by definitive treatment of the stone.

  1. ESWL (Extracorporeal shock wave lithotripsy) – the stone is broken using sound waves and the resultant stone fragments are passed along with the urine. This procedure can be used in small radio-opaque (those seen on X-ray) stones.

ESWL cannot be done in pregnancy, patients on blood thinning medication (eg warfarin, xarelto, dabigatran, clopidogrel, brillanta), very overweight individuals.

  1. Ureteroscopy and lithotripsy – this involves passing a fine telescope via the urinary tract and fragmenting the stone using either a manual stone breaking device or a holmium laser. The fragments are either retrieved using a basket or are small enough to be passed in the urine. This procedure can be utilized for most stones.
  1. PCNL (Percutaneous nephrolithotomy) – this involves puncturing the kidney via a small hole in the back and extracting the stone fragments after breaking the stone. This procedure is usually reserved for large stones or stones in calyceal diverticula (small pockets in the kidney).

Benign Prostatic Enlargement (BPH)


  • I have a poor urine flow. What is the cause?
I have a poor urine flow. What is the cause?

Poor urine flow can be due to obstruction to flow such as a stricture urethra (narrowing in the urine tube) or prostatic enlargement. Occasionally this can be due to weak bladder musculature.


  • What is BPH (Benign enlargement of the prostate)?
What is BPH (Benign enlargement of the prostate)?

This is a normal process of ageing whereby the prostate enlarges in size. It can obstruct the flow of urine by impinging on the urethra.


  • What is the treatment of BPH?
What is the treatment of BPH?

BPH treatment is aimed at improving the lifestyle of the person involved and treatment is only necessary if the symptoms are moderate to severe. Mild symptoms require lifestyle modifications. A consultation with a Urologist is required to discuss this further.

For moderate and severe symptoms –

  1. Medical management – This involves taking oral pills to improve urine flow.
  2. Endoscopic management – Patients with inability to pass urine, failed medical treatment, recurrent infection, recurrent bleeding from prostate or kidney dysfunction due to obstruction to the flow of urine require endoscopic management.

Several options include – urolift procedure, transurethral surgery and Greenlight laser ablation to remove the enlarged portion of the prostate.

  1. Open surgery – this is reserved for large prostate glands blocking the flow of urine.

Surgery for the treatment of BPH, by either TURP or open prostatectomy, only removes a part of the prostate gland; the section around the urethra that is blocking urine flow is removed. Prostate cancer is often treated by a radical prostatectomy where the whole prostate gland is removed.


  • What side effects of treatment?
What side effects of treatment?
  1. Medical treatment

Alpha blockers (Prazosin, Tamsulosin, Alfuzosin, Terazosin) – giddiness, dizziness, nasal congestion, retrograde ejaculation (semen goes back in the bladder rather than out the urethra on ejaculation), fatigue, precipitation of narrow angle glaucoma.

Caution – avoid if undergoing cataract surgery in the near future. Please refer to specific drug pamphlet for drug interactions and further useful information.

5 Alpha Reductase Inhibitors (Finasteride, Dutasteride) – fatigue, tiredness, decrease in libido decrease in ejaculate, erectile dysfunction, breast tenderness.

Caution – needs regular PSA assessment. This drug reduces the PSA levels and prostate cancer can occur at lower levels of PSA. Please refer to specific drug pamphlet for drug interactions and other useful information.

Combination therapy – alpha blocker along with 5 ARI.

  1. Endoscopic or surgical treatment – There is a risk of bleeding, retrograde ejaculation (permanent), narrowing of the urethra, bladder neck, and regrowth of the prostate in the future. Please discuss with our Urologists for more information.

Erectile dysfunction


  • What is Erectile dysfunction (ED)?
What is Erectile dysfunction (ED)?

The inability to sustain an erection to have a satisfactory sexual intercourse is called Erectile dysfunction.

1 in 5 men over the age of 40 years suffer from ED.


  • What are the causes of ED?
What are the causes of ED?

The cause is usually multifactorial in most cases.

  1. Neurogenic – damage to erectogenic nerves – due to Diabetes, surgery or trauma.
  2. Vasculogenic – damage to blood supply to the penis – due to diabetes, atherosclerosis, trauma or surgery.
  3. Hormonal – from low levels of testosterone – obesity, testicular failure or pituitary causes.
  4. Psychogenic – impotence can occur due to mental disorders such as depression.
  5. Pharmacological – due to side effects of medications.

  • What can I do about it ?
What can I do about it ?

Lifestyle modifications such as regular exercise, healthy diet, maintaining appropriate weight, avoiding excessive alcohol, smoking cessation and other factors causing atherosclerosis that can delay the occurrence of age related impotence.


  • What treatment options are available?
What treatment options are available?
  1. Lifestyle modification – as discussed above
  1. Oral medications – 5 phosphodiesterase inhibitors (5PDEIs)

On demand dosing –

Sildenafil – 25, 50, 100mg – recommended starting dose 5omg

Verdenafil – 5, 10, 20 mg – recommended starting dose 10 mg

Tadalafil – 10, 20mg – recommended starting dose 20mg

Daily dosing –

Tadalafil 5 mg daily

Common side-effects: headaches, flushing, dyspepsia, nasal congestion, backache and myalgia

Contraindicated in patients who take long and short-acting nitrates, nitrate-containing medications, or recreational nitrates (amyl nitrate)

Caution in patients with: ischaemic heart disease, heart failure, hypertensive with multidrug regimen and those taking other drugs which can prolong the action of PDE5I. Please refer to specific drug pamphlet for drug interactions and other useful information.

  1. Intrapenile injections – Alprostadil (Caverject)- 10 and 20mcg

Recommended maximum usage is 3 times a week, with at least 24hrs between uses.

Contraindicated in men with hypersensitivity to the drug or risk of priapism. Please refer to specific drug pamphlet for drug interactions and other useful information.

  1. Penile prosthesis – this is a permanent solution to achieve an erection in patients who have failed medical treatment.

Premature Ejaculation


  • What is premature ejaculation (PME)?
What is premature ejaculation (PME)?

Premature ejaculation happens when a man is unable to control the timing of ejaculation, and ejaculates before he and/or his partner feels ready for this to happen, and this causes distress.


  • What are the causes for PME?
What are the causes for PME?
  • Primary – this is a life long occurrence

This occurs due to imbalance in the chemicals resulting in lower threshold of  ejaculation.

  • Secondary – acquired at some stage in life

This occurs due to performance anxiety, new relationship, religious beliefs, etc.


  • What treatments are available for PME?
What treatments are available for PME?
  • Sex therapy and counselling
  • Behavioural techniques –
    • Stop and start technique
    • Squeeze technique
  • Reducing penile sensation – applying topical anaesthetic and using two condoms
  • Oral medications – Selective serotonin reuptake inhibitors (SSRI’s) – dapoxetine, fluoxetine, paroxetine, sertraline.

Side effects – nausea, headache, diarrhoea, somnolence and dizziness. Refer to specific drug pamphlet for drug interactions and other useful information.


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