Questions & Answers

Robotic Surgery Explained

Staffordshire Urology Clinic surgeon Lyndon Gommersall explains the new Da Vinci Si Robotic surgical system.

If you are worried about prostate cancer or wish to discuss private assessment or treatment of prostate cancer please contact the North Staffordshire Nuffield Hospital on 01782 382507 and ask for an appointment with Mr Christopher Luscombe of Mr Lyndon Gommersall.

What is StoneScreen?

StoneScreen is a unique and comprehensive programme which investigates the causes of kidney stones. Using data for over 3000 patients and 40 years experience, a renowned UK group led by Dr Bill Robertson has developed a system for using lifestyle and dietary information, combined with he results of urinary, blood and stone tests to calculate a personalised risk profile. StoneScreen uses this system to provide individualised advice to kidney stone formers. It is the most comprehensive scheme available in the UK for assessing all the potential risk factors that lead to stone formation.


What is “No Scalpel vasectomy” and does it have advantages?

“No Scalpel Vasectomy” was developed in China by Dr. Li Shunqiang 40 years ago. Since introduction over 15 million no-scalpel vasectomies have been performed throughout the world. As the name suggests, the “No Scalpel” method does not involve a scalpel, but a small opening is still necessary. The key to this technique is the special small pointed forceps used to create a tiny hole in the skin, instead of a scalpel incision. As with a conventional procedure, the vas deferens is then located and delivered through the hole, before a segment is removed. Generally the hole in the skin is closed with a suture or glue, but may be small enough to be left to heal spontaneously.

Surgeons who perform the No Scalpel method of vasectomy believe that their procedure produces less complications and discomfort with less bruising, smaller vasectomy scars, and faster recovery time. Other Surgeons who continue to use the standard technique may not believe that there is a significant advantage.

Our Consultants perform both Scalpel and No Scalpel Vasectomies, depending on which procedure is most suitable. Please contact us to make an appointment to discuss this further with one of our experienced Consultants. For further information about Vasectomy click here.

What problems does a low testosterone in adult males cause and how can it be treated?

Low testosterone is relatively common in men especially as they become older. The condition is also known as Hypogonadism, the Male Menopause or Andropause. Low testosterone can cause a number of problems. The most obvious is of a sexual nature with low sex drive and erectile dysfunction. It also causes more non-specific problems such as fatigue, poor sleep patterns, memory loss, depression and anxiety. The ADAM questionnaire can be useful to document to document these symptoms. Testosterone has a beneficial effect on the way the body handles some fats and sugar with low testosterone recognised as one cause of early diabetes and high cholesterol.

The condition can be detected by measuring the blood level of testosterone. This is best measured in the morning as testosterone levels vary and are at their highest in the morning. If levels are low or borderline low, especially if there are symptoms such as erectile dysfunction or low sex drive, then testosterone replacement therapy can be beneficial.

Testosterone replacement therapy can be prescribed as a gel, which is rubbed onto the skin once daily, a patch, which is stuck to the skin, or a surgically implanted pellet that slowly releases testosterone over several months. Blood levels of testosterone should be monitored to ensure that the correct dose is being used. The commonest side effect of the gel and patch is skin irritation at the site of administration. High levels of testosterone can cause aggressiveness, and may make prostate cancer worse.

Can suspected kidney cancer be treated with partial removal of the kidney?

The standard treatment for patients with suspected kidney cancer is to remove the complete kidney. This is known as radical nephrectomy and is almost always done keyhole at the Staffordshire Urology Clinic. However, there is a risk of future kidney failure if one kidney is removed in this way, especially if there is already evidence that the kidney to be preserved is not working perfectly. For this reason it may be suggested that some tumours could be better by only removing the part of the kidney containing the tumour. This has the advantage of preserving as much functioning kidney tissue as possible, but is a much more demanding surgical procedure, with higher risks of complications (in particular there are increased risks of bleeding, urine leak and damage to the kidney; all which may lead to the kidney needing to be removed either at the time of surgery or at a later date). There is also the risk of cancer returning in the remaining, preserved part of the kidney, which may need further treatment.

Despite this being a very demanding procedure even through a large cut and open operation, our surgeons often successfully perform this partial kidney removal laparoscopically (keyhole), which is even more complex. Performing this procedure keyhole has been shown to be equally as effective at cancer cure compared to an open operation, but allows a much quicker recovery. It can be performed purely using keyhole instruments (top video)…..

…….or with the assistance of inserting 1 hand through a small hole (called Hand Assisted Laparoscopic nephrectomy, also known as HAL Nephrectomy) , which doubles as the hole required to remove the tumour (lower video). In our opinion this latter technique has many advantages, although it does require a slightly larger hole and therefore leaves a slightly larger surgical scar.

Partial removal of the kidney can also be used for treatment of a non-functioning or painful part of the kidney in selected cases.

If you would like to discuss keyhole prostate removal then please contact 01782 382507 and book a consultation with Mr Anurag Golash or Mr Christopher Luscombe.

What is an undescended testicle and how is it treated?

Testes are referred to as undescended (or cryptorchid) if they are absent from the scrotum. This is usually picked up in children at routine health checks. It is very common in premature babies (up to 30%) and found in about 3% of full term male infants. Only about 1% of boys at the age of 1 year still have this problem and it is unlikely to improve after 1 year. Rarely descended testes can disappear from the scrotum.

Testes normally develop inside the body and descend into the scrotum, where the reduced temperature allows them to work better. Testes that fail to decend have a slightly increased risk of testicular cancer and if they are left undescended (especially past puberty) are unlikely to make sperm (for fertility). If a testis is undescended several things might have happenend to it:

-it may be trapped inside the abdomen (see picture taken at laparoscopy showing a testis inside the abdomen very close to the groin). If this is detected in a child it may be possible to bring it down into the scrotum, but if this is detected in an adult it is probably better to surgically remove it (click to view surgical video).

-it may be trapped in the groin or thigh. If this is the case, it is usually possible to surgically relocate it to the scrotum (orchiopexy) in a child, although in an adult it may be better to remove it; possibly replacing it with an artificial testicle. An orchidopexy operation involves an operation under general anaesthetic, with a cut in the groin and often a second cut in the scrotum. There are small risks of bruising, bleeding, infection, damage to the testis or very rare risks associated with any operation under general anaesthetic such as heart, lung or thrombosis problems.

-it may have not formed properly and be very small. This type of tissue should be removed as it still has a cancer risk.

-it may have become damaged and disappeared. This condition is not really an undescended testis but might need an operation to diagnose.

It is important to diganose why a testis is missing from the scrotum so that it can be either brought down into the scrotum as soon as possible (probably best at or before 1 year old for future fertility) or removed to avoid the risk of cancer. The later the time a testis is relocated into the scrotum the lower the chance of fertility from that testis. All undescended testes (even if surgically brought down into the scrotum) have a cancer risk unless they are surgically removed; especially those within the abdomen and those that have failed to develop properly (but not those that have been damaged and disappeared).

It might be possible to feel an undescended testis or locate it by ultrasound scan or MRI. An operation to look inside the abdomen with a camera (laparoscopy) can show whether the testis is inside the abdomen (see above) or has descended into the groin (see adjacent picture, showing the vessels that lead to the testis going to the groin with no visible testis inside the abdomen). If the vessels lead to the groin then even if the scans show no testis in the groin it is usually worth an operation to check that there are no remnant of the testis that should be removed, to avoid the risk of cancer.

What is a urethral stricture and how is it treated?

A urethral stricture is a narrowing of the pipe that leads out of the bladder to the genitals (along the penis in a man). the narrowing is usually caused by injury or inflammation (often caused by infection). It can occurr in both men and women. It causes a poor urinary flow and problems emptying the bladder. In severe cases it can cause a complete blockage and inability to pass urine at all (urinary retention).

It can be diagnosed by a number of tests. A flow test, in which urine is passed into a machine that measures the speed of urination, can be useful to first show how slow the stream of urine is. It may then be necessary to either look into the urethra and bladder (cystoscopy) or in men dye can be introduced into the urethra and followed along the penis using x-rays (urethrogram) to look for blockages.

A stricture can be treated by stretching (urethral dilatation) or internal cutting (optical urethrotomy, which is usually not used in women) the narrowed area. This type of operation usually needs a general anaesthetic. There are risks the the operation might cause bleeding, infection or discomfort, and in the long term the stricture can recurr so follow-up is usually required. In recurrent cases patients might be advised to learn to perodically pass a small catheter tube into the urethra to keep the stricture stretched open.  An alternative approach would be to consider a much longer operation to remove  and resurface the stricture (urethroplasty, which is not usually used in women). This type of operation has a much lower risk of stricture recurrence, but is a more major procedure.

What is a cystoscopy?

cystoscopy is a telescopic examination of the bladder. It can be carried out under general anaesthetic (asleep), or under local anaesthetic (awake). If the test is being done to make a diagnosis it is usually done under local anaesthetic (LA), whereas if it is being done as treatment it is usually done under general anaesthetic (GA). If done under LA, there is no need to starve before the operation. A flexible instrument is passed through the urethra into the bladder, and after filling the bladder with salty water the bladder is inspected. The procedure usually takes a few minutes and the results discussed immediately.

…a telescopic examination of the bladder…

After the test is complete the patient is discharged and is free to go back to normal lifestyle, although it is adviseable to increase fluid intake for several days afterwards. The procedure may cause discomfort, bleeding in the urine, or urinary infection. If the procedure is done under GA it usually involves admission to hospital for a day, but not overnight. It is not adviseable for the patient to be alone or drive/operate machinery for 24 hours after a general anaesthetic. The same risks of discomfort, bleeding or infection apply as with a LA procedure, but as with all procedures carried out under general anaesthetic, there are risks of heart, lung or thrombosis problems.