Singh Urology

Secretary: 01332 783423
Derby Private Health: 01332 785200
Nuffield Health, Derby Hospital: 0300 790 6192

Male Genitalia

Erectile Dysfunction

The inability to achieve erections satisfactory for penetrative intercourse

The last decades have seen a significant improvement in the management of erectile dysfunction, as a variety of medical and surgical solutions are now available to improve the quality of erections.

Erectile dysfunction remains a very complex issue. It is now widely appreciated that erectile dysfunction may be an early manifestation of cardiovascular disease or hormonal imbalance. All men should have a detailed consultation and clinical examination at which time a full history will be taken.

Patients can be offered a wide range of treatments depending on the cause of the erectile dysfunction. These range from oral medications (Viagra, Cialis, Levitra) to injections into the corpora of the penis (Caverject). Vacuum devices are a valid alternative to drug therapies in selected patients and may be useful when drugs do not work.

If none of the medical treatments is successful then patients are offered implantation of a penile prosthesis, which guarantees the rigidity necessary for penetrative sexual intercourse. A variety of penile prostheses are currently available on the market. The simplest are the semi-rigid or malleable prostheses but many men prefer the hydraulic devices, as they can be deflated when the erection is not required and guarantee a better rigidity.

Peyronie’s Disease

Peyronie’s disease is a relatively common benign condition of the penis leading to the formation of fibrous scars or plaques within the erectile tissue. In the early stages Peyronie’s disease can be painful and in the long term it may cause erectile dysfunction and deformity of the penis during erection as the plaque is not elastic and therefore does not stretch as the surrounding normal tissue.

Once the disease is stable, surgery is offered if the erections are poor or the curvature makes sexual intercourse uncomfortable or impossible. Surgery traditionally involves either shortening the longer side of the penis to compensate for the already shortened scarred side (this is known as the Nesbit or Yachia procedure) or lengthening the shorter side of the penis using vascular or artificial grafts (Lue technique).

In patients with associated erectile dysfunction that does not respond to medications, the implantation of a penile prosthesis will correct the deformity and guarantee the rigidity necessary for sexual intercourse.

Hydrocele

A hydrocele is a collection of fluid in a sac in the scrotum next to the testis (testicle). A smooth protective lining surrounds the normal testis and this makes a small amount of ‘lubricating’ fluid to allow the testes to move freely. Excess fluid normally drains away into the veins in the scrotum. Occasionally, some fluid accumulates as a hydrocele. Hydroceles are normally painless although large hydroceles may cause discomfort because of their size. Walking or sexual activity may become uncomfortable if you have a very large hydrocele.

If the hydrocele causes no symptoms, one option is simply to leave it alone. If it becomes larger or troublesome, you can have the hydrocele operated on to drain the fluid and prevent a further build up of fluid in the future.

Before the operation

Before your operation you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

You may be asked to attend for a pre-assessment appointment where you will have blood tests, chest X-ray and ECG depending on your general health and any pre-existing medical conditions (older patients). Please bring any medications with you to this appointment and you will be told if any of them need to be stopped prior to surgery. Make sure you alert the staff if you take warfarin, aspirin, clopidogrel or any other blood-thinning medications.

You will be asked to come into Hospital on the morning of the operation. You should be “Nil By Mouth” for a certain time prior to admission. Please check when you can eat and drink before the operation as your procedure may be cancelled on the day if you have had anything to eat or drink at the wrong time.

The anaesthetist will see you in your room to go through any questions before surgery. You will be asked to sign a consent form, which explains the risks and benefits of the hydrocele repair procedure.

How is the procedure carried out?

The procedure is carried under general or local block regional anaesthesia in the operating theatre. A cut is made into the skin of the scrotum over the hydrocele. The liquid is emptied out. The testicle is examined and if all is well, the inner coverings of the testicle are stitched up to stop the liquid building up again. Finally, the skin is stitched up using dissolvable stitches. A local anaesthetic is usually given just before the general anaesthetic wears off so there is less pain for a few hours after the operation.

After the operation

Once your operation is over, you will be woken and taken to the recovery suite to be monitored by the staff there before being moved back to the ward. You will be able to eat and drink on the ward and if you feel pain or feel sick, let the staff know, as they will be able to give you appropriate medication. You will be given regular, as well as stronger painkiller tablets as and when you need them. The dressing is loose gauze padding with a scrotal support to apply some pressure to the wound.

The operation is usually done as a day case. This means that you come into hospital on the day of the operation and go home the same day. You may need to stay in overnight if your operation has been carried out in the afternoon.

Discharge advice

For men who have had a general anaesthetic, you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours. Try to keep the wound area dry for 48hrs and then bathe as normal. Soap and tap water are quite all right. Salted water is not needed.

You should try and wear the scrotal support for about a week to prevent swelling around the operation site. If bleeding continues, contact us for advice using the numbers below. Avoid sexual activity for a week and no heavy lifting for about two weeks. Driving should be safe after one week if all is well. Check with your insurance company if you have any doubts.

You will be given an appointment to attend the outpatient clinic about 4-6 weeks after surgery. Any questions can be answered at this time.

Complications

You will be asked to sign a consent form prior to surgery. The main complications that may occur are as follows:

  • Bleeding and pain around the wound site afterwards – this usually settles within 12hrs.
  • Infection post-procedure – unusual, but require antibiotics if persistent.
  • Recurrence of hydrocele – again unusual, but can occur, sometimes requiring re-operation.

Circumcision

Q | What is a circumcision?

A | Circumcision of males involves removal of the fold of skin (foreskin), which covers the glans penis.

Common indications for this operation include:

  • Phimosis – This is when the foreskin cannot be retracted over the glans penis. At age 3 years about 10% of boys are unable to retract the foreskin, but by teenage, the majority of boys should not have a problem.
  • Paraphimosis – This is when a tight foreskin is retracted and gets stuck in the retracted position leading to swelling and sometimes pain. This tends to occur in older men, however, can affect any age and should be treated as an emergency. You should seek urgent medical review if this occurs.
  • Recurrent balanitis – Balanitis is infection of the foreskin causing inflammation and pain around the end of the penis. Antibiotics are usually given in the first instance and circumcision can then be an option once the inflammation has settled.
  • Recurrent urinary tract infections – this can be an indication in young boys and should be discussed with your specialist.

Q | Before the operation

A | Before your operation you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. If you have parental responsibility for the child, you will be asked to sign the consent form for a medical circumcision.

You may be asked to attend for a pre-assessment appointment where you will have blood tests, chest X-ray and ECG depending on your general health and any pre-existing medical conditions (older patients). Please bring any medications with you to this appointment and you will be told if any of them need to be stopped prior to surgery. Make sure you alert the staff if you take warfarin, aspirin, clopidogrel or any other blood-thinning medications.

You will be asked to come into Springfield Hospital on the morning of the operation. You should be “Nil By Mouth” for a certain time prior to admission. Please check when you can eat and drink before the operation as your procedure may be cancelled on the day if you have had anything to eat or drink at the wrong time.

The anaesthetist will see you in your room to go through any questions before surgery. You will be asked to sign a consent form, which explains the risks and benefits of the circumcision procedure.

Q | The circumcision procedure?

A | The procedure is carried under general or local block regional anaesthesia in the operating theatre. The part of the foreskin to be removed is marked out and the foreskin is gently pulled forward and trimmed away. The edges are closed using dissolvable stitches. A local anaesthetic is usually given just before the general anaesthetic wears off so there is less pain for a few hours after the operation.

Q | After the operation

A | Once your operation is over, you will be woken and taken to the recovery suite to be monitored by the staff there before being moved back to the ward. You will be able to eat and drink on the ward and if you feel pain or feel sick, let the staff know, as they will be able to give you appropriate medication. You will be given regular, as well as stronger painkiller tablets as and when you need them. The dressing is very loose gauze with tape that may fall off soon after your return to the ward.

Q | Discharge advice

A | For men who have had a general anaesthetic, you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours.

Before discharge, your nurse will give you advice about caring for the healing wound, hygiene and bathing. It will be more comfortable to wear loose clothing such as boxer shorts or a dressing gown with no underpants or trousers until the wound has healed. Tight-fitting clothes may rub the wound and make it sore.

It is important to keep the penis clean. The area should be kept dry for 48 hours after the operation. After this, take warm baths or showers once a day. Don’t use bubble bath or scented soaps, as these may irritate your operation site. The penis should be left to dry naturally.

Dissolvable stitches are used so they will not require removal; however the wound may bleed slightly until all the stitches have dissolved.

Children will be able to return to school after 7 to 10 days and resume sports and swimming two or three weeks after the operation provided there is no discomfort or swelling.

Adults should not drive until they can perform an emergency stop without discomfort. This is usually around five days after the operation.

Follow your doctor’s advice about sexual activity. Having an erection will be painful for a few days after the operation. You should not have sexual intercourse until the wound has healed completely. This can take up to about four weeks. If you have sexual intercourse too soon, the wound could re-open and you may need another operation.

You will be given an appointment to attend the outpatient clinic about 4-6 weeks after surgery. Any questions can be answered at this time.

Q | Complications

A | You will be asked to sign a consent form prior to surgery. The main complications that may occur are as follows:

  •  Bleeding and pain around the penis afterwards – this usually settles within 12hrs.
  • Infection post-procedure – rare, but require antibiotics if persistent.
  • Meatal stenosis – this is a narrowing of the end of the urethra tube where the urine comes out at the end of the penis. This is a rare complication when the blood supply has been affected to this area of the penis.