Procedures

The UroLift ® System treatment is a revolutionary, minimally invasive procedure. It works by lifting or holding the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal or prostate tissue. Clinical data has shown that the UroLift System treatment is safe and effective in relieving lower urinary tract symptoms due to BPH without compromising sexual function. The goal of the UroLift System procedure is to relieve symptoms so you can get back to your life and resume your daily activities. The UroLift System procedure is NICE recommended.

The UroLift System procedure is a short procedure that is performed by a Urologist. The Urologist places tiny implants to hold the prostate lobes apart, like open curtains on a window, to relieve compression on the urethra. This allows urine to flow normally again. The UroLift System procedure is generally a day case procedure which is carried out under local anaesthesia +/- sedation. Typically, patients return home the same day without a catheter.

UroLift is an alternative for patient’s looking for something other than drug therapy or more invasive surgery. The procedure might be right for you if any of the following apply to you:

• You do not want to take another pill every day
• You have tried BPH medication but are unhappy with the side effects
• You do not want to undergo major surgery due to potential surgical risks of side effects and complications
• You want a BPH solution that preserves your sexual function
• You want to regain your quality of life with minimal downtime

Most common side events reported include haematuria, dysuria, micturition urgency, pelvic pain and urge incontinence. Most symptoms were mild to moderate in severity and resolved within two to four weeks after the procedure. This procedure is not suitable for everyone and nearly all patient will need a telescope test to look at the prostate to check if they are suitable.

For more information, visit our Benign Prostatic Hyperplasia page.

PAE uses an endovascular technique to shrink the prostate. The purpose of the treatment is to relieve the urinary symptoms associated with BPH. AUA offers careful assessment including CT angiography and in suitable patients, this treatment is performed by a highly skilled radiologist.

The potential benefits of prostate artery embolisation compared with surgery include fewer complications, avoiding a general anaesthetic and it may be done as a day case procedure.

For more information, visit our Benign Prostatic Hyperplasia page.

Circumcision is an operation and is often carried out as a day case, so there should be no need for the child to stay in overnight. It is quite a straightforward procedure, with the foreskin removed from just behind the head of the penis using a scalpel or surgical scissors. Dissolvable stitched should be used, meaning a follow-up to remove stitches shouldn’t be required.

Immediately after the operation, the penis will be sore for a few days and it can take up to six weeks for it to fully heal.

For more information, visit our Circumcision page.

A biopsy is a sample of tissue taken from the body to be analysed in the laboratory under a microscope. Biopsies of the prostate gland (located near the rectum in males) are usually performed to identify prostate cancer, which is the only definite diagnosis. The technique of obtaining a prostate biopsy is to insert a biopsy needle transrectally (through the rectal wall) or transperineally (through the space between the anus and penis) to reach the prostate. These needles are usually guided by ultrasound imaging, but for better clarity of soft tissues, MRI imaging or a new technique that combines both ultrasound and MRI is now used for accurately identifying cancerous areas in the prostate.

The MRI fusion prostate biopsy is performed under sedation by first obtaining an MRI of the prostate. The ultrasound procedure is then commenced and a fusion computer software overlaps the MRI and ultrasound images to create a clear 3D picture that precisely guides the biopsy needle to the suspicious areas of the prostate. The procedure may take about 30 to 90 minutes to obtain an adequate number of tissue samples. A patient is provided with pain medication to keep them comfortable.

For more information, visit our Urological Diagnostics page.

A TRUS prostate biopsy may be used to evaluate the prostate for abnormalities such as enlargement, cancer or male infertility. In order to try and provide a diagnosis, the is biopsy is performed where a small sample of the suspicious tissue is removed from the prostate for further examination. Transrectal ultrasound (TRUS) is a type of prostate biopsy that involves inserting an ultrasound probe through the rectum to guide a biopsy needle to collect a tissue sample for examination.

For more information, visit our Urological Diagnostics page.

A transperineal biopsy of the prostate is carried out to check whether there is any cancer in the prostate. It is carried out using ultrasound and is a reliable way to check the prostate.

While prostate biopsies can be performed through the rectum, this sometimes results in the inadequate sampling of certain parts of the prostate. A transperineal prostate biopsy goes through the skin between the scrotum and anus and can overcome these drawbacks.

A prostate biopsy is ordered in the following situations:

• A doctor finds the prostate abnormal on palpating through the rectum
• The patient has a high prostate-specific enzyme in the blood, indicative of prostate cancer
• To monitor existing prostate cancer that does not require treatment yet
• To identify other prostate conditions such as benign prostatic hyperplasia (enlargement) and prostatitis (bacterial infection of the prostate)

If the doctor believes a biopsy is required, an MRI scan may be done to confirm that it is indeed needed, and to help identify where samples should be taken from.

A transperineal prostate biopsy can be performed under local or general anaesthesia. It is more common to be carried out under a local anaesthetic but if this is not recommended, then an anaesthetist will discuss the alternatives.

Prior to the procedure beginning, an antibiotic tablet or injection will be given and then the patient is positioned to allow access for the biopsy. The skin over the perineum is sterilised and biopsy needles are inserted through this region to enter different parts of the prostate gland, including those inaccessible through the trans-rectal approach. The ultrasound imaging probe is lubricated and inserted through the anus into the rectum. It creates images that guide the doctor throughout the procedure. Multiple biopsies may be taken and this will depend on the PSA level, what the MRI identified and other risk factors. These are sent to the laboratory for further examination.

The procedure will take around 30-45 minutes and if it was done under a local anaesthetic, then the patient should be able to go home after a couple of hours. If it was done under general anaesthetic, then it may require an overnight stay.

As with any procedure, a transperineal prostate biopsy may have some side effects such as bleeding in urine and semen, and reduced urinary flow. These are relatively common, particularly blood in the urine. Infection may also occur but this is rare. Drinking plenty of fluids can help stop the bleeding.

For more information, visit our Urological Diagnostics or patient resources pages.

In order to reach stones, a narrow rigid or flexible scope (tube with a camera) is used to negotiate the narrow passageways of the urinary tract. This requires no cuts at all in the skin, but instead, a laser device is used to break the stone up into small pieces. These then pass naturally or can be removed piece by piece. For some patients a plastic tube called a ureteric stent will need to stay inside the body for a period of time to help with the post-surgery healing process and to allow stone fragments to pass. There can be some mild pain and discomfort following the procedure, and patients may feel an urgent need to urinate. However, infection is rare and antibiotics are effective in cases where this occurs.

For more information, visit our Urinary, Bladder and Kidney Stones page.

SpaceOAR is an absorbable hydrogel used to reduce rectal side effects following radiotherapy in prostate cancer patients. The hdyrogel or prerectal spacer not only reduces the rectal toxicity but also helps to reduce urinary toxicity and sexual dysfunction after radiotherapy.

The spacer is inserted under a short general anaesthetic through the perineum in between the rectum and the prostate. The recovery period is 24-48 hours. The procedure has got minimal after-effects. Occasionally the patient can experience rectal fullness, urinary burning, perineal bruising and very rarely retention.

For more information, visit our Prostate cancer page.

A prostatectomy is where the prostate gland and vesicles (sperm sacs) are completely removed. In some cases, the draining lymph glands and sperm-carrying tubes also need to be removed.

The removal of the prostate may be required to completely remove any prostate cancer, reduce the need for any other treatment such as radiotherapy, reduce the PSA blood level and preserve sexual function and continence. Our team includes the lead pelvic cancer surgeon for the north Essex population. We run specialist cancer clinics at Colchester Hospital, Southend University Hospital and Oaks Hospital.

We carry out this procedure using robotic surgery under general anaesthetic. This means we use mini-instruments that are highly sophisticated to make the surgery as minimally invasive as possible. Small keyhole incisions are made in the lower abdomen to allow us to insert the robotic instruments. These allow us to free the prostate from the bladder and urethra, enabling it to be removed. This approach helps to preserve the muscles and nerves that control continence and erections. The urethra is reconnected to the bladder using absorbable stitches.

A prostatectomy carried out using robotic surgery usually takes around two to three hours to perform. Following the procedure, a catheter I’s inserted to drain the urine to allow the new join between the bladder and urethra to heal.

Side effects from the procedure can include some bruising and swelling around the incisions and scrotum. Other effects may be some should pain and bloating before any bowel movements recommence. In terms of longer-term side effects, there is a risk of erectile dysfunction, urinary incontinence, bleeding and pain in the incisions. Furthermore, there is a chance that additional treatment could be required if a PSA test identifies that cancer is still present.

For more information please visit our Prostatectomy page or Prostate Cancer page.

This technology uses ‘shock waves’ (like sound waves) to break kidney stones into small fragments. It is the most common procedure for the management of kidney stones. Lithotripsy takes about 45 to 60 minutes to complete. During the procedure, a patient will lie on a water-filled cushion. High-energy sound waves are created outside of the body by a machine and these waves travel through the body until they hit the kidney stones and break them into tiny pieces. A patient may feel a tapping sensation on their skin as the shockwaves enter the body. A tube is inserted through the bladder or back into the kidney to help drain urine from the kidneys until all the tiny fragments of stone pass out of the body through urine. The tube may be inserted before or after the procedure. A series of treatments is usually required. ESWL is performed in the day surgery unit. Lithotripsy is indicated in people with large kidney stones causing pain, urinary tract infection, bleeding, and renal damage.

For more information, visit our Urinary, Bladder and Kidney Stones page.

There are two types of vasectomy and both are quick procedures:

• Conventional vasectomy using a scalpel (surgical knife)
• No-scalpel vasectomy

The first involves a local anaesthetic, followed by two small cuts on each side of the scrotum to access the tubes that carry the sperm. These tubes are cut and a small section is removed. They are then either tied or sealed shut. The small cuts are stitched and often dissolvable stitches are used.

A no-scalpel vasectomy also has a local anaesthetic, but instead of a cut, a very small puncture hole is made to get to the tubes. There are no stitches and the risk of complications is lower.

Our vasectomy price is approximately £2300.

For more information, visit our Vasectomy page.

The only way to join up the vas again is through a surgical procedure. This can often be carried out as an outpatient case and can be done through two methods.

The first is a straightforward vasovasostomy and the surgeon will make two cuts to access the tubes. The two severed ends of the tube are sewn together again.

The second is called a vasoepididymostomy, and this involves the vas being attached to the epididymis, which is what holds the sperm in the testicle. This is more complicated and may have to be done if a vasovasostomy is not possible or unlikely to be successful.

The type of reversal will depend on whether sperm is seen in the fluid in the vas – if it is not present, then it is likely a vasoepididymostomy is required. It is unlikely that a man will know which method needs to be used until the operation is underway. It may also be that a combination of the two different methods is required on each side.

It can take up to a year for the sperm to return to the semen, but it can happen within a few weeks.

For more information, visit our Vasectomy reversal page.

Varicoceles are common and occur when an abnormal network of veins develop in the scrotum around the testicle. Some men just have them on one side, but they can occur in both. While they are harmless and can have no symptoms, they can cause aching or discomfort. In order to remove varicoceles, they can be embolised under local anaesthetic. This is a non-surgical and minimally invasive method and is permanent. It sees a small cut made in either the groin or the neck, with a small wire and tube steered into the veins to target the abnormal vein. This is done through the use of x-rays to guide the wire.

Embolisation can be carried out as a day case, even for men with varicoceles on both sides.

For more information, visit our Varicocele page.

Sperm can be retrieved from the testicles or the epididymis through certain techniques:

• Percutaneous epididymal sperm aspiration (PESA)
• Microsurgical epididymal sperm aspiration (MESA)
• Testicular sperm aspiration (TESA)
• Testicular sperm extraction (TESE) – single or multi-site
• Microscope-assisted testicular sperm extraction (MicroTESE)

These are appropriate for men who have no sperm in their semen due to a blockage, if they are unable to ejaculate, they have had a sexually transmitted infection or they have a problem with sperm production, which can be the case for men who have had chemotherapy or a genetic condition affecting fertility.

For more information, visit our Male infertility page.

A telescope is passed down the urethra to cut away prostate tissue causing an obstruction to the urinary flow with an electric loop. It can relieve pressure from the urethra and treats symptoms associated with urination, but it will not cure the cancer.

For more information, visit our Prostate cancer page.

An operation under general anaesthetic to cut away a tumour from the inside of the bladder wall using a telescope. The telescope is passed down the urethra and the bladder is filled with fluid first. An electric loop is used for the cutting and a catheter is temporarily placed after the procedure.

For more information, visit our Bladder cancer page.

A diagnostic ureteroscopy is usually performed under a general or spinal anaesthetic, as the bladder is examined with a small telescope and a guidewire is inserted into the opening of the ureter. From there it goes to the kidney and an instrument or flexible telescope is inserted, with the guidewire to follow in order to inspect the ureter and/or kidney.

This technique allows a biopsy to be taken or for an abnormality to be removed, and stones can also be extracted or fragmented with a laser.

For more information, visit our Urological Diagnostics page.

This is an operation to drain fluid from around the testicle through an incision in the scrotal skin. The bag of tissue that contained the fluid is everted or excised so the fluid collection is less likely to recur in the future. This is performed under a short general anaesthetic on a day surgery basis.

For more information, visit our Hydrocele page.

Vacuum devices are highly effective in patients that wish to avoid taking drugs or for whom such drugs are not appropriate. These are non-invasive, mechanical pumps and work by putting the penis into a plastic cylinder, where the area air then removed with a pump. This creates a vacuum that causes the penis to fill with blood, leading to an erection. A constriction ring is then put on the base oft he penis to prevent blood from escaping, keeping the erection in place.

The constriction ring should be kept on less than 30 minutes, and it must be removed as soon as intercourse is complete.

For more information, visit our Erectile dysfunction page.

During this test, a thin and bendy cystoscope is inserted into the urethra and into the bladder. A local anaesthetic will be applied before, to numb it and allow the cystoscope to move more easily. After this, water may be pumped into the bladder to allow it to be visualised. A camera in the cystoscope will take images that are transmitted to the monitor, which will be assessed by the doctor. Sometimes a small tissue sample may be removed for testing, which may take a couple of weeks to process for results.

For more information, visit our Urological Diagnostics page.

Hydrodistension may be recommended, which can stretch the bladder beyond its normal capacity. This can improve symptoms of bladder pain or an overactive bladder.

This procedure involves gently stretching the bladder through the use of liquid – it is slowly filled to make it less sensitive. A telescope is inserted into the bladder through the urethra to allow an inspection of the bladder. Fluid is then added until it is very full, and then it is emptied and filled again. This helps to examine whether there are any changes that could indicate the cause of the pain. A biopsy may be taking and a catheter may be inserted. This would be carried out either under a general or spinal anaesthetic, but usually doesn’t require an overnight stay.

For more information, visit our Overactive and Painful bladder page.

For patients with an overactive bladder, addressing the symptoms is often a priority. The nerves responsible for regulating bladder function can be stimulated through a thin needle electrode inserted above the ankle. The patient remains seated for 30 minutes, while a stimulator is turned on, that triggers a sensation in the ankle or foot by mild electrical pulses.

This is often carried out as a series of treatment across 12 weeks, and patients can start to see improvements around five to six weeks after the first treatment.

For more information, visit our Overactive and Painful bladder page.

In a radical nephrectomy, the entire diseased or injured kidney is taken out, as well as the ureter, which is the tube leading to the bladder. Furthermore, the adrenal gland and fatty tissue may also be removed.

In some cases, a bilateral nephrectomy is carried out, which is where both kidneys are removed.

For more information, visit our Nephrectomy page.

A ‘keyhole’ operation that is performed under general or spinal anaesthesia and is used to remove large stones from the hollow centre of the kidney. An incision is made in the back, with a hollow tube inserted through the kidney to reach the stones. A ballistic device is used to break the large stone into smaller pieces, which are then plucked out of the kidney. This is a major operation but it is very effective in removing all the stone in a single go.

The procedure is indicated for stones resistant to shockwave lithotripsy (a non-invasive method that uses sound waves), large stones (more than 2 cm) that occur as a result of kidney infections which require complete removal, and stones that are high up in the ureter near the kidney.

For more information, visit our Urinary, Bladder and Kidney Stones page.

The prostate gland may become enlarged and block the flow of urine. As a result, the size of the prostate needs to be reduced to address any obstructions and help avoid surgery.

One method that can be used is the Rezūm procedure. This involves injections of steam into the prostate tissue that is blocking or obstructing the urethra or that may be extending into the bladder. Over the next 3-6 months, this shrinks the tissue, which allows urine to start flowing again.

The prostate steam treatment can be carried out under a general, regional or local anaesthetic. Following this, a telescope is inserted through the urethra, into the bladder. Steam is injected through the telescope and a bladder catheter is inserted, which will remain in place for a few days.

While the procedures takes just 10-15 minutes to perform, the patient will go back to the hospital to have the catheter removed. In the meantime, the patient will be supported in managing the catheter at home.

There are common side effects which include temporary burning, stinging and bleeding when urine is passed. There may also be discomfort pain in the pelvic area, which again is likely to be temporary.

There are other alternatives to the Rezūm procedure, such as Urolift, TURP or HoLEP. We always recommend a full discussion to go through the benefits of each to allow for a decision to be made.

For more information, visit our patient resources page.