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Hydrocele Symptoms and Causes

What are the Symptoms and Causes of a Hydrocele?

A hydrocele is a collection of fluid around the testicle. There may be a variety of causes for this, although most commonly the cause is never found. However, other important causes to exclude are infections of the testicle and also testicular tumours. All patients with a hydrocele should undergo an ultrasound scan of the testes to ensure the underlying testis is normal. Hydroceles can increase to quite dramatic sizes. In most cases, hydroceles can be managed without any treatment and certainly if the hydrocele does not cause any pain or discomfort then this can be managed conservatively without surgery.

In some instances where patients have pain or a hydrocele is very large patients may request to have surgery performed. Surgery is usually performed as a day case or an overnight stay depending upon the size of the hydrocele. We do not advocate aspiration of the hydrocele as this may result in the introduction of infection and also reduce the chances of successful hydrocele repair afterwards.

There are two different types of technique of repairing a hydrocele; the Jadoulay’s repair where the lining of the fluid membrane surrounding the testes is everted around the testicle and stitched, or alternatively a Lord’s plication where the membrane is gathered around the testis. In either case there is a risk, of course, that the hydrocele can recur.

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Erectile Dysfunction – Diagnosis and Treatment

Erectile Dysfunction (Impotence)

Erectile dysfunction (ED) or impotence is the repeated inability to obtain or maintain an erection that is sufficiently firm to achieve the kind of sex desired by a man and his partner. It can range from total inability to obtain an erection, to an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED difficult and it’s extremely common to experience some degree of erectile dysfunction at some point or other – in fact 50% of men suffer erection difficulties at some point in their lives.

Older men may accept ED as a ‘normal’ part of the ageing process without realising it can be treated effectively, and therefore do not seek advice about treatment.

Causes of erectile dysfunction

An erection involves a precise sequence of events – starting with nerve impulses from the brain, through to responses within the muscles and blood vessels within the penis – and so lots of things can potentially cause erectile dysfunction, including physical, psychological and drug-related factors.

Physical causes:

  • Vascular disease
  • Diabetes mellitus
  • Hormone abnormalities such as hyperprolactinaemia
  • Certain prescribed drugs
  • Hypercholesterolemia (high cholesterol)
  • Diseases affecting the erectile tissue of the penis
  • Neurological diseases
  • Severe chronic diseases such as kidney and liver failure
  • Alcoholism and drug abuse
  • Surgery (especially radical prostate and bladder surgery)
  • Injury to the penis, spinal cord, pelvis, prostate or bladder
  • Heavy smoking
  • Being overweight

Drug induced causes:

  • Alcohol
  • Antihypertensives (medication for high blood pressure) e.g. diuretics, beta blockers, methyldopa
  • Cimetidine
  • Marijuana, heroin, methadone
  • Major tranquillisers
  • Tricyclic antidepressants
  • Digoxin
  • Glucocorticosteroids
  • Oestrogen, anti-androgens

Psychological causes of Erectile Dysfunction:

  • Stress and anxiety from work or home
  • Relationship conflicts and dissatisfaction
  • Depression and other psychiatric conditions and their medications
  • Sexual boredom or unresolved sexual orientation

Determining the cause of erectile dysfunction usually begins with an in-depth chat about your medical and sexual history and general health, to help indicate which root to investigate. Physical examinations and tests may also be carried out.

Treatment for Erectile Dysfunction

There are usually lots that can be done to help erectile dysfunction. This may be something as simple as lifestyle changes, or addressing underlying psychological issues or stress, through to certain medications, injections and surgical implants, depending on the root cause of the problem and the best solution for the individual patient.

It’s always best to seek professional advice before commencing any treatment for erectile dysfunction, however, to ensure underlying causes have been adequately investigated, and that the treatment is appropriate and won’t interact negatively with any other drugs you’re taking.

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Epididymal Cyst Treatment

Epididymal Cyst Treatment

Epididymal cysts are quite common, although the exact causes aren’t fully understood.

In most cases, they don’t require surgery – in fact surgical treatment is usually strongly advised against for men who wish to have children, as it can damage the sperm tube or epididymis, which acts as a reservoir for sperm, at the back of the testicle.

In men who have completed their family, or have large cysts which are causing pain, they can be excised or removed (although they may sometimes recur). This is usually performed as a day case procedure, although sometimes an overnight stay is required.

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What is a Vasoepididymostomy?

A vasoepididymostomy is either performed in cases of blockage to the epididymis (sperm reservoir) or in some instances when a vasovasostomy (vasectomy reversal) is not possible.

In these cases, dye is injected (a vasogram) to ensure that there is no blockage further into the abdomen and if the situation is amenable to reconstruction, a microscope is used to perform a vasoepididymostomy by using very fine stitches.

This is performed under an operative microscope using very fine suture material and the procedure can take up to four hours.

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Vasectomy Reversal

A Vasectomy reversal is a procedure that reverses a vasectomy surgery. A vasectomy is a birth control measure men undergo that prevents semen from carrying sperm. Although the surgery is very popular, some men can later decide to have their vasectomy reversed.

Male patients can undergo a vasectomy reversal, which allows them to once again father children. Despite claims that a vasectomy reversal is difficult to perform and doesn’t always work, the surgery can be successful.

Prior to the procedure

There are a number of reasons men decide to undergo a vasectomy reversal. Regardless of the reason, patients will consult with their doctors about the possibility of having the procedure performed and will undergo an examination.

Patients should understand that a vasectomy reversal can be a far more in-depth surgery than the original vasectomy. This is due to the surgeon needing to repair the tubes that were snipped and clipped during the original procedure.

Doctors will put patients through an exam to see if they are healthy enough to undergo the surgery. In addition, doctors must determine if patients can produce healthy sperm before operating. Some doctors want to know if a patient’s spouse is capable of having children as well before completing the surgery.

What does the procedure involve?

A vasectomy reversal is performed under general anaesthetic. Surgeries may take up to three hours to complete. This is far different than a vasectomy procedure in which patients are put under a local anaesthetic and surgeries can take as little as 15 minutes. The difference in operation time shows the complexity of the surgery.

Incisions are made on the scrotum and the surgeon reconnects the vas deferens. The operation is completed under microscope. After the tubes are reconnected, they are stitched together. At the same time, sperm will be extracted directly from the testicles and frozen to ensure there is back up sperm available should the vasectomy reversal fail. The frozen sperm can be used for ICSI.

Recovery time

Patient recovery time can be extensive. Patients will need a week or longer off work to overcome the discomfort they feel.

It is advised men wait a month before resuming sexual activity. The testicle tubes may not heal fully if men begin having intercourse too soon.

Patients may take over the counter painkillers to relieve the post-surgery pain. In addition, icing the area can lessen swelling and discomfort.

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Congenital Penile Curvature Treatment

Congenital curvature of the penis is quite a common condition.

Usually the penis is bent downwards and is noticed by young men when they become sexually active. In most cases patients simply need reassurance that the bend is a normal variant, although in some men the bend can be quite severe such that they are unable to have intercourse.

Congenital curvature should be distinguished from Peyronie’s Disease and the treatment for men who are unable to have intercourse due to the bend preventing them from penetrative intercourse is the Nesbit’s procedure. This is where a small amount of tissue is taken on the opposite side to the bend to shorten the penis.

In most cases because the bend is downwards or to the side, the Nesbit’s procedure is performed on the top of the penis or on the side of the penis. The results, however, from Nesbit’s procedure for congenital curvature are extremely good. Grafting procedures do not work in this type of condition.