Percutaneous Epididymal Sperm Aspiration (PESA)

Percutaneous Epididymal Sperm Aspiration (PESA) is a form of surgical sperm removal (SSR).  SSR can be useful in a number of circumstances. This includes couples who wish to try for a baby after a previous vasectomy but vasectomy reversal either isn’t suitable or isn’t desired.  Or when couples are unable to conceive due to a diagnosis of azoospermia due to blockages.

The good news is azoospermia does not automatically mean couples will never be able to conceive.  Instead, there are a number of treatment options available, depending what’s causing the condition.

PESA is usually a suitable option for men who have been diagnosed with an obstruction or blockage that’s preventing their sperm from exiting the epididymis.  In other words, sperm is being produced in the testes.  It just isn’t able to exit the man’s body.  PESA is also an option for men who wish to try for another pregnancy following a previous vasectomy.

How is PESA performed?

PESA is a minimally invasive surgical sperm removal technique, essentially involving extracting sperm directly from the epididymis, via very fine needle and light suction.  The sperm will be analysed before being frozen. It’s usually possible to get a generous sample with a single PESA procedure and outcomes are generally positive.

If appropriate, PESA can be carried out with local anaesthetic used to temporarily numb the area, so no pain is felt.  This means you’ll be able to go home shortly afterwards.  Plus there are less risks involved compared with more invasive procedures that require general anaesthetic.

Because PESA is a relatively minor and minimally invasive surgical technique, recovery time is generally quick and straightforward.  However, some tenderness after the procedure is normal, so you may need to take it easy for a few days.  Regular painkillers are required, and wearing a scrotal support/supportive underwear can definitely help.  You’ll also be advised to wait until the area is healed before resuming sexual intercourse and vigorous exercise.  This can often be just a period of a few days.

Risks and success rates of PESA

All surgical procedures carry a degree of risk, including the risk of infection and bleeding.  While these are generally minimal, it is important to be fully informed.  Any risks and positive outcomes of the procedure will always be discussed with the patient before going ahead.

In addition, it is essential to remember that there is no guarantee that PESA will result in a successful sperm extraction or pregnancy.  However, if the treatment is deemed suitable for you, outcomes are generally good.

Alternatives to PESA

At London Andrology we offer a number of surgical sperm retrieval techniques. You can find more information about these procedures on our Sperm Retrieval Techniques page. Which technique is most suitable largely depends on individual circumstances and why the treatment is required.  If you are having difficulty conceiving, we can help you by investigating and diagnosing the root causes of the problem and talk you through the treatment options.



Penile Reconstruction In London

Penile reconstruction is suitable for men who are experiencing any number of issues with their penis.  Particularly because successful penile reconstruction can play a major part in resolving the mental and physical anguish of penis issues.  Therefore, reconstruction surgery is an ideal solution for many men in this specific situation.

Prior To The Procedure

Penile reconstruction patients will first meet the surgeon to ensure they are an appropriate candidate for the operation.  The surgeon will review the patient’s medical history and examine him.  Consideration as to whether the patient is fit and healthy is an essential decision at this stage.

Another crucial consideration at this stage lies with the patient.  And that is the risks and complications a penile reconstruction involves.  In addition, the surgeon may well consider whether a psychiatric evaluation is necessary prior to the procedure.

During the procedure patients will be given an antibiotic drip to help the prevention of infection.  Depending on the area of the penis and the damage, operations can differ.  Balanitis Xerotica Obliterans or Lichen Sclerosis can occur in some cases.  These conditions can cause the skin on the head of the penis to become scarred.  The skin can be removed during surgery and a skin graft can be put in its place.

Previous surgeries can also cause scarring and swelling in the penis.  Radiotherapy treatments for patients who have suffered from testicular cancer can also seek out penile reconstruction.  Ultimately, the penis can be reconstructed to look more cosmetically pleasing to the eye.  An important aspect for many patients.

Recovery following the procedure

Patients will most likely experience bruising, swelling, discomfort, and numbness following a penile reconstruction surgery.  The area operated on will be bandaged to prevent infection.  Patients will be given detailed instructions on how to care for their wounds.

Men will need to avoid sexual intercourse for up to six weeks.  Physical contact during sex could undo the surgery or cause unwanted healing and scarring of the penis.  Patients will need to monitor the area for infection, although the possibility for injection is low.



Penile Prosthesis or Implants

A penile implant is a device placed inside the penis enabling it to become erect. It is often a last resort procedure after other treats for erectile disfunction have failed. There are two main types of penile implants.

The first type is inflatable implants and it consists of a reservoir and cylinders combined with a pump. The second type of penile implants are the malleable implants. A malleable device does not need to be pumped up and is a rod rather than a cylinder.

Prior to the procedure

Erectile dysfunction can be treated through medication. However,in some cases tablets or injections fail and the only remaining option is a penile implant. A penile implant can also be used in males who suffer from Peyronie’s Disease, who may also have erection problems.

Males interested in a penile implant will need to consult with their doctors over whether or not they are a good candidate for an implant. Patients should remember penile implants do not improve sexual desire or penis size.

Doctors will review a patient’s medical history and complete an examination before the procedure. They will also go over a patient’s options and types of penile implants.

What does the procedure involve?

Patients will be given an IV of antibiotics to help prevent the possibility of infection. The patient will also receive either a general anesthetic or spinal anesthetic. The area in which the surgery will be conducted will be shaved and scrubbed in preparation for the surgery.

To insert an inflatable penile implant, doctors will make a small incision in the scrotum. A fluid reservoir is then placed inside. Men who have had surgeries previously can have the reservoir inserted via an incision in the abdomen. Malleable devices can be inserted in the same way; however, a fluid reservoir or pump does not have to be added.


Patients may be prescribed medication for pain following the procedure. In some cases, patients will be able to cope with pain using over the counter medication. Post-surgery pain can persist for a week or more.

Men may not be able to resume physical activity for four to six weeks. Patients should consult with their doctors about the healing process and possible medications for pain.

The scrotum can be bruised and sore for weeks following the operation. Although the chance of developing an infection is low, patients will need to watch out for infection.



Microsurgical Varicocele Ligation in London

Microsurgical varicocele ligation is a procedure performed using a high-powered operating microscope.  The procedure aims to eliminate varicoceles or large, diluted veins of the spermatic cord in the testicles.  A varicocele is a large vein that forms in one or both testicles.  The veins become large due to the pooling of blood.  This can become painful and unsightly.

Males suffering from varicoceles will most likely experience the condition on the left side of the body.  Varicoceles can cause a dragging, heavy sensation in the testicles.  Sufferers may also feel aches and pains in the scrotum.  And pain can occur after long periods of standing.

The cause of varicoceles is unknown and issues with kidneys can also occur.  Varicoceles often occur in men with fertility issues.  Currently, experts are split on whether fixing varicoceles helps fertility in patients.

Microsurgical Varicocele Ligation Procedure

The patient’s varicoceles will be graded based on their size.  Size is graded between 1 and 3 with largest or most visible being given the higher number.  An incision is then made in the scrotum and the spermatic cord is dissected.  It is here that the abnormal veins are exposed.  The veins will be dissected and tied off to drain blood away from the testicles.

Recovery From The Procedure

Patients may suffer from pain in their groin for 3-6 weeks following the procedure.  The scrotum may bruise and swell too, as is typical with any operation.  This can last up to 4 weeks.  On average, men who experience the procedure can return to work within 3 days.  However, jobs in which men perform physical activity will mean a week from work is necessary.

Swelling and pain can be reduced by applying ice to the affected area.  In addition, men may choose to wear snug fitting underpants, to hold the scrotum in place.  Patients may take over the counter painkillers to reduce swelling and pain.