Frequently Asked Questions

Phimosis (a tight foreskin that cannot be retracted) Balanitis (inflammation affecting the foreskin and glans) Posthitis (foreskin inflammation) Penile skin tears from sexual activity causing painful or incomplete foreskin retraction

Enhanced personal hygiene and self-care Potential reduction in urinary tract infections Potential decrease in sexually transmitted infection risk Lower incidence of penile cancer observed in follow-up studies of circumcised infants

Circumcision is performed as a day case procedure, with discharge typically occurring within 2 to 3 hours following surgery. The operation usually takes under thirty minutes and may be carried out using local, regional, or general anaesthesia. During the procedure, the complete foreskin is removed, leaving the glans fully exposed. A local anaesthetic penile block is administered to provide effective post-operative pain relief.

Post-operative care is crucial to ensuring a positive patient experience after circumcision. Comprehensive aftercare instructions will be provided, along with a contact number should any concerns arise following the procedure.

Arousal leading to erections in the penis is a multifactorial condition involving the psyche, blood vessels, neural inputs and healthy penile corporal structure. Ailments that affects any of these can cause erectile dysfunction. Smoking Diabetes Obesity Anxiety & Stress High cholesterol High blood pressure Coronary or Vascular Disease Age Medications such as beta blockers

Being multifactorial aetiology ED management can be complex and will need thorough holistic evaluation and an overview of the situation which will be performed in the outpatient setting in a confidential manner. Psychosexual therapy Oral medications Penile injections/gel inserts Penis pumps Surgery and Implants

Life style modification and awareness of female fertile period Potentially medications to improve spermatogenesis Surgery: To correct varicocele or repair obstructed vas deferens Assisted Reproductive Technology (ART) such as sperm aspiration

Microscopically there are two variants broadly on histology: Seminoma: Found usually in males in thirties or forties Nonseminoma: Usually develops early men in their twenties and thirties

Early detection and treatment is keystone for a successful outcome. A multidisciplinary approach would be required to manage these patients who may need surgery, radiotherapy or chemotherapy. Sperm storage pre treatment would be recommended.

There is no incidence of increased prostate cancer after a vasectomy There is no incidence of increased cardiovascular disease after a vasectomy There is no incidence of increased chance of erectile dysfunction because of a vasectomy Vasectomy is a safe and effective method of male sterilisation

Following instructions will help reduce convalescence after the procedure. Must wear tight underpants/ scrotal support for at least 2 weeks post procedure Must take medications as prescribed post procedure Must use contraception for at least 4 months and submit a semen sample at 3 and 4 months post procedure to make sure there are no sperms seen before discontinuing contraception May resume work after 48 hours if at a desk job

There are various factors which help determine outcomes. Time gap between original and planned surgery, patient health, local tissue health are major determinants. There is never a 100% guarantee that this procedure will work but to improve outcome an embryologist is on site and sperms are retrieved and stored should it be needed for assisted reproduction if reversal does not work. Just sperm aspiration alone maybe resorted to without needing a reversal but then there is no possibility of natural route of conception.

Vasectomy Reversals are performed under general anaesthesia. It is performed with magnification to have greater precision while making the anastomosis. The procedure is performed as a day case and the patient is discharged home on antibiotics, anti-inflammatory medications and scrotal support. Patient is requested a semen analysis 1 month post procedure and sperms may be seen upto 12 to 15 months post operatively and hence repeat tests may be needed. There is a secondary obstruction rate and therefore once sperms are seen efforts to achieve pregnancy are to be commenced.

The list is not exhaustive but some factors leading to bladder cancer are shown below: Smoking Chronic bladder irritation Parasitic infections Exposure to certain types of chemicals such as aniline dyes Occupational hazard such as in industrial printing inks

Bladder cancer needs to be excluded in any patient who presents with haematuria (blood in the urine) Increased frequency of urination or urgency may also herald bladder cancer Advanced stages can present with symptoms relevant to the spread of the disease

Treatment for bladder cancer depends on whether the cancer is limited to the urothelium or invaded into the structure (wall) of the bladder. Treatment hence ranges from endoscopic (camera based) resections +/- intravesical therapy (chemotherapy into the bladder) right to neoadjuvant chemotherapy with radical surgery or radiotherapy. A multidisciplinary approach is essential for successful long-term outcomes for such cancers.

It may not be found despite investigating but some causes can be as listed below: Urethritis Ejaculatory duct pathologies UTI Sexually transmitted infections (STI) Blood disorders Iatrogenic such as following a prostate biopsy

Appropriate assessment, investigations and prompt management is needed to manage this alarming presentation and if this is an issue an urgent urological opinion will be beneficial.

Cancer Urinary stones Urinary tract infections (UTIs) Injuries Kidney injury Medications such as blood thinning agents Certain food as beet root may stain urine red Indwelling catheters

Treatment for hematuria should be sought urgently. After detailed history and through physical examination appropriate investigations are to be undertaken which would include relevant blood tests, urine tests, imaging and endoscopy for initial assessment. This symptom should not be disregarded and urgent urological review is to be sought.

It is an involuntary urgency to pass urine which may lead to incontinence. Incontinence may be associated with sneezing or coughing as well and may also be associated with pain the bladder area. This then indicates a diagnosis more complicated than OAB on its own.

Idiopathic (unknown cause) Dietary such as excessive caffeine/fluid intake Pelvic muscle weakness Medications such as diuretics Urinary tract infection (UTI) Neurological disorders such as CVA, parkinsonism, multiple sclerosis

A comprehensive management mode is essential with patients participating and committing actively in the therapy is essential to successful outcomes. Dietary modification Review of medications Prescribe appropriate medications for OAB Tibial nerve stimulation BOTOX injection into the bladder Very rarely surgery

Recurrent urinary tract infections (rUTI) Interstitial cystitis / painful bladder syndrome Chronic urinary retention Neurogenic bladder Bladder pain syndrome Chronic urinary urgency or frequency Persistent haematuria of unclear cause Post-radiation cystitis

Frequent urination during day or night Persistent urgency or sudden urge to void Bladder or pelvic pain that improves on voiding Burning sensation that does not fully resolve with antibiotics Sensation of incomplete bladder emptying Recurrent infections (3 or more in a year) Blood in the urine that recurs over time

Mr. Godbole takes a detailed history and uses targeted investigations to confirm the underlying cause. Tests typically include urine analysis and culture, bladder diary, post-void residual scan, uroflowmetry, cystoscopy, and urodynamics where indicated. Imaging such as ultrasound or CT urogram is added if structural abnormalities are suspected.

Treatment is tailored to the diagnosis and the impact on quality of life. Conservative measures include bladder retraining, fluid and dietary modification, and pelvic floor physiotherapy. Medical therapy may use anticholinergics, beta-3 agonists, prophylactic antibiotics, oral pentosan polysulphate, or hormone replacement in postmenopausal women. Procedural options include intravesical glycosaminoglycan therapy, BoTox injections to the bladder, sacral neuromodulation, and surgical correction in selected cases.

Urinary tract infections can be uncomplicated or complicated. Uncomplicated UTI symptoms include: Urinary frequency, urinary urgency, dysuria (Painful and burning sensation while urinating), dark coloured and odorous urine, blood in the urine (haematuria) Complicated UTI symptoms include: All or some symptoms of uncomplicated UTI PLUS Abdominal/loin pain, Fever/chills/rigors, Nausea, vomiting, malaise, apathy, confusion, delirium

Treatment would start with an outpatient consultation which would entail taking a detailed history and physical examination. You will be requested to offer a urine sample for testing and may need other tests as blood tests and scans as appropriate. Therapy will mostly need antibiotics for bacterial infections. Treatment would be directed to treat current active infection and a strategy to prevent recurrence.

The majority of kidney stones consist of calcium and oxalate. While dietary factors play a role, underlying metabolic disorders may also contribute. Less commonly, stones may be composed of uric acid. Clinical symptoms typically appear when stones move or cause obstruction. Pain is the predominant symptom, often accompanied by fever, chills, and rigors. Some stones grow without causing symptoms, potentially leading to significant kidney damage and serious health consequences. Timely investigation, precise diagnosis, and appropriate treatment are vital to prevent complications. However, not every stone requires active intervention. A comprehensive approach to stone management is essential, with personalised treatment plans tailored to each patient's specific circumstances.

Elevated BMI Excessive animal protein consumption Inadequate fluid intake Iatrogenic causes including bariatric surgery Familial predisposition

Kidney stones commonly present as an emergency with the following symptoms: Severe colicky (gripping) pain Pain typically radiating from the loin to the groin Possible blood in the urine General malaise with fever, chills, and rigors Urinary frequency and urgency with a burning sensation

Effective stone management requires accurate diagnosis combined with a holistic assessment of the patient to determine the most appropriate treatment. The stone's size, shape, location, and position are critical factors, while the presence or absence of obstruction determines the clinical urgency. Treatment options range from non-invasive to minimally invasive approaches: Extracorporeal Shock Wave Lithotripsy (ESWL) Ureteroscopy with Laser Lithotripsy (URS/RIRS) Percutaneous Nephrolithotomy (PCNL) Laparoscopic stone surgery

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland and is usually an older man's disease. The pressure on the urethra (water tube through the penis) leads to symptoms of obstruction such as poor stream, straining to pass urine, dribbling, getting up at night to pass urine, hesitancy. There are many effective treatments for bother from BPH but it is vital to understand the individual patients' needs and circumstances to tailor the treatment which will suit them best.

LUTS (lower urinary tract symptoms) can be: Obstructive: Poor stream, Straining to pass urine, Hesitancy, Post void dribbling, Nocturia (waking up at night to pass urine) Irritative: Urgency, Frequency, Incontinence

Due history taking, thorough physical examination and investigations are necessary to arrive to an accurate diagnosis. Symptom scores and voiding diaries maybe needed too. A tailored plan will be made, and the best choice of treatment will be discussed with you based on your age, prostate size, and your condition of your health. Modern medicines have altered LUTS management and reduced greatly the need for surgical intervention. Bipolar Transurethral resection of the prostate (TURP) Urolift Rezum HoLEP (holmium laser enucleation)

Older Age A family history of prostate cancer Obesity Genetic Changes Race/ethnicity (black males are at a higher risk of prostate cancer)

Prostatic symptoms may be similar for both benign and malignant causes and early urological attention and care would be advisable for some or all symptoms as below: Trouble urinating Blood in semen Decreased size and strength of urine stream Discomfort in pelvic area Erectile dysfunction

Investigation of urinary bother (also called as LUTS or lower urinary tract symptoms) would be organised which would also include testing for potential existence of prostate cancer. In the clinic after a detailed history examination would include a Digital Rectal Exam (DRE) to delineate the shape, size and texture of the prostate as well as the overlying rectal mucosa. Prostate-Specific Antigen (PSA) is a blood test which is used as a surrogate tumour marker, but it is also elevated in non-cancerous conditions hence a comprehensive overview in assessment is vital.

Depending on the stage and other pathological parameters individual patients may be recommended various options which may include active surveillance, robotic radical prostatectomy, radiation therapy, hormone therapy, HIFU. Early detection and appropriate management is vital in long term success. Active surveillance Robotic radical prostatectomy Radiation therapy Hormone therapy HIFU

At HRG Urology, we deal with: Urgency and frequency of passing urine Urge incontinence Stress incontinence Painful bladder syndrome

These can be overwhelming and can be distressing and debilitating both in the personal and professional setting. A patient-centred approach in investigation and appropriate tailored management will be very beneficial.

A multi-disciplinary approach is used whereby patient relief is aimed for. At Nest Hospital, along with Consultant Gynaecologist Dr Ulkanatu, HRG Urology will deliver health, urinary services for improvement using modern modalities and minimally invasive treatment offering maximal benefit.

Along with esteemed colleagues who are consultant gynaecologists, general surgeons, laparoscopic surgeons, and radiologists, a dedicated Endometriosis Unit will be commencing. A comprehensive holistic approach will be offered to our patients in a multidisciplinary team setting with evidence-based care. Non-invasive options such as pain management Alternative therapies including yoga and ayurveda Laparoscopic surgery as indicated Robotic surgery for complex cases Multidisciplinary team collaboration Evidence-based treatment protocols