My Penis Stuff

This procedure involves removal of part of the prostate gland through the urethra.

A long, thin tube with a viewing instrument (cytoscope) attached is inserted into the urethra. Prostate tissue is removed through the cytoscope.

What To Expect After Surgery

You are usually hospitalized for 2 to 3 days. Complete recovery generally requires 3 to 4 weeks.

Why It Is Done

This surgery may be done for:

• Chronic bacterial prostatitis that resists antibiotic treatment, with or without infected prostate stones (prostatic calculi).
• Repeated urinary tract infections because of another prostate problem for which surgery may be appropriate, such as prostate enlargement (benign prostatic hyperplasia, or BPH).

How Well It Works

Few men with chronic bacterial prostatitis have their symptoms improve after this surgery.

Risks

• Urinary incontinence
• Inability to get or maintain an erection (erectile dysfunction)

What To Think About

To eliminate category II (chronic bacterial) prostatitis successfully, the surgery must completely remove the portion of the prostate that contains the infection.

In transurethral microwave therapy (TUMT), an instrument (called an antenna) that sends out microwave energy is inserted through the urethra to a location inside the prostate. Microwave energy is then used to heat the inside of the prostate. Cooling fluid is circulated around the microwave antenna to prevent heat from damaging the wall of the urethra. To prevent the temperature from getting too high outside the prostate, a temperature sensor is inserted into the man’s rectum during the procedure. If the temperature in the rectum increases too much, the treatment is turned off automatically until the temperature goes back down.

The temperature becomes high enough inside the prostate to kill some of the tissue. As this part of the prostate heals, it shrinks, reducing the blockage of urine flow.

This treatment is done in a single session. It usually does not require an overnight stay in the hospital. A general or spinal anesthetic is needed during the procedure.

Microwave therapy is also known as cooled thermal therapy or by the name of the equipment (Targis or Prostatron).

What To Expect After Surgery

You are generally able to go home after surgery. You may not be able to urinate and may require catheterization to drain your bladder. For most men, this lasts for a week or less. You may also have to take antibiotics or anti-inflammatory medications.

You can generally return to work 1 to 2 days after treatment. Sexual activity can be resumed 1 to 2 weeks after surgery.

Why It Is Done

TUMT is done to help relieve the symptoms of benign prostatic hyperplasia (BPH). It is an option for men who want more than medications for treatment of their symptoms.

How Well It Works

Studies note that TUMT is more effective than treatment with the alpha-blocker terazosin when checked 18 months later.

In one study, transurethral resection of the prostate (TURP) improved symptoms better than TUMT. But in two other studies, there was no major difference in how well the two treatments worked.

Risks

The main complication of TUMT is the inability to urinate (urinary retention) for more than a week. This condition is treated by inserting a tube directly through the abdominal wall into the bladder to drain urine (suprapubic catheter). Erection problems and retrograde ejaculation (ejaculation backward into the bladder) appear to be less common after TUMT than after TURP.

Other complications include persistent irritation of the urethra and blood in the urine.

Recent reports have warned that the procedure has in a small number of cases caused serious injuries and complications, including damage to the penis and urethra. Injuries have required colostomies, partial amputation of the penis, and other procedures. In December 2000, the U.S. Food and Drug Administration (FDA) issued a warning about these injuries.

What To Think About

Most trials using TUMT have been limited by a small number of participants, a short length of time of study, and limited follow-up of the participants after the trial ended.

This procedure is not recommended for men with prostate cancer, men who are suspected of having prostate cancer, or men with prosthetic hip joints or pacemakers.

Transurethral incision of the prostate (TUIP) may be done to treat benign prostatic hyperplasia (BPH). The surgeon uses an instrument inserted into the urethra that generates an electric current or laser beam to make incisions in the prostate where the prostate meets the bladder. Cutting muscle in this area relaxes the opening to the bladder, decreasing resistance to the flow of urine out of the bladder. No tissue is removed. It is done under either general or spinal anesthetic.

The procedure usually requires an overnight stay in the hospital.

What To Expect After Surgery

TUIP is a much less invasive procedure than transurethral resection of the prostate (TURP). TUIP usually requires an overnight stay in the hospital. A catheter is left in the bladder for 1 to 3 days after surgery.

Why It Is Done

TUIP may be a good option for men with only slightly enlarged prostates.

TUIP may be chosen instead of TURP in men who:

• Are at higher risk for complications from surgery and anesthetic, including men with serious health problems. TUIP involves less blood loss and can be done more quickly than TURP.
• Want to avoid the risk of developing retrograde ejaculation, a condition in which semen flows backward into the bladder. This side effect is more common with TURP than with TUIP.

How Well It Works

Symptoms improve after TUIP in about 80% of cases. Generally, men notice about a 73% improvement in their American Urological Association (AUA) symptom index scores. For example, if you have a score of 25 (indicating severe symptoms), it could be reduced to about 6 (indicating mild symptoms).

Short-term improvement in BPH symptoms is about the same for TUIP as for TURP. Studies comparing the two types of surgery suggest that the outcomes are similar. However, men who have had TUIP generally are less likely to develop retrograde ejaculation than men who have TURP.

Risks

The possible risks of transurethral incision of the prostate (TUIP) include the following:

• Retrograde ejaculation, in which semen flows backward into the bladder, occurs in about 6 to 55 men out of 100. Retrograde ejaculation is not harmful.
• Erection problems in men who did not have one of these problems before the surgery are reported in about 4 to 25 men out of 100.
• Incontinence occurs in about 1 man out of 100.
• The need for a blood transfusion during surgery is rare.
• A second operation because of a complication of the surgery is needed in about 1 to 3 men out of 100.

What To Think About

Surgery usually is not required to treat BPH, but it may be a reasonable choice for some men. Choosing surgery depends largely on your preferences and comfort with the idea of having surgery. Things to consider include your expectations, the severity of your symptoms, and the possibility of developing complications.

Usually, no tissue is removed in TUIP; therefore, no tissue is available for prostate cancer testing.

Men who have severe symptoms often have great improvement in quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life. Men with only mild symptoms may want to think carefully before having surgery to treat BPH.

What is testicular cancer?

Testicular cancer occurs when cells that are not normal grow out of control in the testicles (testes). It is highly curable, especially when it is found early.

The testes are the two male sex organs that make and store sperm. They are located in a pouch below the penis called the scrotum. The testes also make the hormone testosterone.

Testicular cancer is most common among white males. It is not common in men of African or Asian background.¹ Although rare, testicular cancer is the most common form of cancer in men between the ages of 20 and 34.

What causes testicular cancer?

Experts don’t know what causes testicular cancer. But some problems may increase your chances of getting it. These include:

• Having a testicle that has not dropped down into the scrotum from the belly. This is called an undescended testicle. Normally, a baby’s testicles drop down into his scrotum before he is born or by the time he is 3 months old.
• Klinefelter syndrome. This is a genetic problem that affects males. Normally, males have one X and one Y chromosome. Males with Klinefelter syndrome have at least two X chromosomes and, in rare cases, as many as three or four.
• A family history of testicular cancer.

Most men who get testicular cancer don’t have any risk factors.

What are the symptoms?

The most common symptoms of testicular cancer include:

• A change in the size or shape of one or both testes. You may or may not have pain.
• A heavy feeling in the scrotum.
• A dull pressure or pain in the lower back, belly, or groin, or in all three places.

How is testicular cancer diagnosed?

Most men find testicular cancer themselves during a self-exam. Or your doctor may find it during a routine physical exam.

Because other problems can cause symptoms like those of testicular cancer, your doctor may order tests to find out if you have another problem. These tests may include blood tests and imaging tests of the testicles such as an ultrasound or a CT or CAT scan. These tests can also help find out if cancer has spread to other parts of your body.

How is it treated?

Nearly all men with testicular cancer begin treatment with surgery to remove the testicle that has cancer. This surgery is called radical inguinal orchiectomy. Removing the testicle allows your doctor to find out the type of cancer cells you have. It also helps him or her plan any other treatment you may need.

Treatment after surgery may include:

• Watchful waiting. You may be able to wait and watch to see what happens. During watchful waiting, you will have regular checkups with your doctor to make sure that the cancer is gone.
• Chemotherapy. This is powerful medicine that destroys any cancer cells that remain after surgery.
• Radiation therapy. This is a high dose of X-rays used to destroy cancer cells. It is mostly used to treat a kind of cancer called seminoma, but it is sometimes used after surgery to kill leftover cancer cells. Radiation therapy can also be used to treat cancer that has spread beyond the testes.

Chemotherapy is often used for cancer that has spread to other parts of the body. In some cases surgery is used to remove that kind of cancer.

Testicular cancer is highly curable when it is found early. Even when it is found at an advanced stage, it is considered very curable.

How will having testicular cancer affect you?

In most cases, removing a testicle does not cause long-term sexual problems or make you unable to father children. But if you had these problems before treatment, surgery may make them worse. Talk to your doctor if you have any questions or concerns about sexual problems or whether you can father children.

Some men choose to get an artificial, or prosthetic, testicle. A surgeon places the artificial testicle in the scrotum to keep the natural look of the genitals.

Unlike many other kinds of cancer, most testicular cancers grow slowly and respond well to treatments such as chemotherapy and radiation therapy. But these treatments can cause side effects. Most of the time, the side effects last only a little while and then go away. Long-term side effects from treatment are rare.

What is a spermatocele?

A spermatocele (epididymal cyst) is a sperm-filled cyst in the long, tightly coiled tube that lies above and behind each testicle (epididymis). It feels like a smooth, firm lump in the scrotum on top of the testicle.

What causes spermatoceles?

Although the cause of a spermatocele is often unknown, it may be caused by obstruction of the tubes that carry sperm from the testicles (epididymal ducts).

What are the symptoms?

Often a spermatocele does not cause symptoms. You may notice what looks or feels like an extra lump or mass above the testicle on one side of your scrotum, or a general enlargement of your scrotum. Symptoms, when present, can include pain, swelling, or redness of the scrotum or a feeling of pressure at the base of the penis.

How is a spermatocele diagnosed?

A spermatocele is usually diagnosed by examining the scrotum. As part of the examination, your health professional will shine a light behind each testicle (transillumination) to check for solid masses that may be caused by other problems, such as cancer of the testicle. Because spermatoceles are filled with fluid, light will shine through them (transillumination). Light will not pass through solid masses that may be caused by other problems, such as cancer of the testicle. An ultrasound may be used to confirm the diagnosis of a spermatocele.

How is it treated?

Spermatoceles are not usually dangerous and are treated only when they cause pain or embarrassment or when they decrease the blood supply to the penis (rare). Treatment is not usually needed if a spermatocele does not change in size or gets smaller as the body reabsorbs the fluid.

If the spermatocele gets larger or causes discomfort, a procedure to remove the spermatocele (spermatocelectomy) may be needed.

Sexually transmitted diseases (STDs) are spread by sexual contact involving the genitals, mouth, or rectum, and can also be spread from a pregnant woman to her fetus before or during delivery. STDs, which affect both men and women, are a worldwide public health concern.

Although most STDs can be cured, some cannot, including HIV (which causes AIDS), genital herpes, and human papillomavirus (HPV), which can cause genital warts.

STDs can be spread by people who don’t know they are infected. Always use protection every time you have sex, including oral sex, until you are sure you and your partner are not infected with an STD.

If you are in a relationship, delay having sex until you are physically and emotionally prepared, have agreed to only have sex with each other, and have both been tested for STDs.

Abstinence as prevention

Completely avoiding sexual contact (abstinence), including intercourse or oral sex, is the only certain way to prevent an infection.

Discuss safe sex with your partner

Discuss STDs before you have sex with someone. Even though a sex partner doesn’t have symptoms of an STD, he or she may still be infected.

Questions to ask someone before having sex include:

• How many people have you had sex with?
• Have you had sex without a condom?
• Have you ever had unprotected oral sex?
• Have you had more than one sex partner at a time?
• Do you inject illegal drugs or have you had sex with someone who injects drugs?
• Have you ever had unprotected sex with a prostitute?
• Have you ever had an STD, including hepatitis B or hepatitis C? Was it treated and cured?

Safe sex practices

Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood. Genital herpes and the human papillomavirus (HPV) can be spread when symptoms are not present. Even if you and your partner have been tested, use condoms for all sex until you and your partner haven’t had sex with another person for 6 months. Then get tested again.

• Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner’s genital area, or pain while urinating.
• Don’t have more than one sex partner at a time. The safest sex is with one partner who has sex only with you. Every time you add a new sex partner, you are being exposed to all of the diseases that all of their partners may have. Your risk for an STD increases if you have several sex partners at the same time.
• Use a condom every time you have sex. Latex and polyurethane condoms do not let STD viruses pass through, so they offer good protection from STDs. Condoms made from sheep intestines do not protect against STDs.
• Use a water-based lubricant such as K-Y Jelly or Astroglide to help prevent tearing of the skin if there is a lack of lubrication during sexual intercourse. Small tears in the vagina during vaginal sex or in the rectum during anal sex allow STDs to get into your blood.
• Avoid douching if you are a woman, because it can change the normal balance of organisms in the vagina and increases the risk of getting an STD.
• Be responsible. Avoid sexual contact if you have symptoms of an infection or if you are being treated for an STD or HIV. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times.