My Penis Stuff

Varicoceles are enlarged varicose veins that occur in the scrotum. They are fairly common, affecting 15% of men overall, and 40% of men with known infertility. Varicoceles occur most often in the left testicle.

Varicocele repair is performed to improve male fertility. It can usually be done surgically on an outpatient basis using local or general anesthetic. A small incision is made in the abdomen close to where the testicles originally descended through the abdominal wall. The veins that produce the varicocele are identified and cut to eliminate blood flow to the varicocele.

Alternatively, a nonsurgical procedure called percutaneous embolization can be done to repair a varicocele. A small catheter is inserted through a large vein in the groin or neck and advanced to the varicocele, which is then blocked off by a balloon, coil, or medication.

What To Expect After Surgery

Varicocele repair typically is done on an outpatient basis. You can expect to go home within 4 hours of a routine varicocele surgery. Pain medicine is prescribed for a few days after surgery.

You should be able to resume light work duties 1 to 2 days after surgery and full strenuous activities within 1 week.

Why It Is Done

Varicoceles are thought to raise the temperature of the testicles or cause blood to back up in the veins supplying the testicles. Although the mechanism by which varicoceles affect fertility is poorly understood, varicoceles seem to help damage or kill the sperm. Varicocele repair is typically performed to improve the fertility of men who have both a varicocele and impaired sperm.

Varicocele repair is a controversial practice. Many infertility experts express concern that it is not effective as an infertility treatment.

How Well It Works

While some researchers have observed that varicocele repair produces favorable pregnancy rates, others have noted that these pregnancy rates are the same as the rates of couples who have chosen not to have a varicocele repaired.

A recent review of research has found no benefit of varicocele repair for male or unexplained infertility.

Risks

• Infection at the site of surgery
• Fluid buildup in the scrotum (hydrocele) that requires draining
• Injury to the arteries or nerves in the pubic area

What To Think About

There is no proof that fertility rates improve after this surgery. However, some doctors think that larger varicoceles are linked to sperm problems. It is also possible that varicocele surgery would improve the semen quality, making other fertility treatments easier.

Small varicoceles that are only apparent with ultrasound testing do not require repair.

What is urinary incontinence in men?

Urinary incontinence is the accidental release of urine. It is not a disease but rather a symptom of a problem with a man’s urinary tract.

Urine is produced by the kidneys and stored in a muscular sac called the urinary bladder. A tube called the urethra, which is surrounded by a special ring of muscles called the urinary sphincter, leads from the bladder through the prostate and penis to the outside of the body. As the bladder becomes filled with urine, complex nerve signals ensure that the sphincter stays contracted and the bladder stays relaxed. This interaction between nerves and muscles prevents urine from leaking out of the body.

During urination, nerve signals cause the muscles in the walls of the bladder to contract, forcing urine out of the bladder and into the urethra. At the same time the bladder contracts, nerve signals cause the muscles surrounding the urethra to relax, allowing urine to pass through and out of the body.

Incontinence may occur if the bladder suddenly contracts or if it doesn’t contract when it should, leading to a buildup of too much urine in the bladder, which can cause leakage. Incontinence may also occur if the muscles around the urethra are damaged or suddenly relax or if the urethra is blocked, keeping urine from draining properly and causing eventual leakage around the blockage.

Incontinence affects 13 million Americans and occurs twice as often in women as in men.¹ Although incontinence occurs more often in older men than in young men, it is not considered a normal part of the aging process.

How is urinary incontinence in men classified?

Urinary incontinence may occur for only a short time (acute) or may become an ongoing problem (chronic). Acute incontinence is often related to other medical problems and treatments. This topic will focus on types of chronic urinary incontinence.

• Stress incontinence occurs when you sneeze, cough, laugh, lift objects, or do other activities that increase stress on your bladder.
• Urge incontinence is an urge to urinate that is so strong that you often cannot make it to the toilet in time. Urge incontinence occurs when your bladder contracts when it shouldn’t. This can happen even when you only have a small amount of urine in your bladder. Overactive bladder is a kind of urge incontinence. Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine.
• Overflow incontinence is leakage that occurs when the bladder fails to empty properly, due to a blockage or weak bladder muscle contractions. Obstruction is usually related to either enlargement of the prostate or narrowing of the urethra from scar tissue.
• Total incontinence is a continual leakage of urine due to loss of sphincter function.

Functional incontinence is a rare form of urinary incontinence related to physical or mental limitations that restrict a man’s ability to reach the toilet in time.

What causes urinary incontinence in men?

Urinary incontinence occurs when the muscle (sphincter) that holds your bladder’s outlet closed is not strong enough to hold back the urine. This may happen if the sphincter is too weak, if the bladder muscles contract too strongly, or if the bladder is overfull. In men, urinary incontinence often is related to a problem or a treatment involving the prostate gland, such as enlargement of the prostate (benign prostatic hyperplasia, or BPH).

• Stress incontinence may develop when a man’s prostate gland is removed and there has been dysfunction of or damage to the nerves or the sphincter, resulting in inadequate support for the lower bladder (bladder neck). The sphincter must then do all the work of maintaining continence, and the extra pressure (stress) of sneezing, coughing, or straining forces urine past the sphincter and through the urethra.
• Urge incontinence is caused by bladder contractions that are too strong to be stopped by the sphincter, causing an irresistible need to urinate. In many cases, the cause of urge incontinence and overactive bladder cannot be determined, but sometimes it can be traced to urinary tract infections, early BPH, interstitial cystitis, or early bladder cancer.
• Overflow incontinence is usually caused by a blockage of the urethra that forces urine to build up in the bladder. Often the blockage stems from an enlarged prostate gland (benign prostatic hyperplasia) or a narrowing of the urethra. Eventually the pressure from the full bladder forces excess urine past the obstruction. Overflow incontinence may also occur because of muscle weakness of the bladder.

Urinary incontinence can sometimes be aggravated by drinking alcohol or by taking diuretics, antidepressants, sedatives, narcotics, or nonprescription cold or diet medicines.

What are the symptoms?

The main symptom of urinary incontinence is the accidental release of urine. Additional symptoms will vary depending on the type of urinary incontinence.

• Stress incontinence: Unintentional release of a small amount of urine occurs with coughing, straining, lifting, or changing posture.
• Urge incontinence: The need to urinate is so strong that you cannot reach the toilet in time.
• Overflow incontinence: You have uncontrolled dribbling of urine, or you have the urge to urinate but can only release a small volume of urine.

How is urinary incontinence in men diagnosed?

Your medical history and a physical examination, along with some simple diagnostic tests such as a urinalysis, often provide enough information for your health professional to determine the cause of your incontinence. Additional tests called urodynamics may be needed if the incontinence is caused by more than one problem or if the cause is unclear.

How is it treated?

Incontinence is usually treatable with medicines, specific exercises, or surgery, after a health professional has determined what is causing the problem. Treatment varies based on the type of incontinence and how much it is affecting your life.

Incontinence can be an embarrassing problem, and men are sometimes reluctant to seek help. Some men might find it more of a problem than others and choose more aggressive treatment. Most men don’t require surgery to treat their symptoms. All men with symptoms of urinary incontinence should see their health professional.

During transurethral resection of the prostate (TURP), an instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow.

TURP usually requires hospitalization and is done using a general or spinal anesthetic.

What To Expect After Surgery

The hospital stay after TURP is commonly 1 to 2 days.

Following surgery, a catheter is used to remove blood or blood clots in the bladder that may result from the procedure. When the urine is free of significant bleeding or blood clots, the catheter can be removed and you can go home.

Strenuous activity, constipation, and sexual activity should be avoided for about 6 weeks. Symptoms such as frequent urination will continue for a while because of irritation and inflammation caused by the surgery, but they should ease during the first 6 weeks.

Why It Is Done

Your doctor may recommend TURP if symptoms caused by benign prostatic hyperplasia (BPH) have not improved in response to home treatment and medications.

TURP is now the most common surgery used to remove part of an enlarged prostate. Open prostatectomies (in which an incision is made into the abdomen) generally are needed only when the prostate is very large.

How Well It Works

On the average, men experience an 85% improvement in their American Urological Association (AUA) symptom index scores. For example, if you had a score of 25, after this surgery it might be reduced to about 4. Men who are very bothered by their symptoms are most likely to notice great improvement in their symptoms after TURP; men who are not very bothered by their symptoms are less likely to notice a significant change.

In men who have moderate to severe symptoms of prostate enlargement, TURP is more effective than watchful waiting in relieving urinary symptoms. Studies have found that:²

• 90% of men who had TURP had reduced symptoms compared with 39% of those who used watchful waiting.
• After 5 years, 10% of those who had TURP had a “treatment failure,” mainly an inability to urinate, urine left in the bladder, and an increase in the severity of symptoms. This compares with 21% of men using watchful waiting during the same period who had an increase in symptom severity or complications.

TURP and transurethral incision of the prostate (TUIP) had equal effectiveness.

Compared with visual laser ablation, TURP was more effective at relieving symptoms but required a longer hospital stay. Another laser treatment method, contact laser vaporization, is as effective at reducing symptoms as TURP.

Risks

The risks of transurethral resection of the prostate (TURP) include problems with sexual performance, incontinence, and problems from surgery.

Problems with sexual performance

• Erection problems may develop in men who did not have problems before the procedure. The risk of this may depend on how sexual performance is defined and measured, how sexually active the man was before the surgery, and how old he is. Many men in the age group who are likely to have BPH also have some problems with getting an erection. Subsequent erection problems are reported by about 3 to 34 men out of 100. Viagra (sildenafil) is effective in helping most men achieve an erection after they have had TURP.
• A study comparing TURP with watchful waiting and laser surgery indicated that men who had TURP were no more likely to have erection problems, pain on ejaculation, or a perception of an inferior sex life than men who either had laser therapy or practiced watchful waiting.
• Some older studies that reported high rates of erection problems in men after TURP may have failed to assess the sexual function of the men before surgery and may have had differing definitions of what an erection problem is, so they may have overestimated the numbers of men who had an erection problem as a side effect of TURP.
• Ejaculation backward into the bladder (retrograde ejaculation) is very common, occurring in about 25 to 99 men out of 100. This does not affect sexual function.

Loss of ability to control urine flow (incontinence)

• A small number of men (about 1%) say they are completely unable to hold back their urine after the surgery.
• Some men find that they can still hold in their urine after the surgery, but they tend to leak or dribble.

Problems related to having surgery

• About 4 out of 100 men require a blood transfusion during or after surgery.
• TURP syndrome occurs in about 2 out of 100 men who have TURP. This syndrome occurs when the body absorbs too much of the fluid used to wash the area around the prostate while prostate tissue is being removed. The symptoms of TURP syndrome include mental confusion, nausea, vomiting, high blood pressure, slowed heartbeat, and visual disturbances. TURP syndrome is temporary (usually lasting only the first 6 hours after surgery) and is treated with medication that removes excess water from the body (diuretic).
• About 5 out of every 100 men need the operation again after 5 years.
• Repeat surgery because of a complication of the surgery is needed less than 10% of the time.

What To Think About

Surgery usually is not required to treat BPH, although some men may choose it because their symptoms bother them so much. Choosing surgery depends largely on your preferences and comfort with the idea of having surgery. Things to consider include your expectation of the results of the surgery, the severity of your symptoms, and the possibility of developing complications from the surgery.

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 deciding to have surgery to treat BPH.

For men who have clear indications for surgery, TURP may be less effective than open prostatectomy in relieving the symptoms of BPH. (See the Surgery section of the topic Benign Prostatic Hyperplasia [BPH].)

About 10% of men who have TURP or open prostatectomy are found to have previously undetected early-stage prostate cancer. Cancer discovered this way generally is slow-growing, often requires no additional treatment, and will not be the eventual cause of death in most men. For more information on prostate cancer, see the topic Prostate Cancer.