What is Radical Prostatectomy?

Radical prostatectomy (or more appropriately titled ‘complete prostatecomy’) is the surgical removal of the entire prostate gland, a walnut-sized organ located just below the bladder. This procedure is often recommended for men diagnosed with localised prostate cancer (localised meaning the cancer is confined to the prostate) and surgery is a viable treatment option.

Why is a Robot Used? When is a Robot Not Used?

Robotic-assisted radical prostatectomy involves the use of a surgical robot to enhance precision and control during the procedure. This approach offers several advantages, including improved precision, smaller incisions, and potentially faster recovery times. However, there are instances where a robot may not be used, such as when there is no access to robotic technology or due to the surgeon’s preference or expertise. The pros of robotic-assisted surgery include enhanced precision, smaller incisions, and potentially faster recovery, while the cons are essentially limited to the increased cost of robotic systems.

Who is it for?

Radical prostatectomy is typically recommended for men diagnosed with localised prostate cancer. The decision to undergo surgery is based on factors such as the stage of cancer, the patient’s overall health, and the potential benefits of surgical intervention.

Are There Any Side Effects?

Like any surgical procedure, radical prostatectomy is associated with potential side effects. These may include erectile dysfunction, changes in ejaculation, incontinence (temporary or permanent), urinary issues, and potential impact on fertility. It’s crucial for individuals considering this procedure to discuss these potential side effects with their healthcare team.

What Happens to a Man After the Prostate is Removed?

The absence of the prostate may impact urinary and sexual function. Regular follow-ups are essential to monitor recovery and detect any potential recurrence of cancer. Patients should openly communicate with their healthcare team about any concerns or changes in their health post-surgery.

The impact of radical prostatectomy on sexual function involves several aspects, including erection, ejaculation, and climax. The surgical removal of the prostate and seminal vesicles affects ejaculation, leading to dry ejaculation as seminal fluid is no longer produced. The division of the vas also prevents the ability to father children. Erection is influenced by cavernous nerves, located close to where prostate cancer commonly arises. While preserving these nerves is possible, it may not always be advisable for cancer removal.

Recovery of erections, if nerves are spared, takes an average of 4 months, with improvement continuing for 2-3 years post-surgery. Despite recovery, erections may be slightly less firm than before, and individual outcomes vary based on age and pre-surgery erectile strength. The likelihood of recovering erectile function is over 80% with good surgical technique and appropriate rehabilitation, as indicated by independent questionnaire-based follow-ups.

How Painful is the Recovery?

While pain levels can vary, discomfort is expected after surgery. Pain management strategies are employed to alleviate discomfort and enhance the overall recovery experience. Patients should follow their healthcare team’s guidance on postoperative care and pain management.

How Does This Affect Life Expectancy?

Generally, the removal of cancerous tissue through radical prostatectomy can contribute to increased life expectancy. However, individual outcomes depend on various factors, including the stage of cancer, overall health, and adherence to postoperative care. Ongoing monitoring and follow-ups are crucial to track recovery progress and detect any potential signs of cancer recurrence.

Radical prostatectomy is a significant step in the treatment of localised prostate cancer. Understanding the procedure, potential side effects, and the recovery process is essential for individuals considering this option. Open communication with healthcare professionals and adherence to postoperative care guidelines can contribute to a smoother recovery and improved long-term outcomes.

For more information about Radical Prostatectomy and how it is performed by Dr Paul Cozzi please refer to this page.

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For a more detailed guide to Water Vapour Therapy and how it is performed by Dr Paul: see our attached PDF for more information.

What is WVT?

WVT, or Water Vapour Therapy, involves injecting sterile water vapor into the prostate gland using a handheld device. The procedure is designed to target and shrink excess prostate tissue, providing relief from bothersome urinary symptoms associated with BPH. The entire process can take up to three months, during which the injected water vapor causes the excess tissue to die off, eventually being reabsorbed by the body.

Why would someone undergo WVT?

WVT becomes a consideration when an individual experiences bothersome urinary symptoms related to an enlarged prostate. These symptoms may include frequent urination, urgency, weak or slow urine stream, increased frequency during the night, a feeling of incomplete emptying of the bladder, or difficulty initiating urination. WVT serves as a viable alternative to medications or more invasive surgical options.

What are the benefits of WVT?

1. Reduced Urinary Symptoms: WVT aims to shrink excess prostate tissue, alleviating pressure on the urethra and improving urine flow, thus reducing urinary symptoms.
2. Minimally Invasive: Compared to traditional surgical procedures, WVT involves a shorter recovery time and less discomfort.
3. Preservation of Sexual Function: WVT seeks to minimize the impact on sexual function, distinguishing itself from some other BPH treatments.

Is WVT effective?

Studies suggest that Water Vapour Therapy is effective in relieving symptoms associated with BPH. Long-term follow-up results indicate a high level of patient satisfaction, with over 95% reporting ongoing improvement in symptoms five years after the procedure.

Are there any side effects or risks?

While WVT is generally well-tolerated, like any medical procedure, it does carry some potential side effects:

• Common Side Effects (In a percentage of cases):
  • Painful urination (dysuria) – 17%
  • Blood in urine (haematuria) – 12%
  • Blood in semen (haematospermia)
  • Urinary tract infection – 4%
  • Inability to urinate or completely empty bladder leading to catheter reinsertion – 4%
  • Bladder spasms
  • Retrograde ejaculation – 4.4%
• Rare and Delayed Side Effects (In around 1% of patients):
  • Bladder neck scarring (requiring further surgery)
  • Bladder stone formation (requiring further surgery)
  • Scarring in the urethra (requiring further surgery)
  • Urosepsis – fever and temperature requiring re-admission to the hospital

Patients considering WVT should discuss these potential side effects with their doctor to make an informed decision.

Is there a link between BPH and prostate cancer?

BPH is a non-cancerous enlargement of the prostate, and having BPH does not increase the risk of developing prostate cancer. However, it is possible to have both conditions simultaneously. Regular check-ups and open discussions with your healthcare provider are crucial for monitoring prostate health and addressing any concerns.

In conclusion, Water Vapour Therapy represents a promising option for individuals seeking effective relief from the symptoms of an enlarged prostate. However, like any medical procedure, it is important to weigh the benefits against potential risks and consult with healthcare professionals to make informed decisions tailored to individual health needs.

In conclusion, Water Vapour Therapy (WVT) has emerged as a promising solution for those dealing with urinary issues linked to an enlarged prostate. The advanages of WVT include a minimally invasive approach and proven effectiveness.

While acknowledging potential side effects, the positive long-term outcomes, where over 95% of patients maintain symptom improvement five years post-treatment, underscore the reliability of WVT. It’s important for individuals considering this therapy to engage in open discussions with their doctor to make informed decisions based on their health profiles.

Additionally, the reassurance that having an enlarged prostate (BPH) does not increase the risk of prostate cancer emphasises the significance of regular check-ups and proactive conversations with healthcare professionals to monitor and address prostate health.

Water Vapour Therapy exemplifies a stride forward in providing effective and minimally invasive options for managing BPH. With a balanced understanding of its benefits and risks, individuals can collaborate with healthcare professionals to enhance their quality of life and urinary health.

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Have you recently been diagnosed with Peyronie’s Disease, or do you suspect you might have it? While Penile Curvature is not typically a cause for immediate concern, it can bring about pain and discomfort for some men. In this comprehensive guide, we aim to provide valuable information and support to anyone who may be dealing with this condition.

What are the symptoms

The most common sympton’s for those experiencing Peyronie’s disease include the following:

• Penile curvature – may develop a curve or bend during erections. For this reason the disease may also be known as ‘Curved penis disease’.
• Scar tissue: Plaque or fibrous tissue forms under the skin, often causing a lump or hard area.
• Erectile dysfunction: Some individuals may experience difficulties in achieving or maintaining an erection.
• Pain: Pain may be experienced, particularly during erections.
• Shortening of the penis: In some cases, Peyronie’s disease can lead to a reduction in penile length.

What does Peyronie’s Disease look like?

Peyronie’s Disease causes the penis to develop a curve due to scar tissue inside it. This condition makes the penis bend noticeably when erect, which can be upward, downward, or to one side. The bend can be mild or severe enough to make sex difficult. Sometimes, you might also feel hard lumps under the skin of the penis. These changes can cause pain, especially during erections. If unsure it is always recommended to consult your GP if you suspect you have Peyronie’s Disease. The video below demonstrates some of the visual clues commonly linked to Penile Curvature:

Who is likely to suffer from Peyronie’s Disease

Penile Curvature typically targets men aged between 40 and 70, with its prevalence highest within this age range. Additionally, certain risk factors have been identified, making it more common in individuals with a family history of connective tissue disorders and those who smoke.

How is it diagnosed

A physical examination of the penis provides an initial assessment, while ultrasound serves as a valuable tool for visualizing the plaque and scar tissue.

Does it get worse over time / can you ignore the problem?

Whilst Penile Curvature may worsen over time but it doesn’t always. It is important to not overlook the condition, as ignoring it could potentially lead to complications. We recommend taking immediate action and coming up with a plan for treatment with your GP if you suspect you have Peyronie’s Disease.

What are the causes

It’s not always clear, but it’s thought to involve trauma or injury to the penis as a primary trigger for Penile Curvature. Additionally, genetic predisposition, connective tissue disorders, and certain lifestyle factors like smoking may also contribute to the development of this condition. Understanding these potential causes can help individuals better manage and address their Peyronie’s Disease.

Is there any alternative/home based treatments

Penis traction devices have been known to offer assistance in reducing curvature in some cases. These devices are designed to gently stretch the penile tissues, potentially helping to alleviate the effects of Penile Curvature. In addition to traction devices, healthcare professionals may also recommend the use of topical gels or creams as part of the treatment plan. These topical applications can contain active ingredients aimed at minimizing discomfort and promoting healthier tissue in the affected area. When considering treatment options for Penile Curvature, consulting a healthcare provider for personalized guidance is essential to determine the most suitable approach for one’s specific situation.

Treatment options

Treatment options for Peyronie’s Disease include the following:

• Surgery: Surgical options include procedures to straighten the penis or remove the plaque.
• Nesbit’s Procedure
• Shockwave Therapy

What is the cost of treatment?

The cost of treatment or surgery for Peyronie’s disease in Australia can vary widely depending on factors like the specific procedure, location, and healthcare provider. However we would suggest the following as a guide:

• Out of pocket cost: Approx $3000
• Medicare Rebate: $600 Approx

Please note this does not include hospital, pharmaceutical and anaesthetist costs

Can viagra fix the issue

Partially, Viagra or similar medications may aid in improving erectile function, yet they do not address the underlying curvature resulting from Peyronie’s disease.

How much length is lost

The extent of lost length can fluctuate, contingent on the severity and placement of the plaque – every situation is different.

Does it affect erections

Yes – Peyronie’s Disease can lead to erectile dysfunction in some cases.

What can Peyronie’s Disease be mistaken for

Peyronie’s disease can sometimes be misinterpreted as several other conditions due to its variable symptoms. Initially, it might be mistaken for an isolated case of erectile dysfunction, as the curvature and deformity of the penis can affect its functionality. Additionally, Peyronie’s disease can be confused with various other penile conditions, such as congenital curvature, penile fracture, and, in rare instances, conditions like penile cancer, scleroderma, or other forms of fibrosis. Furthermore, it can share symptoms with genital warts, lipomas or cysts, and Balanitis Xerotica Obliterans (BXO), making an accurate diagnosis crucial for proper treatment and management.

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For a more detailed guide to Cystoscopy: see our attached PDF for Flexible Cystoscopy and Cystoscopy for more information.

Cystoscopy is a common medical procedure in Australia that involves the examination of the inside of the bladder using a thin tube with a camera attached to it. Here are some of the commonly asked questions about cystoscopy we see here at the clinic:

Why do I need a cystoscopy?

Cystoscopy is a diagnostic tool used to investigate urinary problems such as frequent urination, painful urination, blood in the urine, or abnormal urine tests. In our practice we find that Cystoscopy is used to identify and diagnose conditions such as bladder stones, bladder cancer, urinary tract infections, and enlarged prostate glands.

How is the procedure performed?

Dr. Paul Cozzi performs a cystoscopy as an inpatient procedure, meaning you will be admitted to the hospital. The procedure involves the insertion of a narrow tube through the urethra into the bladder. The tube is equipped with a camera that captures images of the bladder’s interior, allowing the doctor to examine the bladder wall and look for any abnormalities.

Is cystoscopy painful?

This procedure is performed under general anaesthetic so you will not feel any pain during the procedure. However after the procedure you may feel a slight stinging sensation when you urinate, but this should only last a day or two.

Are there any risks or complications associated with cystoscopy?

As with any medical procedure, there are risks associated with cystoscopy. However, these risks are rare and typically minor. The most common complications include urinary tract infections, bleeding, and difficulty urinating.

How long does the procedure take?

The length of the procedure depends on the reason for the cystoscopy and any findings during the examination. Generally, the procedure takes about 15-30 minutes.

Will I be awake during the procedure?

No. A cystoscopy is usually performed under a general anaesthetic, meaning you will be asleep.

What should I expect after the procedure?

After the procedure, patients may experience some discomfort or pain while urinating. We recommend drinking plenty of fluids to help flush out the bladder and reduce any discomfort. Patients may also notice some blood in their urine, which is normal and should subside within a few days.

When can I return to work after a cystoscopy?

Patients can typically return to work the day after the procedure, but this may depend on the nature of their job and any discomfort they may experience.

Can I drive myself home after the procedure?

No. You will someone to drive you home and stay with for 24 hours whilst you fully recover from the effects of anaesthetic.

How often do I need to have a cystoscopy?

The frequency of cystoscopy depends on the individual’s medical condition and the findings of previous examinations. We recommend that patients with bladder cancer have regular cystoscopies to monitor their condition and detect any changes or abnormalities.

Takeaway

In conclusion, this guide has provided a comprehensive overview of cystoscopy, a crucial urological diagnostic procedure. It covers the purpose, preparation, procedure, risks, and benefits. Cystoscopy allows for direct visualisation of the urinary tract, bladder and urethra, aiding in the diagnosis and treatment of various conditions. While risks exist, advancements in technology and techniques have improved accuracy and patient comfort. It is important to consult healthcare professionals for personalized advice.

For a more detailed guide to Cystoscopy: see our attached PDF for Flexible Cystoscopy and Cystoscopy for more information.

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What is Shockwave Therapy?

Shockwave therapy is a non-invasive medical treatment that has been used since the 1980s to treat various medical conditions. It involves delivering high-energy sound waves, also known as shockwaves, to soft tissue to promote healing and reduce pain. Shockwave therapy was originally used for the disintegration of kidney stones but has since evolved into a recognized treatment modality in orthopaedics, cardiology, and urology for conditions such as Erectile Dysfunction, Peyronie’s disease, and chronic pelvic pain.

Why would a doctor recommend Shockwave Therapy?

Shockwave therapy has been shown to be effective in the treatment of a number of conditions such as:

• Erectile Dysfunction
• Peyronie’s Disease
• Chronic Pelvic Pain

What are the benefits of Shockwave Therapy?

Shockwave therapy is an excellent alternative to surgery, as it is non-invasive and has a no risk of infection or complications. Additionally, it is significantly more cost-effective than surgery. Patients who undergo shockwave therapy can resume their daily activities immediately after treatment and do not require any special care. In fact you can even drive home after your Shockwave session!

What is the approximate cost of Shockwave Therapy per session?

The cost of shockwave therapy varies depending on the location and the number of treatments required, with an approximate cost of $250 per session.

Is Shockwave Therapy covered by Medicare?

At present, Shockwave Therapy is not covered by Medicare, although this may change in the future.

How effective is Shockwave Therapy?

Studies have shown that shockwave therapy is effective in treating the symptoms of urological conditions, with improvements often experienced during the prescribed course of therapy. Furthermore, at 12- and 24-weeks post treatment, symptoms had continued to improve. 

What is the difference between Focused and Radial Shockwave Therapy?

Focused shockwave therapy is a specific type of shockwave therapy that is commonly used for the treatment of urological conditions. It delivers shockwaves that are strongest at the focal zone, where they can target specific areas of the body more precisely. Radial shockwave therapy, on the other hand, delivers shockwaves that decrease in intensity as they transmit into the tissue.

Is Shockwave Therapy painful?

Most men describe Shockwave therapy as a painless experience. Shockwave therapy is generally considered to be a painless experience, with most patients reporting little to no discomfort.

Who should not get Shockwave Therapy?

People with a blood clotting disorder or those taking certain blood-thinning medications such as warfarin should discuss with their urologist whether focused shockwave therapy is suitable for them.

How many session are needed?

For the treatment of Erectile Dysfunction, Peyronie’s Disease, and Chronic Pelvic Pain Syndrome, the number of sessions required varies. Patients with Peyronie’s Disease typically require four treatments, one session per week. Those with Chronic Pelvic Pain Syndrome also require four treatments, one session per week. For Erectile Dysfunction, six treatments are typically required, with two sessions per week and a one-week interval between sessions or once per week for 6 weeks.

Takeaway

In conclusion, focused shockwave therapy is a non-invasive, cost-effective, and effective treatment option for urological conditions such as Erectile Dysfunction, Peyronie’s disease, and chronic pelvic pain. While more research is needed to determine the permanency of improved symptoms, patients who have undergone shockwave therapy have reported lasting results and increased satisfaction. If you are experiencing any of these conditions, talk to your urologist to see if focused shockwave therapy is right for you.

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What is Urolift? What does it do?

Urolift is a minimally invasive treatment for benign prostatic hyperplasia (BPH) also known as prostate gland enlargement and Involves the insertion of tiny permanent clips (device implants) into the enlarged prostate gland tissue using a telescope that goes into your bladder. The implants are placed between the inner and outer surfaces of the prostate so that they pull the obstructing lobes away from the urethra. They become incorporated into the prostate tissue within 3 months. 

Why choose Urolift? What symptoms does it help with?

Urolift is used to reduce urinary symptoms caused by BPH such as: 

• Frequent and urgent need to urinate 
• Difficulty starting urination 
• Slow (prolonged) urine flow 
• Increased frequency of urination at night 
• Stopping and starting flow while urinating 
• Feeling of incomplete emptying of bladder 

If you have any of the symptoms listed above then you could be a suitable candidate for the Urolift system.

Who does it benefit?

Urolift is suitable for men diagnosed with BPH but not middle lobe enlargement. 

How much does Urolift cost in Sydney? 

The following is an approximate guide only

Surgeons fee approximately $2425 

Rebate = Medicare + private health fund $557

*NB this does not include anaesthetist fees nor hospital accomodation fees. Hospital accomodations fees will usually be covered entirely by a private health fund. 

Are there any side effects?

Urolift has demonstrated fewer side effects compared to those typically seen with surgical therapies, but as with any interventional procedure, you may experience some of the following side effects: 

• Painful urination
• Blood in the urine
• Blood in semen
• Urinary tract infections
• Inability to urinate or completely empty the bladder

Other frequently asked questions

How painful is it? 

It is common to experience some temporary pelvic discomfort after the procedure. 

How long does it last? 

The follow up data on outcomes for 5 years+ demonstrates consistent results confirming effectiveness over the medium to longer term. 

Do you need a catheter after Urolift? 

Patients typically return home the same day after this procedure without a catheter. However in some cases a catheter may be required for the first night only. 

What is better urolift or laser? 

That is dependent on outcomes and determined case by case. The decision making process is a shared experience between Dr Cozzi and the patient after a full and thorough evaluation of the patient, his wishes and his individual anatomy. 

Benefits of Urolift 

• Urolift is the only BPH procedure that does not cause new and lasting erectile and ejaculatory dysfunction.
• There is no heating, cutting or removal of tissue during a Urolift procedure.
• It can be done in day surgery
• It’s minimally invasive 

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Our team at Dr Paul Cozzi has been treating Erectile Dysfunction (ED) for over 20 years and in that time we have seen a number of advancements in the field, with one of the more compelling options being Internal Penile Prosthesis (IPP). In our experience, Penile Prosthesis can be one of the most effective long term solutions for ED – particularly when other more conventional methods have already been eliminated. We have written this guide to try and help patients when researching their options regarding ED.

What does a Penile Prosthesis do? 

Put simply, An IPP inflatable penile prosthesis is a three-piece inflatable device implanted in to the penis to support an erection for as long as desired. It effectively allows the user to generate and maintain an erection when needed and then reverse this process when required. The device is easy to use and discrete, it has no visible components once inserted.

Who is a Penile Prosthesis for?

We would typically recommend an IPP to men who are suffering from chronic erectile dysfunction (commonly known as impotence). It is also important to note that, although highly successful an IPP (like all surgical procedures) carries risk and we would recommend that you try less invasive options first.

How does the device work?

• The pump is contained in the scrotum. By squeezing and releasing the pump the device moves fluid from the reservoir into the cylinders. The cylinders are inflated with the fluid and mimic an erection. The cylinders are rigid when inflated. 
• To deflate the device simply push the button on the pump. This will move the fluid back into the reservoir leaving the penis once again soft and flaccid.

How much does it cost? 

The price of a Penile Prosthesis is dependent on a number of factors which are summarized below:

• Surgeon’s fees are generally around $3-5k which includes an assistant if required. 
• Hospital fees are completely covered if the patient carries appropriate private health insurance (PHI) cover.
• The prostheses its self is fully rebated with the appropriate level of PHI. 
• For uninsured patients the device cost would be $10-13,000 depending on the brand and also the hospital the procedure is done at.
• Anaesthetists fees will vary from one anaesthetist to the next. You will be directed on how to obtain a quote from the assigned anaesthetist via your surgeon prior to surgery.

If the patient is uninsured, we recommend obtaining an estimation of fees from the hospital prior to surgery. This estimate of fees can be obtained via the surgeons’ rooms on the patient’s behalf. Alternatively, the patient can request it for themselves. Note: Hospital fees will vary from hospital to hospital for uninsured patients.

What rebates (Medicare) are available? 

The Medicare rebate for this procedure is between $1000-$1500

How long does it last?

The lifetime of an IPP depends entirely on how the device is used (ie how often). As a general guide we have observed that 5-10 years is reasonable with some men still happy with their devices’ function 20 years after the initial procedure. 

Do they increase size?

IPP’s do not increase natural length but implants that provide lengthening properties can assist in addressing the penile shortening that some patients may experience after prostate cancer treatment. 

Can a woman tell if a man has a penile implant?

Most patients report that they are very happy with the natural look and feel of the penile implant when flaccid or erect. Additionally – many partners of patients with IPPs report they wouldn’t know their partner had an implant if they had not known about the surgery. 

Will a penile prosthesis affect ejaculation? 

Generally an IPP does not interfere with ejaculation or orgasm. This is considered a minimally invasive surgery. 

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