Erectile problems


Difficulty achieving a satisfactory erection is very common, affecting 1 in 10 men, increasing with age. This can cause anxiety and relationship problems, yet is usually very treatable. There are many causes, including smoking, age-related circulation changes, diabetes, Peyronie’s disease, medications, pelvic surgery, psychological and in rare circumstances hormonal or nerve problems.

Assessment & Diagnosis

Assessment of the cause and severity of the problem is usually simple, with outpatient examination, urine and blood tests.


If any reversible cause is found, lifestyle modification and appropriate counselling are the initial treatment. There are now many treatment options, including oral medication, injection therapies, vacuum devices, and in rare cases surgical procedures.

Scrotal swelling


Many men at some point in their lives develop scrotal pain or swelling. Most swellings are benign (non-cancerous) but can cause worry and discomfort. Common swellings include fluid around the testis (hydrocoele), enlarged veins (varicocoele), infections of the testis, and cysts in the epididymis. Testicular cancer is rare but occurs in higher rates in men who testes came down late into the scrotum.

Assessment & Diagnosis

Assessment of scrotal lumps is simple, with physical examination and ultrasound scanning, giving prompt diagnosis and reassurance.


Most surgery to treat benign scrotal swellings is performed as a day case.

Family Planning


This is the most reliable form of contraception. This involves tying off the vasa tubes which carry the sperm from the testes. This is most commonly performed under local anaesthetic. This should be considered to be a permanent form of contraception.

Reversal of vasectomy

On rare occasions men who have undergone vasectomy wish to father (further) children. Surgery to rejoin the vasa tubes can restore fertility, but this is not guaranteed. Vasectomy reversal is carried out under general anaesthetic, either as a day-case or overnight stay. The tubes are carefully dissected out to give healthy ends, which are joined using micro-sutures. The success of surgery is dependent on the length of time since the original vasectomy, with pregnancy achieved in 80-90% of men having their vasectomies reversed within 5 years.

Microsurgical vasectomy reversal is recommended and uses a high-powered surgical microscope to magnify structures from five to 40 times their actual size. Use of an operating microscope provides better results, as it allows the urologist to manipulate stitches smaller in diameter than an eyelash, to join the ends of the vas. Mr Zaki Almallah at The Bladder Clinic offers this at BMI Priory Hospital, with other highly specialist assisted conception techniques.

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Peter Cooke

Mr Peter Cooke MB ChB MD FRCS England FRCS Ireland FRCS (Urology) is a leading urological surgeon and cancer specialist.

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