Andrology and male fertility surgery

I assess before I offer anything, because trouble with erections is often the first sign of something else going on, and a repeat prescription can bury that. Where tablets and injections have stopped working, an implant is the option most men have never had explained to them properly. I am one of the highest volume penile prosthesis surgeons in the UK, implanting by both the infrapubic and the penoscrotal approach.

An erection that will not go down is a medical emergency. If it has lasted more than four hours, go straight to A and E or call 999. Do not wait for office hours, and do not wait for a call back: the tissue can be permanently harmed if it is left.

I look for the cause before I treat the number, because a low result can point at something worth finding. Treatment that starts without that step can settle the symptoms and hide the reason.

I do this under an operating microscope, as a day case. How long ago the vasectomy was changes what is realistic, so it is worth asking rather than assuming it is too late.

Local anaesthetic, and one puncture rather than a cut, so most men are back to normal within a few days. It is meant to be permanent, and I would rather talk it through with you than have you arrive unsure.

Not every varicocele needs an operation, and plenty are found by accident and best left alone. The ones I operate on are those causing pain, or that are showing up in a semen sample.

I try to find the site of the blockage, whether at the testis, the epididymis, the vas, the ejaculatory ducts or the seminal vesicles. If the site of the blockage is amenable to unblocking, for example at the ejaculatory duct, then I can perform a surgery to open it. Sometimes blockages cannot be rectified, and surgical sperm retrieval is required.

I scan it before I plan anything, because a swelling you can feel from the outside can be several different things underneath. Getting it looked at early usually means a smaller decision later.

If you have been told a lump might be cancer, the wait between the scan and someone sitting down to explain it is the hardest part, and I keep that gap as short as I can. Diagnosis and surgery, with a specialist team behind it.

Tightness, tearing or inflammation that keeps returning tends not to settle by itself once it has started, and men often put up with it for years first. I do this for a medical reason, or because you have decided you want it.

Lichen sclerosus, sometimes written as BXO, is a long-term skin condition of the foreskin and head of the penis, and the name is usually handed to you before anyone explains it. Treatment starts with an ointment and regular review rather than an operation. If the skin keeps tightening, splitting or scarring despite that, circumcision is what I would talk through with you.

Blood in the semen is frightening to see, and most of the time it is not a sign of anything serious. A low grade infection or inflammation is the usual cause, and it often settles by itself. I would take a careful history, examine you, test a urine sample and take some blood, and over the age of forty I would arrange a PSA blood test as well. If it keeps coming back, or there is anything else going on alongside it, that is the point at which I would look further by arranging a special scan rather than wait.

Much of what I see here has already been through one operation elsewhere, and that changes what is possible and what I would advise. It is worth a conversation before you decide nothing more can be done.