WE ARE ASKED IN CONSULTATION

Benign prostatic hyperplasia (BPH) is not a cancer nor does it increase the risk of developing it, therefore, it is not a dangerous disease in itself. However, if not treated properly, it can lead to major complications that do seriously affect health and quality of life. Among the possible consequences of uncontrolled BPH are: acute urinary retention (inability to urinate), recurrent urinary tract infections, bladder stone formation, progressive damage to the bladder or kidneys. Therefore, although it is not malignant, it does require medical attention and urological follow-up. With early diagnosis and appropriate treatment, BPH can be effectively controlled and complications avoided.

Depending on the treatment used, it may affect the patient's ejaculation. It is important to discuss this with the urologist.

If BPH is not treated in time, it can cause more serious complications such as bleeding in the urine. But it is more common in diseases such as urinary tract infection; bladder, prostate or kidney cancer; some kidney disease or injury, etc. It is vital to see a doctor as soon as possible.

The prostate helps us to maintain good urinary continence. It also produces much of the seminal fluid, which is like "gasoline" for the sperm.

Prostate cancer in its early stages usually has no symptoms, so the only way to detect it early is through medical check-ups. The main tests are the PSA blood test and digital rectal examination. In advanced stages, symptoms such as difficulty urinating, increased urinary frequency, blood in the urine or bone pain may appear. If you are over 50 years of age, or if you have a family history, it is advisable to see a urologist even if you do not have any discomfort.

Prostate cancer is curable, especially when detected in early stages. If the tumor is localized, cure rates exceed 90% with treatments such as surgery, focal therapy or radiotherapy. In advanced cases, although it is not curable, there are very effective therapies that allow it to be controlled for years. Early detection is essential to increase the chances of cure. For this reason, periodic urological check-ups are recommended from the age of 50 (or earlier if there is a family history).

Robotic surgery is recommended in a variety of situations where its advantages can significantly improve patient outcomes compared to traditional open or laparoscopic surgery. It is considered especially beneficial in complex procedures where high precision and surgical dexterity are required in confined spaces, in patients with comorbidities and/or when urinary or erectile function is sought to be preserved.

It is normal to bleed after a prostate biopsy for one to two weeks, depending on the type of bleeding. There may be blood in the urine, stool and/or semen.

No, a urine culture does not detect cancer, as its purpose is to identify urinary tract infections through the presence of bacteria. However, other urine tests, such as a urinalysis or urine cytology, may suggest the presence of cancer by detecting blood or abnormal cells in the urine. If there is suspicion of cancer in the urinary system, additional studies such as biomarker tests, ultrasound, CT scans or biopsies are required to confirm the diagnosis. If you detect blood in the urine with no apparent cause, it is essential to see a physician for further evaluation.

In general it is good. These tumors are usually diagnosed before they infiltrate the muscle, allowing the bladder to be preserved. The problem lies in the fact that it is a chronic disease that has recurrence and relapses over time. It requires many check-ups and treatments and the patient must adhere to them without skipping check-ups, which can lead to metastasis.

In general, when the tumors are muscle-invasive and have not moved, but are located in the bladder, the bladder must be removed and the urine diverted with a bag to the skin. In very selected patients and with specific characteristics of the tumor, different neobladder techniques can be used.

You have to live with it. It is true that it can be operated, but in the future it can reappear and therefore it is necessary to undergo check-ups to stop it in time. The key is to keep it under control.

Robotic surgery is recommended in a variety of situations where its advantages can significantly improve patient outcomes compared to traditional open or laparoscopic surgery. It is considered especially beneficial in complex procedures where high precision and surgical dexterity are required in confined spaces, in patients with comorbidities and/or when urinary or erectile function is sought to be preserved.

First we perform surgery to determine the type of tumor and its local extension. Then, depending on various factors, other treatments may be necessary.

This is a possibility, although it is not always the case. Many young men preserve sperm prior to surgery in order to have healthy sperm available when they consider having offspring.

It is a silicone prosthesis that is placed in place of the testicle so that the aesthetic impact is minimal. They are available in various sizes to place the type of prosthesis more in accordance with the anatomy of each person.

No, it is done with local anesthesia and does not hurt. Afterwards you may have some discomfort, but it is much less than you imagine.

The surgeon will try his best to make sure that this is not the case, with conservative treatments and surgeries.

Most likely it is nothing but it is best not to be overconfident. Penile tumor sometimes grows very slowly and gives few symptoms.  

Only in some cases, when the tumor is advanced.If the tumor is caught early, the treatment is much less aggressive. 

To know if a kidney cyst is malignant, it is important to perform a series of studies and medical evaluations. The most common steps to determine the nature of a kidney cyst are: Renal ultrasound: ultrasound can show the shape and size of the cyst, as well as the presence of any suspicious features, such as irregular walls or inhomogeneous fluid. Computed tomography (CT): If the cyst has suspicious features on ultrasound, a CT scan may be done to obtain more detailed images. This helps to identify if there are solid masses within the cyst or changes in the cyst walls that suggest malignancy. Magnetic resonance imaging (MRI): is useful to better characterize the cyst and may provide additional information about its composition. This is particularly useful if there is doubt after the CT scan. Bosniak classification: The Bosniak classification system is used to categorize renal cysts based on their appearance on imaging and help determine the risk of malignancy. Biopsy: In some cases, if the cyst is suspected to be malignant or if imaging tests are inconclusive, a renal biopsy may be performed to obtain a sample of the tissue and examine it under the microscope. In general, benign kidney cysts do not cause symptoms. However, if a cyst becomes large, it may cause pain in the back or abdomen. If the cyst is malignant, there may be additional symptoms such as blood in the urine, unexplained weight loss or fatigue.

Surgery is the standard treatment, achieving cure rates of over 90% in small tumors. There are various types of surgery depending on the size of the tumor, but whenever possible, the aim is to remove only the tumor, preserving the rest of the kidney and renal function.

Kidney cancer does not present symptoms until there is tumor growth. When tumor growth has already occurred, symptoms usually include pain, appearance of an abdominal mass or blood in the urine.

It is usually related to smoking and obesity. Although there are also other risk factors such as age or first-degree family history that may play a role.

When prostate problems are present, pain may manifest in various areas of the body depending on the specific condition and its severity. The most common causes of pain are prostatitis and advanced prostate cancer. The following are the areas where pain may occur: - In the perineum (area between the anus and the genitals): when there is prostatitis. - Lower abdomen, especially if there is urinary obstruction due to an enlarged prostate. - Lower back: in advanced prostate cancer, pain may radiate to the lower back due to bone metastases. It may also appear in chronic prostatitis due to persistent inflammation. - Groin and inner thighs: some prostate conditions may cause pain radiating to the groin or inner thighs due to pressure on nearby nerves. - Testicles and penis: some forms of prostatitis may cause pain in the testicles or base of the penis, as inflammation can affect nearby nerves and tissues. - Anus or rectum: The prostate is very close to the rectum, so inflammation may cause rectal pain or a feeling of pressure. It may be felt more when sitting for long periods of time.

Shock waves help regenerate blood vessels in the perineal muscles, which reduces prostate inflammation and muscle contractures and increases blood flow to the prostate gland.

Acupuncture improves the symptoms of prostatitis and can be considered an effective and safe therapeutic alternative.

In case of urinary fistula, either with the vagina or the gastrointestinal tract, involuntary urine leakage or gas emission through the urethra may occur. If not operated, these symptoms do not disappear. Occasionally, fistulas may close spontaneously by placing a bladder catheter, but surgical intervention is usually required.

If the fistulas are not operated, the probability of spontaneous healing is low, although sometimes they can close with the placement of a bladder catheter. However, the time required is not short, requiring several weeks.

Treatment ranges from conservative maneuvers such as bladder catheterization to the need for surgery. The type of surgery depends on the origin and size of the fistula and may require a vaginal, abdominal or laparoscopic approach. In cases of fistulas from the urinary tract to the digestive tract, a colostomy may be required, i.e. a bag to collect the feces.

In case of radiotherapy, fistulas usually have a more complex treatment. Radiotherapy is an effective treatment in multiple tumors and its complications are rare. However, on isolated occasions, especially in association with pelvic surgery, it increases the risk of development of fistulas from the urinary tract to the vagina or the gastrointestinal tract.

It seems that there are several genes that can increase the risk of having Peyronie's disease. In other words, it has a strong genetic component. On the other hand, some men explain that after an intense sexual intercourse -sometimes after a penile crunch- they began to feel discomfort.

No. Most commonly it is a plaque of fibrosis. It typically appears on the penis and is mildly painful on examination.

There are several treatments that can improve the incurvation, from non-invasive therapies to surgery. It is necessary to understand what stage of Peyronie's disease we are in and what symptoms we have in order to consider the best treatment for each case.

Yes, although as a last option. When there is a very important curve or Peyronie's is accompanied by erection problems, sometimes the only alternative is surgery.

The amount of use given to the prosthesis will affect its useful life. A sexually active man will find that over time the prosthesis becomes less effective. For this reason, it is recommended to have check-ups every 5 years.

30 minutes of daily physical exercise, a healthy and balanced diet and reducing stress can help improve the quality of erections.

Try to regain your self-confidence by confronting the problem. Walking away will only increase apprehension and prevent any form of intimacy with your partner. Be patient, regaining self-esteem is a gradual process. Savor the intimate moments as a couple and enjoy the preliminary moments.

When all other treatments have failed and the patient has no contraindications.

It is very easy. With a blood test (fasting and in the morning) we can study the state of the hormonal axis that regulates testosterone and androgens.

It is not recommended. It will cause you to stop producing testosterone on your own and become dependent on the medication. If you need testosterone, it is a very safe and effective medication; but taking it without needing it is a mistake.

Currently, in Spain, the best alternative is a testosterone gel that is applied every morning on the skin and, after some time, we can proceed to injectable testosterone.

Testosterone treatment in men with hypogonadism is very safe and has very few side effects. It has been shown not to increase the risk of heart disease or prostate cancer.

Premature ejaculation is defined as an intercourse time of less than 2 minutes. In Europe, studies suggest that the average intercourse time is around 5 minutes.

Yes, pelvic floor rehabilitation can help you gain more sexual control.

Approximately up to 85% of men improve. In our experience, it depends on the level of control at the start of treatment and the commitment of the patient.

In some situations there are surgical procedures that can improve intercourse time, although you need to know the pros and cons.

Yes, your ejaculate will be the same with the difference that it no longer contains sperm. But from the point of view of the macroscopic characteristics of the sperm, it is completely normal.

No, caution must be taken through some other contraceptive method in the relations until the next analysis that confirms that you can no longer have children. In general, a seminogram is usually performed 3 months after the vasectomy to ensure the results, and until that time it is possible to be fertile.

Yes, it is possible to reverse a vasectomy. However, undoing a vasectomy is a very complex procedure - called vasovasostomy - which succeeds in re-repermeabilizing the seminal duct only 50% of the time.

The most common side effect of vasectomy is scrotal pain, which usually subsides with anti-inflammatory drugs, although 1% of men have chronic pain, bleeding is very rare and infection is exceptional.

During the first days after vasovasostomy, it is advisable to lead a less active life. There is no need to rest, but intense physical activity and heavy lifting are contraindicated. As you feel better you will be able to progressively lead a more normal life. You will be able to resume physical activity after approximately 3 weeks, if the evolution is good.

After a vasovasostomy, it is recommended to abstain from sexual intercourse for a period of 3 weeks. This time allows for adequate healing and reduces the risk of complications, such as opening of the suture due to the intense muscle contractions that occur during ejaculation. It is essential to follow your doctor's instructions and attend follow-up visits to ensure optimal recovery before resuming sexual activity.

If everything goes well, you should be able to leave the same day. It is a technically complex and relatively long surgery, but once it is finished, you will be able to go home within a few hours.

If the vasovasostomy fails to repermeabilize the seminal duct, the next step is testicular biopsy to obtain spermatozoa. In fact, on many occasions these are two procedures that are performed simultaneously.

The semen analysis does not predict 100% fertility. Far from it, it indicates that there may be a problem in the man that decreases the risk of fertilization. However, with an abnormal semen analysis you can be fertile.

The 5 most useful tips are: do not smoke, do not drink alcohol, do intense physical exercise, take care of your diet (avoid processed foods) and avoid being overweight. All these factors improve your health and the probability of improving your fertility.

Infertility can be an emotional problem for the couple. In this matter, nothing is anyone's fault. Listen to how your partner feels without judgment and tell him or her how you feel.

It will depend on the quality of the semen analysis and the eggs. It will also depend on your age and whether there has been fertility at some point. No one technique is best for everyone. They all have pros and cons. So talk to your reproductive expert to understand the advantages and disadvantages of each strategy so that you can make a consensual decision.

It is not usual. Especially with malleable prostheses, which have less surgical material, the feel is practically normal. With inflatable prostheses there are a few more structures, although they remain discreet even during sexual intercourse.

Penile prostheses have an estimated average life of about 10 years and once this time has passed, the prosthesis can be changed with a surgery as simple as the first one.

Yes, sexual desire, orgasm sensation and ejaculation will remain the same. The penile prosthesis is responsible for providing a firm erection, but does not directly affect the ejaculation process. Therefore, the penile prosthesis allows you to regain erectile function and enjoy a satisfying sex life, without interfering with your ability to ejaculate.

The length of the penis is not increased. On the contrary, in some cases a shortening of 1-2 cm is observed. Some prosthesis models allow a 10% increase in size when activated, to try to counteract the loss of penile length caused by erectile dysfunction.

The symptoms of urethral stricture are very common to other diseases of the urinary tract or prostate. Therefore, to confirm the problem it is necessary to perform diagnostic tests.

This will depend on the location of the stricture, the length and the previous surgeries we have performed on the stricture. The first step is to perform an internal urethrotomy, but in many cases more aggressive surgeries will have to be performed.

No. Self-catheterization may be a marginal option in some patients but it is not an effective treatment to solve the problem in most people.

It may be due to congenital, inflammatory, infectious or traumatic reasons. It can also occur due to urethral tumors, dermatological diseases or medical procedures involving the introduction of an instrument through the urethra.

The loss of the renal unit can occur in those patients with stones that show few or no symptoms, since they grow silently and become large.

A person with kidney stones can do physical exercise and should do so, since it leads to an improvement in metabolism and is known to promote the elimination of solutes. It is true that physical activity will dehydrate more, especially if it is summer, having to hydrate more than usual because of the fluid lost in sports.

The postoperative period will depend on the type of intervention performed. If it has been treated with lithotripsy, the patient will not need hospitalization, since it is an outpatient procedure. However, if endoscopic surgery was performed, the patient is usually hospitalized for at least one day with a double J catheter in place to protect the kidney.

The double J catheter presents a series of side effects such as discomfort and irritation caused by the end of the catheter inside the bladder. In order to minimize them, in addition to medical treatment, we try to keep the catheter as short as possible.

Some substances such as caffeine, alcohol, spicy foods or carbonated beverages, among others, can worsen urinary incontinence, but we must always look for other causes.

Yes, there are protective measures to limit the extent of incontinence so that you can live as normal a life as possible, but our advice is always to get to the diagnosis in order to solve it.

Yes, it is very common. After the age of 40, a large percentage of men have urinary symptoms and that can be associated with incontinence. Get prostate checkups if you are over 50 or if you have any urinary symptoms.

Yes, there are different techniques depending on the cause of the incontinence and its severity. Generally, it is a last resort because there are other effective and safe options.

In general, pelvic floor exercises performed with a specialist in pelvic floor physiotherapy are recommended.

In general, an active lifestyle, avoidance of excess weight and assessment by a specialist in pelvic floor physiotherapy are recommended.

Basically, if in your day-to-day life, you involuntarily leak urine when you laugh, sneeze or strain.

Most patients with voiding urgency do not have urinary incontinence, but should consult a specialist.

Men also have symptoms of overactive bladder and specific treatment should be considered.

In addition to hygienic-dietary measures, there are specific oral and patch drugs for the treatment of overactive bladder. The use of botulinum toxin is also useful to manage overactive bladder.

In case of pelvic floor weakness and stress incontinence, surgery is performed for the treatment of stress urinary incontinence. However, in case of overactive bladder there is no clear surgical treatment.

Patients with overactive bladder show in the urodynamic study detrusor bladder muscle contractions during filling, which allows the diagnosis of overactive detrusor. In addition, the urodynamic study provides information on bladder capacity, the elastic capacities of the bladder, how bladder emptying works and the presence of stress urinary incontinence, among others.

Excessive discharge and itching. It does not usually cause the need to urinate frequently. The existence of back pain and fever may indicate that the infection is affecting the kidney and therefore, medical evaluation should be performed and appropriate treatment should be prescribed. In many occasions the management can be done at home with antibiotics.

No, UTI is not contagious. It is true that sexual intercourse is a risk factor for developing it, but it is not a contagious disease.

Drink plenty of water, avoid compulsively washing the genital area to avoid irritating it and favoring the appearance of urinary tract infection. Make sure you are well lubricated during penetration during sexual intercourse, empty your bladder completely at the end of intercourse, avoid spending too much time with a wet genital area at beaches or swimming pools, avoid using diaphragms or condoms without lubricant or with spermicide as contraceptive methods.