Andrology is the study of the male genital tract and we are a multidisciplinary practice based in Central London that specialises in the investigation and treatment of problems in this area. In addition, our sexual health physicians also deal with female sexual health issues. The main areas covered are as follows.
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In many couples with infertility the cause of the problem is the male partner and even where there are problems with the woman there can be additional male factors that warrant investigation and treatment. We work closely with the Assisted Conception Unit at University College London Hospital, offering investigation and treatment of the male partners. When there are no sperm in the ejaculate (azoospermia) it may be possible to offer reconstructive surgery though such men require careful investigation often with exploratory surgery. It is important that such surgery is performed by a surgeon who can perform microsurgical reconstructive surgery should this be necessary. In some cases reconstructive surgery is not possible, or desired, and in those cases an alternative approach is to surgically retrieve sperm from the man for use in an assisted conception cycle (“test tube baby”). This can either be performed at the same time as eggs are retrieved from the woman or in advance and the sperm frozen for future use. It is possible to combine reconstructive surgery with sperm retrieval. Clearly these various permutations require detailed consideration and discussion between the couple and clinicians with experience of all forms of treatment.
In many cases the lack of sperm in the ejaculate is because the man has previously had a vasectomy but later regretted this due to a change in circumstance. Vasectomy reversal surgery normally has a good chance of success if carried out by a suitably skilled surgeon. It is however essential that the surgeon offer a microsurgical approach as this will result in a better chance of success and will sometimes be essential. As with other causes of azoospermia men who have undergone previous vasectomy may prefer to have sperm retrieved for use in assisted conception either instead of or in conjunction with attempted reconstructive surgery. The chances of success will vary according to a range of factors such as the duration since the original vasectomy and the age of the female partner. In order to decide on the best form of treatment a couple need to be seen by a specialist who can examine the male partner and give the chances of success for the various forms of treatment based on his individual history.
Even when there are sperm in the ejaculate other male factors may cause problems with conception and we offer investigation into the full range of such factors. One such factor that may require surgery is varicocele (abnormal penile blood supply). Whether or not such surgery is beneficial is an interesting area of current research that needs to be discussed with each couple individually. Some men with varicocele however experience discomfort and may require surgical correction regardless of whether or not it is affecting their fertility.
This is a relatively uncommon form of cancer and our surgeons are closely involved with the Regional Centre based at University College Hospital. They offer thorough investigation and surgery in close coordination with their colleagues in other disciplines.
Peyronie’s disease is a relatively common benign condition of the penis whereby fibrous scars or plaques form within the erectile tissue. In the early stages these can be painful and in time may cause deformity of the penis due to greater shortening of one side of the penis than the other. In the early stages of the disease medical treatments may be of benefit in slowing down or reversing progression of the disease. We offer the full range including drug therapies and mechanical devices to stretch the affected tissues. Once the disease has stabilised then surgery can be offered if the residual deformity is such as to cause problems with sexual intercourse. Such surgery traditionally involves shortening the longer side of the penis to compensate for the scarred side. This is known as the Nesbit procedure. In addition to this technique we also offer procedures to increase the length of the shorter side of the penis using vascular or artificial grafts (Lue technique). Finally, if the man suffers from erectile dysfunction in addition to penile curvature then the implantation of a penile prosthesis will overcome both problems.
Some men are born with a bent penis. Thankfully such congenital penile curvature tends to be less severe than that caused by Peyronie’s disease and thus may be effectively dealt with by the simpler forms of reconstruction such as the Nesbit technique. Whether or not surgery is necessary and if it is then the choice of surgical approach does however need to be discussed on a case by case basis.
Other men have abnormalities of the penile suspensory ligament which can cause abnormal erections. In some cases this has been caused by an accident but often is a congenital condition (one that the man was born with). Our surgeons have pioneered corrective surgery for this condition.
Phalloplasty is the surgical creation of an artificial penis or phallus. This is most commonly performed in men who have undergone female-to-male gender reassignment. It is also required for men who have lost their penis through cancer or accident. Our unit has pioneered such surgery in the United Kingdom and offer a variety of surgical techniques. All techniques however require a series of operations and careful consideration of the best form of treatment is essential before starting treatment.
Thankfully there is nowadays much more awareness of the problem of erectile dysfunction than previously and most men have heard of the availability of drug treatments such as Viagra, Cialis and Levitra. However not all men will respond to such treatments and others will find them unsuitable for their particular circumstances. Such men require expert evaluation to determine the causes of the problem in order that the appropriate treatment can be provided.
We offer a wide range of investigations, by no means all of which will be required by every patient. Many will have already had their hormones tested but some will not. All men should have a detailed consultation and clinical examination at which time a full history will be taken. Often a test injection will be given to see if this enables the man to obtain an erection. Should this be the case then that can be offered as a form of therapy. If not then further investigation may be warranted such as colour Doppler ultrasound or monitoring of the overnight erections (NPT monitoring).
Nowadays there are a wide range of treatments that may be appropriate depending on the cause of the problem. These range from oral drugs (Viagra, Cialis, Levitra) to injections such as Caverject. Vacuum devices are an alternative to drug therapies and may work when drugs do not.
Shockwave therapy (eg ED1000) is a revolutionary treatment for erectile dysfunction. This is a non-invasive treatment which uses low intensity shock waves to stimulate formation of new blood vessels in the penis, thus increasing penile blood flow and helping men to achieve a stronger erection. The treatment takes place over a number of sessions, it is painless and no anaesthesia or sedation is required. Patients generally feeling a gentle “tapping” sensation, and there are no reported side effects.
Abnormalities of the penile vasculature that are amenable to surgery are rare but reconstructive surgery in such cases gives very good results. It is essential therefore for such patients to have expert assessment by the radiologists and surgeons working together to determine whether they are likely to benefit from such surgery.
If none of the other treatments prove of benefit then it is always possible to restore a man’s ability to have sexual intercourse by the implantation of a penile prosthesis. These give the penis enough rigidity to have sex and come in a variety of types. The simplest are the semi-rigid malleable prostheses but many men prefer the hydraulic devices that can be deflated when the erection is not required. Our surgeons have more experience of implanting these devices than any other centre in the UK.
There are a variety of conditions associated with ejaculation that can affect a man at various stages of his life. Of these perhaps the most common is premature ejaculation. This normally responds to relatively simple measures and often men with this condition find that relatively simple advice is all that is required to overcome the problem. It is however important that they have a full discussion with an expert to ensure that the correct diagnosis is arrived at. Some will require other forms of therapy and we offer a variety of treatments.
In contrast complete absence of ejaculation (anejaculation) can be due to a variety of causes some of which will respond to counselling or drug treatments and others that will require surgery. Thorough investigation is often required to determine the exact cause of the problem and hence the most appropriate form of therapy. When the anejaculation is due to previous surgery or trauma then the man will often have an otherwise normal orgasm and in that case the lack of ejaculate will only be a problem if fertility is required. Such men may benefit from surgical sperm retrieval as mentioned above.
Blood in the ejaculate (haemospermia) is a condition that requires thorough investigation to determine the cause of the problem. It may be the sign of underlying disease requiring treatment. Even when the condition is benign surgical correction may be required if the bleeding is such as to cause alarm or inconvenience.
Historically problems of female sexuality in areas such as arousal and desire have largely been ignored by the medical profession. Our physicians have a keen interest in research in this field and offer a coordinated approach to exploring such problems. It is essential that diagnosis is related to the individual needs of the patient and treatment tailored to her particular circumstances.
We offer a fast and convenient service to screen for and treat sexually acquired infections.
Both men and women can suffer from long term pelvic or genital pain of uncertain origin. Such conditions are notoriously difficult to manage but our Sexual Medicine specialists both have a keen interest in such problems and offer the full range of investigations. They work in close conjunction with their colleagues in other disciplines to investigate and treat each patient according to their individual circumstances.