Welcome to Bayside Urology

Bayside Urology was established in 1995 as the combined urology practice of Dr Christopher Love, Dr Nicholas Redgrave, Dr David Dangerfield, and is based in the southern bayside area of Melbourne.

We aim to provide a high standard of comprehensive care for all patients with urological diseases, and take particular pride in utilizing new and advanced techniques.

We believe patient education, and good doctor – patient communication are both essential elements of our care, and together with our nursing, secretarial and reception staff aim to provide education, care and support in urological management.

Thank you for visiting this site which is designed to act as a resource for urology patients, and we hope that the information provided will assist in the management of your urological problems.

Dr Chris Love

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Dr Christopher Love, M.B., B.S, F.R.A.C.S. has been in private urology practice since 1987.

Areas of Specialty

  • Erectile Dysfunction
  • Penile Implant Surgery
  • Peyronie's Disease
  • Prostate Disease
  • Vasectomy (no scalpel technique)
  • Incontinence
  • Sexual Rehabilitation
  • Bladder Disease
  • Kidney Disease
  • Urinary Stone Disease

Dr Nicholas Redgrave

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Dr Nicholas Redgrave M.B, B.S. (Melb. 1985), M.S. (Melb. 1991), F.R.A.C.S. (Urol. 1993).

Areas of Specialty

  • Prostate Cancer
  • Stone management (Day stay in most cases)
  • Vasectomy Reversal
  • Vasectomy (Local anaesthetic and sedation – 40 minute turnaround)
  • Erectile Dysfunction
  • Voiding problems
  • Incontinence

Mr David Dangerfield

dangerfield

Mr David Dangerfield, MB., BS(Qld), FRACS(Urol)

Areas of Specialty

  • Prostate cancer
  • Kidney stone management
  • Uro-oncolgy inc. kidney,bladder &testicular cancer
  • Advanced Laparoscopic Surgery
  • Voiding dysfunction
  • Vasectomy
  • Erectile Dysfunction

Dr Chris Love

Dr Christopher Love, M.B., B.S, F.R.A.C.S. has been in private urology practice since 1987.

After graduating from Monash University in Melbourne in 1978, he did basic surgical training at Prince Henry’s Hospital, Melbourne. He completed advanced surgical training as a specialist urologist at St. Vincent’s Hospital, Melbourne and has also trained at Royal North Shore Hospital and The Prince Henry – Prince of Wales Hospitals in Sydney, Australia, and spent training time at U.C.S.F., San Francisco U.S.A.

Since completing training, Dr Love has held a variety of positions as a Visiting Urologist at Prince Henry’s Hospital Melbourne, Monash Medical Centre Melbourne, Sandringham and District Memorial Hospital and Mordialloc – Cheltenham Community Hospital.

He is currently the Senior Urologist at Monash Medical Centre in Melbourne, Australia, and a Visiting Urologist to West Gippsland Hospital, Warragul in rural Victoria, as well as running a busy private urology practice based in the bayside suburbs of Melbourne.

He is a:

  • Fellow of the Royal Australasian College of Surgeons
  • Full Member of the Urological Society of Australia and New Zealand
  • Corresponding Member of the American Urological Association Member of the Continence Foundation of Australia
  • Member of the Asia-Pacific Society for Impotence Research
  • Member of the International Society for Impotence Research
  • Member of the Societe Internationale d’Urologie
  • Corresponding member of the Sexual Medicine Society of North America

Dr Love has been actively involved in clinical research, education and teaching over his whole career, and has attended multiple international conferences, meetings and workshops, having been a presenter and facilitator at many of them.

He has lectured on, and demonstrated, surgical techniques throughout Australia and in the Asian – Pacific region, and has been a Scientific Advisor and Research Advisor to a number of pharmaceutical and surgical equipment companies locally and internationally.

Areas of Specialty

Dr Love’s interests in urology include general urology, stone disease, vasectomy and prostate diseases, both prostate cancer and benign prostatic hypertrophy (BPH).

His areas of special expertise and experience include the management of erectile dysfunction or impotence, Peyronie's disease, sexual and urinary rehabilitation after prostate cancer treatment, management of incontinence in both men and women, and the problems of the aging male, including androgen deficiency and men’s health assessments.

Dr Love is a major implant surgeon in Australia, particularly in the field of penile implants for treatment of erectile dysfunction, but also including slings and artificial urinary sphincters for the treatment of incontinence, and other areas of prosthetic urology such as testicular prosthesis. www.loveurology.com.au

He also has an ongoing interest and involvement in the use of new technologies and minimally – invasive techniques in urologic surgery.

Dr Nicholas Redgrave

Dr Nicholas Redgrave M.B, B.S. (Melb. 1985), M.S. (Melb. 1991), F.R.A.C.S. (Urol. 1993)

Nick Redgrave completed his basic medical and surgical training in Melbourne in 1985 and was awarded the TF Ryan Medal in Clinical Medicine, and later completed Master of Surgery after a year of performing microsurgery and writing a thesis regarding kidney transplantation. He completed Urological surgery training in 1993 and received the Keith Kirkland prize in Urology. He then undertook a fellowship at the Institute of Urology in London, receiving advanced training in Reconstructive Urology and Andrology before returning to Melbourne to commence Practice at Bayside Urology and to join Monash Medical Centre as a consultant urologist in 1995. He is now a senior urologist at Monash Medical Centre as a specialist there in reconstructive and cancer surgery.

He is a member of the Urology Society of Australasia, the American Urological Association, the AMA and has been on the Medical Advisory Board at Como Hospital for over a decade. He was on the Victorian Urological Training, Accreditation and Education Committee for six years. He still has an active involvement in urological training.

He has an interest in management of urological cancers, especially prostate cancer, with extensive experience in prostate cancer surgery. He has wide experience in complex reconstructive urology.

He has extensive experience in microsurgical vasectomy reversal and local anaesthetic vasectomy.

Areas of Specialty

  • Prostate Cancer
  • Stone management (Day stay in most cases)
  • Vasectomy Reversal
  • Vasectomy (Local anaesthetic and sedation – 40 minute turnaround)
  • Erectile Dysfunction
  • Voiding problems including management of prostate obstruction
  • Incontinence

He feels communication is of paramount importance.

He calls patients personally with test results as they come to hand, as new information often results in new queries and concerns, best answered and allayed immediately.

Prompt correspondence with referring practitioners is also a cornerstone of his practice.

He can offer appointments for new patients within 2 week in most cases.

He uses direct fund billing for insured patients where available, so most insured patients receive no bills for surgical procedures.

Mr David Dangerfield

Mr David Dangerfield, MB, BS(Qld), FRACS(Urol)

After attending Haileybury College, David began a Bachelor of Science at Melbourne University. He was then accepted into Medicine at the University of Queensland and completed his qualification in 1999. He was awarded the prize for medicine whilst attending St John's College. His basic and advanced surgical training was undertaken at the Princess Alexandria, Royal Brisbane and Gold Coast Hospitals. He completed a fellowship in Uro-oncology at Monash Medical Centre in 2008 before being invited to remain for his laparoscopic expertise.

He has recently completed a term as the coordinator of Urological training at Monash, representing the hospital at the Royal Australasian College of Surgeons. He is a member of the Urology Society of Australia and New Zealand, the American Urological Association, the Australian Medical Association and represents Urology on the Medical Advisory Board at Brighton Cabrini Private Hospital.

Mr Dangerfield has gained advanced training in minimally invasive techniques for treatment of urological cancers - kidney, bladder, prostate and testicular

Areas of Specialty

  • Prostate cancer
  • Kidney stone management
  • Uro-oncolgy inc. kidney, bladder & testicular cancer
  • Advanced Laparoscopic Surgery
  • Voiding dysfunction
  • Vasectomy
  • Erectile Dysfunction

Mr Dangerfield consults at multiple locations throughout the south eastern suburbs (Brighton, East Bentleigh, Mentone, Berwick, Frankston, Waverley) and will soon begin consulting in Warragul.

He offers short waiting times, usually within a week, with allocated sessions for urgent referrals. His major surgery is performed through Cabrini Private Hospital. He has access to an operating theatre on a daily basis for emergencies including renal colic, for all patients.

Services

Dr Dangerfield admits patients to Cabrini Private Hospital, Como Private Hospital, Waverley Private, Frankston Private, The Valley Private, St John of God Berwick as well as Monash Medical Centre. He has access to an operating theatre on a daily basis for emergencies.

Dr Dangerfield's special interests

  • Prostate Cancer
  • Kidney Stone management
  • Uro-oncology
  • Advanced Laparoscopic Surgery inc. nephrectomy, partial nephrectomy and pyeloplasty
  • Voiding Dysfunction
  • Vasectomy
  • Erectile Dysfunction

Services

Dr Love and Dr Redgrave work in association as private urologic surgeons, covering the whole field of urology – diseases of the kidneys, bladder, prostate and male genitalia.

Dr Love and Dr Redgrave are graduates of Monash University and University of Melbourne respectively, and are trained in Australian hospitals and both also have international training and experience.

Both Dr Love and Dr Redgrave are Fellows of the Royal Australasian College of Surgeons and Members of the Urological Society of Australia and New Zealand.

Dr Love admits patients to Como Private Hospital in Parkdale, Cabrini Brighton Hospital, Monash Medical Centre Moorabbin Campus, and West Gippsland Hospital and Neerim South District Hospital in Gippsland.

Dr Redgrave utilizes Como Private Hospital in Parkdale, Peninsula Private Hospital in Frankston, Beleura Hospital in Mornington, and South Eastern Endoscopy Centre in Cheltenham.

Dr Dangerfield admits patients to Cabrini Private Hospital Brighton & Malvern, Como Private Hospital in Parkdale, Frankston Private Day Surgery, St. John of God Berwick and West Gippsland Hospital in Warragul.

Areas Covered

Dr Love and Dr Redgrave, working together as Bayside Urology, cover the whole field of urology and are able to treat all urology conditions such as:

  • Kidney — cancer, obstruction, stones
  • Bladder — cancer, bleeding, obstruction, infection, incontinence, control
  • Urethra — stricture, blockage, reconstruction
  • Prostate — cancer, benign enlargement
  • Penis — erectile dysfunction, correction of curvatures and Peyronie’s disease
  • Testes – cancer, torsion, infection, infertility, vasectomy, vasectomy reversal

Dr Love's special interests

  • Erectile dysfunction or impotence
  • Peyronie's disease
  • Sexual and urinary rehabilitation after prostate cancer treatment
  • Incontinence treatments in both men and women
  • Vasectomy (no scalpel technique)
  • Problems of the ageing male, including androgen deficiency and men’s health assessments
  • Urinary Stone Disease

Dr Redgrave's special interests

  • Prostate Cancer
  • Stone management (Day stay in most cases)
  • Vasectomy Reversal
  • Vasectomy (Local anaesthetic and sedation – 40 minute turnaround)
  • Erectile Dysfunction
  • Voiding problems
  • Incontinence

Dr Dangerfield's special interests

  • Prostate Cancer
  • Kidney Stone management
  • Uro-oncology
  • Advanced Laparoscopic Surgery inc. nephrectomy, partial nephrectomy and pyeloplasty
  • Voiding Dysfunction
  • Vasectomy
  • Erectile Dysfunction

young couple

Facts

Here you can find more information about some of the conditions treated by Bayside Urology.

If you would like to discuss any of these conditions further or if you would like to know more about treatment options, please feel free to contact Bayside Urology here.

Erectile Dysfunction ( Impotence )

Erectile dysfunction (ED) is defined as the inability to achieve and/or maintain an erection that is suitable for penetration. Erectile dysfunction is often referred to as “impotence”,however this term is no longer used very often.

ED is more common in older men, but even one third of men over the age of 50 complain of erectile difficulties so it can occur at younger ages. The firmness of the erection changes with age and the delay in the ability to have another erection increases up to a number of days in older men.

An erection is obtained by the spongy tissues in the penis becoming engorged with blood. This process is started by a signal from the brain that travels down the spinal cord through the pelvis causing blood vessels in the penis to dilate or open up. There are chemical factors involved in this process and there is also an important mechanism that traps the blood in the penis,known as the veno-occlusive mechanism. When this does not work effectively the leakage of blood is known as venous leakage and it is difficult to obtain or maintain a hard erection. This commonly occurs when anxiety is present during sexual activity or as a consequence of age and the effects of other medical conditions such as diabetes.

The presence of ED in a younger man may be due to psychological causes or in some cases due to a congenital anomaly in the penile erection tissue or blood vessels.

The causes of ED may involve conditions of the brain and nervous system, the arteries and veins in the penis and the actual penile spongy tissues thenselves. Some medications used to treat medical conditions may affect the erection process and these include blood pressure and cholesterol lowering tablets. Conditions such as high cholesterol, high blood pressure, diabetes and obstructive sleep apnoea may be associated with erectile dysfunction, particularly as these are associated with poor blood flow or vascular disease Peyronie’s disease may affect erections. Excessive alcohol intake and substance abuse are other known factors.

Treatment of erectile dysfunction may simply involve counselling and explanation of the normal anatomy and physiology of erections so that men have a better understanding of why they have the problem. ED may be associated with other vascular or blood flow conditions, particularly in the older man, so it is important to carry out a full general health check including the heart. Overnight erection testing may assist in establishing in a younger man whether the cause is physical or psychological. A common and popular treatment these days is the use of oral medications known as PDE5 inhibitors. The current products available on the Australian market include Viagra™, Cialis™ or Levitra™ tablets. These medications are effective in many situations but cannot be used if the patient is not fit enough to engage in sexual intercourse and/or is on nitrate medication.

When oral medication is not effective, penile injection therapy may work. The injection is self administered into the shaft of the penis, the dose needs to be carefully regulated so that a prolonged erection (priapism) does not occur. The chemicals injected may vary from a single chemical called prostaglandin (PDE1) or alprostadil to a compounded triple mixture that contains PGE1, phentolamine and papaverine.

A vacuum erection device is a non-invasive treatment that allows an erection to occur by creating a vacuum with a plastic cylinder placed over the flaccid penis.

In some cases these treatments are not effective nor acceptable to the patient, or he is looking to have his problem fixed. A very good treatment option in this case is to insert a penile prosthesis. These implantable devices are completely contained within the penis, and give a very hard normal appearing erection that is controlled by the patient and can be used as frequently as desired. They are very quick to inflate so the “spontaneity” of normal sexual activity is restored. This operation is performed by a urologist.

Vascular surgery is mainly performed in younger men when trauma has damaged the blood vessels leading to the genitals, and is rarely used.

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Prostate Disease

The prostate is a variable sized gland located in the male pelvis, usually the size of a walnut measuring 3-4cm long and 3-5cm wide. On average the gland weighs about 20gm. The prostate surrounds the urethra which carries urine from the bladder to the penis. The seminal vesicles attach to the prostate and produce material that mixes with the prostatic fluid to form semen. The tubes from the testicles carry sperm to the prostate where the sperm are mixed with the prostate and the seminal vesicle fluid. The fluid is then ejaculated during orgasm by a connection to the urethra called the ejaculatory ducts.

Prostate disease is a term used to describe any medical problems involving the prostate gland. Common prostate problems experienced by men include:

  • Prostatitis which is inflammation and swelling of the prostate gland.
  • Benign prostatic hypoplasia (BPH) which is a benign (non-cancerous) enlargement of the prostate gland.
  • Prostate cancer.

Prostatitis tends to be a condition in younger men. BPH commonly occurs as men age. Prostate cancer is now the most common form of cancer in men in Australia.

BPH is one of the most common diseases affecting the prostate and is the most common benign tumour in men as they get older. This condition is present in 50% of men over 50 years. The symptoms involve noticeable changes in urination due to the effects of enlargement of the prostate around the urethra. The urinary symptoms may be obstructive (weak stream, dribbling, inadequate emptying) or irritative (urgency, frequency urination through the night). The prostate can be assessed by a digital rectal examination where a gloved and lubricated finger is inserted into the anus. The back of the prostate can thus be felt and an assessment of its size may be possible. This digital examination may also feel a cancerous lump though not all prostate cancers are palpable in this manner.

The PSA blood test (prostate specific antigen) is an important marker of prostate cancer though it is not cancer specific. It may also be raised in benign enlargement or prostatitis. Normal values for PSA blood test results are available for different age groups.

Treatments for benign enlargement of the prostate range from watchful waiting to medication to surgery. Medications derived from plants have shown some benefit, for example, Saw Palmetto. Prescription medications may reduce the symptoms of prostatic obsctruction, yet often this is only a temporary relief. Transurethral surgery of the prostate is a minimally invasive way of treating prostatic obstruction, usually requiring just a two day visit to hospital. GreenLight laser is now the more modern way to treat benign prostate enlargement, enabling a TURP-type operation with minimal risk of bleeding, even when taking blood-thinning drugs, and sometimes involving only day-surgery.

Treatment of prostate cancer is complex and the decision on the most appropriate treatment involves many factors including patient age, tumour characteristics and patient preference. The choices are watchful waiting, radical prostatectomy, radiotherapy, brachytherapy and chemotherapy. Decisions regarding the most appropriate treatment require close consultation with your urologist.

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Stone Management

Urinary tract stones are a common problem with 14% of men and 8% of women developing them at some stage. They can be a cause of severe pain and discomfort, but fortunately can usually be treated with minimal interference to lifestyle in most cases as a day stay in hospital.

Small stones in the kidney may often be observed if they cause no symptoms. However if they cause pain or discomfort they may be disintegrated with sound waves using an extra-corporeal shock wave lithotriptor as a half-day visit to Como hospital, with return to fully normal activities normally the next day.

Stones in the ureter, or the tube between the kidney and bladder, can be a cause of severe pain. Stones may pass spontaneously, but if the fail to do so or are causing severe symptoms, a ureteroscopic stone removal or disintegration may be performed as a day procedure. In this procedure a very fine telescope is passed through the urethral opening all the way to the stone under a short anaesthetic and the stone is removed or disintegrated. Again most patients return fully to normal activities in a day or two.

Large stones in the kidney, especially those associated with urinary infection, sometimes need removal with a fine telescope passed directly though the skin of the back into the kidney. Although this is also a minimally invasive operation, it does require usually a two day visit to hospital and two weeks avoiding strenuous activity.

Bladder stones can cause a lot of bothersome voiding symptoms, but again can usually be treated with telescopic disintegration though the natural orifice.

Open surgery for stone disease is very rarely required.

Patients having recurrent episodes of stone disease can often be helped with medications and specific dietary advice to reduce the risk of stone recurrence.

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Peyronie's Disease

Peyronie’s disease is a localised area of abnormal scar tissue or fibrosis that appears as a plaque or nodule in the penis. The cause is unknown but probably involves genetic changes and low-level trauma to the penis.

These plaques occur in about 1% of men over 50 years of age. A plaque when mature is painless and often associated with curvature of the erection. Most plaques occur on the top of the penis. Patients present with pain, a lump in the penis, a curvature of the erection or erectile dysfunction.

Peyronie’s disease has two distinct phases. The acute phase lasts 12-18 months and may be associated with pain during erection. Nodules form and a curvature may slowly develop. The chronic phase involves thickening of the scar tissue and the absence of pain. The curvature may improve, stay the same or deteriorate. The presence of calcification within the plaque indicates a poorer outcome.

These plaques arise from mild trauma associated with mechanical strain of the erect penis during intercourse. This effect is commonly seen with the partner in the superior position. The exaggerated localised scarring response may be genetic (HLAB27) and associated with scarring in the hands. Penile injection therapy to help to obtain an erection may also predispose to this scarring.

Erection problems may occur in 20% of men with Peyronie’s disease. This may arise from a performance anxiety due to the pain and visible bend or due a physical cause when penile blood vessels are affected by the plaque.

No treatment is required with minimal deformity, no pain and no discomfort. There is no consensus on the best treatments for Peyronie’s disease. Many treatments are anecdotal and not evidence based.

However, when the plaque presents as a painful lump, the pain may be improved by oral medication using colchicine tablets (an anti-inflammatory used for the treatment of gout). Vitamin E can be taken orally and also applied to the skin of the penis. Oral acetyl-L-carnitine and L-arginine are also used. An oral prescription medication oxypentifylline (Trental) has been used with some apparent benefit.

Various chemicals can be injected into the plaque such as cortisone, verapamil , collagenase and interferon.

Penile traction devices may assist to improve the shortening and curvature that Peyronie’s disease may cause.

Three surgical procedures are available to straighten the penis if the bend interferes with penetrative intercourse. However, surgery will not improve the rigidity of the erection if there is already a pre-existing problem with the rigidity. Surgery is only considered if the Peyronie’s has been present for 12 months and stable for 3 months.

The first operation is a plication operation (Nesbitt procedure). It involves shortening the “long” side of the penis to get it straighter but it may cause slight shortening of the erection.

The second operation involves incision of the plaque or scar tissue and grafting of another material into the incised areas and is more complex and has slower recovery but has less effect on penile length.

The third operation is the insertion of a penile implant which is an excellent choice if the patient has a severe curvature and failure of the strength of the erection..

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Incontinence Management

Incontinence of urine is a common problem which causes a lot of inconvenience and distress and interferes with day to day activities impacting quality of life.

There are several types of incontinence.

Urge incontinence is caused by bladder overactivity, which may come out of the the blue with no apparent cause, or be associated with neurological conditions (such as Parkinson’s disease, stroke or multiple sclerosis), or associated with bladder outflow obstruction (such as that caused by prostatic enlargement).

Patients with urge incontinence have frequency, urgency- needing to rush to the toilet- and often don’t make it to the toilet in time, flooding urine before reaching the toilet.

Urge incontinence may be helped with bladder retraining exercises and medications. In recent years the options for medications have expanded considerably. Occasionally a simple day procedure can help, injecting the bladder with Botox though a telescope. Rarely, more major operations may be necessary to help severe cases of bladder overactivity.

Stress incontinence is caused by weakness of the sphincter mechanism which holds urine in. Patients with stress incontinence leak urine when they cough or sneeze or lift weights.

Stress incontinence is very common in women after childbirth and with advancing age and change of life. It can often be helped with pelvic floor exercises, but if this fails, a very simple, minimally invasive sling procedure is effective in most cases, usually just requiring an overnight visit to hospital.

Stress incontinence also occurs in men, usually it follows previous pelvic surgery. Again it often responds to exercises, but occasionally an overnight hospital visit for a sling procedure is required.

Very severe cases of stress incontinence can be treated with implantation of an artificial urinary sphincter.

Overflow incontinence occurs when the bladder is full all the time and doesn’t empty. Like an overfull bucket, fluid leak is a continuous dribble, often worst at night. Overflow incontinence can be caused by severe bladder outflow obstruction or failure of the bladder to contract normally. Treatment involves relief of any obstruction, or medication to stimulate the bladder and/or intermittent drainage of the bladder with a clean catheter by the patient a few times a day.

True or anatomic incontinence is rare and occurs when urine is bypassing the sphincter mechanism. Examples include a fistula or communication between the bladder and the vagina or congenital ectopic ureter. Cases of this type almost invariably require major surgery to correct.

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ANDROGEN (TESTOSTERONE) DEFICIENCY

The most important androgen in men is testosterone. Androgens are the sex steroids or hormones that produce changes in body shape and sexual characteristics typical of men after puberty. Androgens play a major role in the reproductive and sexual function of the adult male. The equivalent sex steroid produced by women is oestrogen.

Androgen deficiency occurs when reduced levels of testosterone arise from a lack of hormonal drive from the brain or problems with the testes. Replacement of testosterone may be given to such men and this is usually continued for life.

About 1 in 200 men under 60 years of age suffer from androgen deficiency. However as men age, testosterone levels begin to fall from the age of 40 years. It is believed that by the age of 65 years, 10% of men will have androgen deficiency and by the age of 70 this figure will have risen to over 20%.

Men's testosterone levels fall much more gradually and over a longer period of time, unlike women, whose oestrogen levels fall rapidly when they go through the menopause.

Men with low testosterone complain of a number of symptoms including easy fatigue, low energy levels, low mood, irritability, poor concentration and reduced libido. Low testosterone may also contribute to erectile problems though androgen deficiency is an uncommon solitary cause of this. As men age, the amount of body fat increases and muscle mass and strength decreases. A fall in testosterone levels is likely to contribute to these conditions. Low testosterone levels are also a risk factor for the development of osteoporosis.

It is difficult to diagnose androgen deficiency in older men purely on the basis of symptoms. Medical research is still needed to develop ways to identify older men who may be at risk of having androgen deficiency. As men age any significant medical illness can cause a fall in the level of testosterone but these levels usually recover when the illness has been treated.

Replacing testosterone in older men who have a very low testosterone has been shown to have a number of benefits on body fat, muscle, cholesterol and bone density as well as an improvement in quality of life.

— Acknowledgement: Andrology Australia.

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The ageing male

Reproductive and sexual health changes occur as a man gets older. These changes involve fertility, hormone levels, prostate health and erectile function.

Fertility

Sperm counts decline with age and the ability of an older man to father a child declines.

Hormones

Testosterone levels begin to slowly fall from the age of 40 years onwards.

The fall is not as dramatic as the drop in oestrogen that occurs in women at the menopause. Whilst low testosterone may result in a decreased libido, ageing men are at risk of osteoporosis and decreased muscle mass.

Tiredness and irritability may also be a feature of low testosterone.

Ongoing research is aimed at establishing at what level men should be treated with testosterone and at what dose. There is still no general consensus on this issue at this moment in time.

Prostate

The commonest change with the prostate gland in the ageing man is benign enlargement. This may affect urine flow. A less common change is prostate cancer which may present with the same symptoms as benign prostate disease or no symptoms at all. Regular prostate checks over the age of 50 years is recommended.

Erectile Dysfunction

Erectile dysfunction increases with age. This may be exacerbated by the presence of medical conditions such as high blood pressure, high cholesterol and diabetes. Many new treatments have been developed for erectile dysfunction.

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Sexual Rehabilitation following treatment for prostate cancer

The main treatments for prostate cancer are radical prostatectomy (open, laparoscopic, robotic), radiotherapy, brachytherapy and HIFU.

The sexual dysfunctions that may occur after these treatments include erectile dysfunction, loss of ejaculation, shortened penis and passing of urine during orgasm. Loss of libido occurs particularly when anti-androgen hormone therapy is used to treat prostate cancer.

The outcome of sexual function after treatment depends on the age of the patient, the level of sexual function present before treatment and in the case of surgery, the sparing of the nerve bundles (better outcome if both sides are spared). The other important factor is to keep the penis “healthy” after cancer treatment to maximize the chance of return of erections, the so-called “use it or lose it” approach.

Surgery tends to result in immediate loss of erections which then hopefully will improve over time, whereas the other treatments may result in a delayed loss of erections, up to 6 months after treatment.

Sexual rehabilitation addresses these sexual dysfunctions, especially erectile dysfunction, that men may experience as a result of treatment for prostate cancer. It is an important part of the holistic care of men undergoing treatment.

There is evidence that the earlier the erectile dysfunction is treated, the better the chance of a return of erections. This is because the lack of erections for a prolonged period of time causes changes to occur in the structure of the penis so that it may not be able to respond with a normal erection. If natural erectile function returns after treatment, the quality of the erections may not be as good as in the past. Erections may take up to 3 years to recover, but usually a good indication of the outcome is seen at 6 - 12 months.

Erections can be induced within 2 to 3 weeks of surgery with penile injection therapy using prostaglandin E1 (PGE1). The penis is injected with a low dose of PGE1, about 2.5 to 5 mcg once or twice a week, whether sexual activity occurs or not. The early and regular "exercising" of the penis to erection has been shown to help the return of erections (but only when the nerves have been saved).

PGE1 injection treatment has been safely used for many years but sometimes its use is painful due to a "chemical" pain. Care must be taken with the amount injected to avoid a prolonged erection and there is a risk of scarring occurring in the penile tissues.

This "exercising" regime allows oxygenation of the erection tissues thus minimising the risk of deterioration of these tissues due to lack of use and low oxygen (hypoxia) levels. If there appears to be an improvement in natural erections whilst on PGE1 therapy, oral treatment can be tried about every 3 months.

The oral treatments are known as PDE5 inhibitors, there are 3 available (ViagraT, LevitraT and CialisT). The tablets are swallowed about 1 hour before planned sexual activity. They can be used on an as required basis. However during the first few months after surgery, these oral tablets may not have the same erection inducing effect that injections have, but some men may prefer tablets to injections at the early stage of recovery.

But there is some evidence that just by taking PDE5 inhibitors, even without an erection occurring, there may be benefit in prevention of deterioration of the erection tissues.

The tablets are used by men who may not be ready to engage in sexual intercourse in the first few months after surgery. The tablets may result in a softer erection not firm enough for penetration, but sexual play is encouraged as part of the "exercise" concept. An orgasm is entirely possible with a soft erection or indeed with no erection when adequate stimulation to the penis occurs.

Another concept of use of the oral tablets is regular dosing to optimise the return of erections and to keep the erection tissues healthy during the period of absent erections. It has been proposed that these tablets be taken at lower doses on a daily or second daily basis. The common side effects include flushing of the face, headache and blocked nose. PDE5 inhibitors cannot be taken by men who are on cardiac medication known as nitrates.

Other treatment choices are use of a vacuum erection device which is a non invasive method involving placement of a cylinder over the penis. Air is extracted by a pump which results in the formation of an erection that is held in place by a rubber constriction ring, and this may reduce the shortening that occurs after radical prostatectomy.

The surgical insertion of a penile prothesis is considered when other treatment have proven ineffective, or when it is apparent that there will be no return of natural erections. It may be possible to tell this as early as 6 months after the prostate surgery. This device allows an erection suitable for penetrative intercourse to occur with the simple activation of a pump discreetly placed in the scrotum.

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Libido Disorders

Libido, also known as sexual desire, is a reflection of a person’s sexual behaviour and desire to engage in sexual activity. Libido arises from the effect of the hormone testosterone which is generally known as “the male hormone” but is responsible for sexual desire in both men and women. Testosterone is responsible for the peak in sexual interest in men around the age of 20 and women in their mid-thirties. The ageing process in men and women reduces the available level of testosterone resulting in a natural decline in libido in the older years. However it has been found that an older man’s libido may not necessarily be related to his level of testosterone.

Libido problems usually present as low desire but sometimes excessive desire can be the issue. These problems may present as a lifelong issue that has always been present or occur only in some situations. Another common desire issue is desire discrepancy where the difference of desire within a relationship creates problems within that relationship.

A common cause of low libido is not related to lack of production of testosterone but rather due to relationship problems, such as when a decision is required for a long term commitment in a new relationship. Any medical condition as well as excessive alcohol intake may contribute to reduced libido. Lack of sexual activity and stimulation may have a negative effect on testosterone production. Any damage to the testes in the male or ovaries in the female will affect testosterone production. This can be seen in removal of such organs or damage from chemotherapy for treatment of cancer.

An assessment of libido problems requires investigation of medical and psychological aspects. It is important to involve the couple in the assessment. Medical treatment if required may involve use of testosterone supplementation, usually in the form of daily gel application or long acting depot injection.

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Ejaculation Problems

Premature Ejaculation

— Introduction

Premature ejaculation (PE) is the commonest male sexual dysfunction and is defined as ejaculation before the person wishes it, often within 1 to 2 minutes after penetration, though it can occur before or on penetration, and is associated with distress to the patient and / or their partner.

PE present since first commencing sexual activity is a primary disorder and is associated with a hypersensitive ejaculatory reflex believed to arise from serotonin receptor sites in the brain. PE may also arise as a secondary disorder at any stage and can be associated with performance anxiety or psychological trauma. PE resulting from anxiety often has a particular situational component, such as when starting a new relationship. Men with PE will usually have better control over their ejaculation time with masturbation. Older men who develop erection problems may develop PE as a compensatory mechanism.

— Treatement

Treatment to slow down ejaculation time is not always appropriate due to the man's expectation of how long ejaculation time should be. There needs to be discussion about these expectations and other factors such as the state of the relationship. Sometimes communication and simple adjustment of the couple's sexual technique is adequate therapy.

An established exercise treatment is the so called “stop-start” technique. This involves stimulation of the erection to the point just before ejaculation occurs and then temporarily stopping to allow arousal to subside, when the stimulation is recommenced.

The stop – start technique was modified by Masters and Johnson who devised the squeeze technique. The partner firmly squeezes the ridge of the penis for 10 seconds to reduce the ejaculatory sensation. This can occur just before penetration or at any time.

— Pharmacological Therapy

SSRI anti-depressants have been successfully used to delay ejaculation. The SSRI is taken daily for a minimum of 6 months. If the PE returns when the medication is stopped, the medication may then be taken on an as required basis before planned intercourse. There are newer quicker acting forms of these medications becoming available so “on demand” treatment will become more common. Whilst delayed ejaculation time is a side effect of SSRI anti-depressant medication, other side effects such as insomnia and anorexia may occur.

Local topical anaesthetics applied as a cream before intercourse have only limited success

Delayed Ejaculation

Delayed or inhibited ejaculation can be a natural consequence of ageing in men. The presence of conditions such as diabetes or the use of anti-depressant medication may exacerbate the problem. There may be emotional causes in younger men who may have always experienced difficulty ejaculating.

Treatment involves techniques to enhance sexual stimulation as well as counselling.

Retrograde Ejaculation

Retrograde ejaculation involves movement of the semen during ejaculation backward into the bladder rather than through the penis. This arises from incompetence of the bladder neck that most commonly occurs after surgery for benign enlargement of the prostate. It may also occur from autonomic nerve damage associated with diabetes.

Treatment is difficult for this condition and often involves counselling to accept the changed ejaculation pattern. There are some medications that tighten the bladder neck but their use is not always suitable.

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Female sexual dysfunction

Roughly half the world's population is female so it is worthwhile to understand the factors that will determine good female sexuality and what some of the difficulties are due to.

In general because females only have a small amount of the libido hormone testosterone, sexual interest and behaviour is more influenced by personal wellbeing, relationship dynamics, context of the sexual activity, appropriateness of the sexual behaviour, sexual beliefs and sexual education. Women may be more affected by negative factors such as lack of time, fatigue, anger and resentment and lack of intimacy.

Among younger women lack of sex education and experience, shyness and insecurity about their bodies and lack of assertiveness may be major contributors to difficulties. Later, tiredness, poor relationships and anger become more relevant and then with menopause hormonal factors become significant.

The main female sexual difficulties are:

  • Inhibited sexual desire and desire discrepancy.
  • Orgasmic difficulties.
  • Dyspareunia.
  • Vaginismus and pain disorders.

Management of each of these difficulties requires specific strategies based on understanding the individuals sexual, psychological and relationship history. Inhibited sexual desire has to be evaluated understanding the broad range of normal female sexual desire which at one end may be that the female is responsive to a male on a few occasions early in the relationship adequate for impregnation. Nature is not particularly interested in recreational sexual activity. In a desire discrepancy situation both partners may be medically and psychologically normal.

Orgasmic difficulties mainly require behavioural sexual techniques and encouragement to overcome inhibitory behaviours. Dyspareunia needs to be properly medically evaluated and relevant causes treated, before corrective behavioural and psychological therapies are instituted. This is the same for pain disorders. Vaginismus needs a very empathic history and then supportive behavioural sex therapy.

With menopause and age related changes there needs to be a proper medical evaluation of the hormonal and anatomical situation before corrective advice is given. It is unusual for medical difficulties to be present in isolation from psychological and relationship issues.

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Relationship Issues

A relationship may involve the interaction of two people, or may involve the way a person relates to a group of people such as work or sporting colleagues. There are many aspects of how a couple relate to each other in the context of their relationship. This depends on whether the couple are just good friends (as in good mates) or whether the couple are involved in a loving and sexual relationship. It also depends on whether the couple are same sex or opposite sex. A good relationship for a couple is the foundation stone for a mutually satisfying sexual relationship.

Relationships are not always equal and require much compromise by both members of the partnership. Desire discrepancy is an example of differing sexual needs within the relationship. There are many factors that determine the differences and similarities that attract two people to each other thus forming a relationship that may or may not flow smoothly.All relationships benefit from both good effective communication and commitment to making the relationship succeed. All relationships require ongoing maintenance and attention no matter how good or bad the situation is. Couples benefit from time alone, especially when children are present. Children pose extra stress on all relationships particularly over differences of opinion on parenting techniques. It is also important for each member to have time out to pursue his or her own interests but not to the detriment of the relationship.

Over time sexual needs change in relationships so the importance of ongoing affection and attention to each partner must always be emphasised. There are many self help books available which address the many issues that most couples face at one time or another. Sometimes the problems prove too difficult to manage without outside help. Relationship or couples counselling may then be an appropriate treatment.

To find out more about relationships please visit the Australian Relationship support website on www.relationships.com.au.

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Location

Contact Details

Tel: (03) 9583 4544
Fax: (03) 9585 5988

66 Balcombe Road
Mentone (Victoria) 3194

Email: info@baysideurology.com.au
Website: http://www.baysideurology.com.au

Dr Love also consults at:
Private Consulting Rooms
West Gippsland Hospital, Warragul 3820, Victoria.
Appointments at Mentone on (03) 9583 4544

Dr Redgrave also consults at:
267 Cranbourne Road, Frankston 3199, Victoria.

Dr Dangerfield also consults at:
Brighton Specialist Centre, 110 Bay St, Brighton 3186

Berwick Consulting Suites, Suite 1, Stephenson House, 8 Gibb St, Berwick 3806

Frankston Private Consulting Rooms, Level 3, 24 Frankston Flinders Road, Frankston 3199

Moorabbin Specialist Centre, 873 Centre Road, Bentleigh East 3165

Waverley Private Hospital, 351 Blackburn Road, Mount Waverley 3149

Clinic Details

For Patients:

BaysideUrology provides 7 day a week, 24 hour a day, 365 day a year cover for all patients seen through the practice.

This practice does not bulk bill (except Gold Card Veterans).

Each Urologist at this practice is very happy to provide telephone advice at any time.

Phone 9583 4544 or call service 9387 1000 after hours to contact the on-call Urologist for advice or urgent referral.

For GPs:

When referring patients, please provide copies of relevant investigation results wherever possible, or details of which Pathology laboratory performed the test.

Please remind patients to bring along all radiological investigations to their appointment.

This practice does not bulk bill (except Gold Card Veterans).

Please discuss patients with special circumstances with the Urologist concerned.

Each Urologist at this practice is very happy to provide telephone advice at any time.

Phone 9583 4544 or call service 9387 1000 after hours to contact the on-call Urologist for advice or urgent referral.