Men’s Urology

Conditions treated by Dr Basto

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that commonly affects men as they age. The enlarged prostate can press against the urethra and impede urine flow, leading to symptoms such as frequent urination, weak urinary stream, incomplete bladder emptying and nocturia (waking at night to urinate).  Complications can occur over time including urinary tract infections, kidney impairment or a bladder that doesn’t contract well (underactive bladder).  Many patients experience a secondary effect of bladder overactivity (overactive bladder) as a result of the blockage.

Each prostate is unique in the symptoms it causes and how it interacts with the bladder. A large prostate on imaging does not necessarily cause symptoms.  Conversely, a small prostate by size can limit urine flow due to its internal shape and compression of the urethra.  Generally, treatments are only required when there are symptoms or complications of BPH.

Treatment for BPH focuses on relieving symptoms, improving urinary function and enhancing the patient's quality of life. For mild symptoms, lifestyle changes and monitoring may be appropriate. Medications, such as alpha-blockers and 5-alpha reductase inhibitors, help relax prostate muscles and shrink the gland.

For moderate to severe symptoms or when medications are ineffective, minimally invasive procedures through the urethra (endoscopic surgery) can be performed to remove excess prostate tissue, restoring normal urine flow.  The gold standard technique for this is a transurethral resection of the prostate (TURP), however other treatment options exist that have their advantages including UroLift, Rezūm water vapor therapy or laser therapies.  Some of these techniques are more helpful at reducing sexual side effects.

In more advanced cases, surgical options such as Holmium Laser Enucleation (HoLEP) or prostate enucleation (open or robotic) are effective in removing obstructive prostate tissue. The goal of treatment is to tailor the approach based on the severity of symptoms, gland size and patient preferences, ensuring safe and effective symptom relief while minimizing complications.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for sexual activity. It can be caused by various factors including vascular, hormonal, or psychological conditions. Treatment options range from lifestyle changes and medications to surgical solutions like penile implants, aiming to restore function and improve quality of life.

Treatments for prostate cancer can include surgery (radical prostatectomy), radiation and/or injected hormone therapies.  Each have side-effects and can result in different long-term effects. 

Prostate cancer survivorship refers to the ongoing care, management and support of individuals who have completed, or are living with, treatment for prostate cancer.  It encompasses physical, emotional and psychological aspects of life after a cancer diagnosis.

Survivorship care focuses on monitoring for cancer recurrence, managing long-term side effects of treatment and addressing quality-of-life concerns. Common issues include stress urinary incontinence, erectile dysfunction, fatigue, bowel dysfunction, and hormonal changes. Other bladder dysfunction or narrowings of the urinary tract (strictures) can also result from the impact of radiation or surgery.  Psychological challenges such as anxiety, depression, and concerns about recurrence are also common.

A comprehensive survivorship plan typically involves regular follow-ups, PSA testing, symptom management and lifestyle guidance. Rehabilitation therapies, counselling, and support groups may play a crucial role in helping patients navigate post-treatment life. The goal is to help survivors maintain optimal health, manage complications and achieve a fulfilling quality of life after treatment.

Stress urinary incontinence (SUI) occurs when urine leaks during physical activities like coughing or lifting due to weakened pelvic muscles. Management options include pelvic floor exercises or surgical procedures like sling placement or artificial urinary sphincters.

Erectile dysfunction (ED) is common after surgery and radiation for prostate cancer. Treatment includes medications, vacuum erection devices, penile injections or implants.

Bladder neck contracture (BNC) involves scarring that narrows the junction between the bladder and urethra, causing urinary obstruction. Treatments may involve dilation or surgical incision.

Climacturia (leakage of urine during orgasm) and arousal incontinence (leakage of urine during sexual stimulation) can occur in up to 30% of men after radical prostatectomy.  This can be distressing for some men yet tends to be underreported to doctors. Dr Basto encourages you to discuss these concerns if they bother you as behavioural strategies and medications may be suitable.  Occasionally surgeries are appropriate.

Dr Basto will create an individualized management plan that aims to restore function and improve quality of life for your specific situation.  Sometimes a discussion before, or just after,  your radical prostatectomy can help prepare you for these challenges.  Dr Basto is happy to support you around the time of your prostate cancer treatments.

Peyronie’s penile curvature is a condition where fibrous plaques form in the penis, causing abnormal curvature, pain and potential difficulties with sexual function. Treatment options include medications, injections, traction devices or surgical correction to reduce curvature and restore normal erectile function. 

Circumcision is a surgical procedure that involves the removal of the foreskin, the fold of skin covering the tip of the penis.

Medical indications for circumcision include conditions such as recurrent balanitis (inflammation of the foreskin and glans), phimosis (tight foreskin that cannot be retracted), paraphimosis (trapped retracted foreskin) and chronic urinary tract infections that do not respond to conservative treatments.

The procedure is typically performed under general anesthesia and can be completed relatively quickly. Healing usually occurs within 1 to 2 weeks. While generally safe, potential risks can include (but are not limited to) infection, bleeding, changes in sensation and scarring.

When performed for medical reasons, circumcision can alleviate symptoms, prevent complications and improve overall penile health. As a urologist, I ensure that patients and their families receive comprehensive information and tailored care to make informed decisions.

A vasectomy is a safe and effective permanent form of male contraception. It involves cutting or sealing the vas deferens, the tubes that carry sperm from the testes to the urethra. The procedure is typically performed under local or general anesthesia and takes about 30 minutes.

After a vasectomy, patients can usually resume light activities within a day or two but should avoid heavy lifting or strenuous exercise for about a week. Mild swelling, bruising, or discomfort is common but usually resolves quickly with rest and over-the-counter pain relief.

It is essential to use an alternative form of contraception until sterility is confirmed. A follow-up semen analysis, usually performed 8 to 12 weeks after the procedure, ensures there are no motile sperm remaining. Until this test confirms a zero motile sperm count, there is still a risk of pregnancy. 

A vasectomy does not affect sexual function or testosterone levels and offers a reliable long-term solution for family planning.

A hydrocele is the accumulation of fluid around the testicle, causing swelling in the scrotum. It is often painless but can lead to discomfort or noticeable enlargement. In most cases, a hydrocele resolves on its own, but if it persists or causes significant symptoms surgical removal can be performed.

A varicocele is an enlargement of the veins within the scrotum, often described as a "bag of worms." It can cause discomfort and there is debated evidence that it can affect fertility. Treatment option including minimally invasive procedures such as varicocelectomy or radiological embolisation, can help alleviate symptoms.  

Epididymal cysts are fluid-filled sacs that form in the epididymis, the tube at the back of the testicle. These cysts are typically benign and may cause a painless lump. If the cyst causes pain or discomfort, surgical removal can be performed.

Penile cancer is a rare but serious condition affecting the tissues of the penis. It often begins as a lesion or ulcer that does not heal.

Early diagnosis and treatment is essential, this may include topical therapies or surgical excision of the lesion including partial or total penectomy. Further management may include lymph node removal in the groin (inguinal nodes) or pelvis. 

Prostate cancer is one of the most common cancers in men. It often grows slowly but can be aggressive in some cases. Treatment options vary from active surveillance for low-risk cases to surgery (prostatectomy), radiation therapy or hormone and other systemic therapies.

As a reconstructive and functional urologist, Dr Basto specialises in restoring anatomy and function of the urinary tract.  For prostate cancer requiring surgical resection, she works closely with trusted uro-oncology colleagues who have specialised expertise in these areas. This collaborative approach ensures that patients receive the highest standard of care tailored to their individual needs, whether in the early or advanced stages of cancer. 

Testicular cancer commonly affects younger men but is highly treatable. It may present as a painless lump or swelling in the testicle. Treatment includes orchidectomy (surgical removal of the affected testicle), chemotherapy and radiation therapy if required. Early detection offers excellent outcomes.

As a reconstructive and functional urologist, Dr Basto specialises in restoring anatomy and function of the urinary tract.  She cares for patients at the time of diagnosis of their testicular cancer or if patients wish for testicular prostheses.  

Once diagnosis is established, she works closely with trusted uro-oncology colleagues who have specialized expertise in testicular cancer. This collaborative approach ensures that patients receive the highest standard of care tailored to their individual needs, whether in the early or advanced stages of cancer.