Angiomyolipoma – AML

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An angiomyolipoma (AML) is the most common benign kidney growth. It has 3 components:
  • abnormal blood vessels,
  • smooth muscle,
  • and fat cells.

While typically benign, the main risk is the potential for the blood vessels to dilate and rupture, leading to serious, life-threatening internal bleeding (hemorrhage). 

Symptoms

Most angiomyolipomas are asymptomatic, and the tumors are often discovered incidentally during imaging for other conditions. However, if the tumor grows large or bleeds, symptoms may include:

  • Pain or discomfort in the abdomen, back, or side (flank pain).
  • A palpable mass in the abdomen.
  • Blood in the urine (hematuria).
  • Nausea and vomiting.
  • High blood pressure (hypertension).
  • Anemia (due to chronic blood loss or acute hemorrhage). 
Acute, severe pain, sometimes with signs of shock, can indicate a spontaneous rupture and is a medical emergency.

Causes and Risk Factors

The exact cause of sporadic AMLs is not known, but they are linked to genetic mutations. 
  • Sporadic cases: Account for 80% of cases, typically affecting women over 40 with a single tumor.
  • Associated with genetic syndromes: The remaining cases are often linked to genetic disorders like 
    • Tuberous sclerosis complex (TSC). In TSC patients, AMLs tend to be multiple, bilateral (in both kidneys), larger, and present at a younger age. 
    • Lymphangioleiomyomatosis (LAM). 

Diagnosis

Diagnosis primarily relies on imaging studies, as the fat content in the tumor gives a characteristic appearance.
  • Computed Tomography (CT) scans are the standard diagnostic tool for identifying the fat component.
  • Magnetic Resonance Imaging (MRI) is useful for cases where CT results are inconclusive, particularly in detecting fat-poor lesions.
  • Ultrasound can be used for initial screening or monitoring, but its findings can sometimes overlap with other kidney conditions.
  • Biopsy may be necessary if imaging cannot definitively differentiate the mass from a potentially malignant tumor, such as renal cell carcinoma.

Treatment and Management

Management depends on the patient’s symptoms, the tumor’s size and growth rate, and the risk of hemorrhage.
  • Active Surveillance: For small (<4 cm) and asymptomatic AMLs, routine monitoring with imaging is generally recommended.
  • Embolization: This minimally invasive procedure seals off the blood vessels in the tumor to prevent or treat bleeding. It is a first-line treatment for acute hemorrhage or for preventing rupture in high-risk cases (e.g., aneurysms >5 mm).
  • Surgery: Nephron-sparing surgery (partial nephrectomy) is often the preferred surgical option to remove the tumor while preserving kidney function.
  • mTOR Inhibitors: Medications like everolimus (Afinitor) are approved for treating TSC-associated AMLs (typically >3 cm) and can shrink the tumors and their associated aneurysms, reducing the risk of bleeding.
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Meatal Stenosis: Lichen Sclerosis

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Lichen sclerosus (LS) affecting the penile meatus causes white, atrophic plaques and scarring that can narrow the meatus. This leads to lower urinary tract symptoms and in severe case urinary retention.  This condition can also lead to phimosis, where the foreskin becomes tight, and can cause difficulty with urination and sexual function. Treatment typically starts with topical corticosteroids, and surgery such as circumcision or meatotomy may be necessary for more severe or stubborn cases. 

Symptoms and effects

  • Narrowed meatus: The meatus can narrow to the point of causing urinary retention, potentially damaging the bladder and kidneys over time.
  • Phimosis: In uncircumcised men, LS can cause the foreskin to become so tight that it cannot be retracted.
  • Urinary problems: A less powerful stream, spraying of urine, and urinary frequency are common symptoms.
  • Pain and scarring: It can cause pain during urination and intercourse, and lead to scarring of the glans, foreskin, and frenulum.
  • Other symptoms: Blisters, sores, and itching can also occur, though these are less common. 

Treatment

  • Medical therapy: The first-line treatment is often an ultrapotent topical corticosteroid, such as clobetasol propionate, applied to the affected areas.
  • Circumcision: This is often curative for LS confined to the foreskin and glans.
  • Meatotomy: In some cases, a surgical procedure to widen the meatus may be required.
  • Dilation: Daily self dilations
  • Other treatments: Depending on the individual case, other treatments may be considered, including phototherapy or laser treatments.
  • Surgical reconstruction: Some patients may require more extensive reconstructive procedures. 

Wes Meatal Dilatation

 

Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Premature Ejaculation

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Premature ejaculation (PE) is the most common male sexual dysfunction. It is defined as the inability to delay ejaculation long enough to satisfy oneself or your partner. This causes personal distress.  While most men experience occasional rapid ejaculation, frequent occurrences may indicate a treatable medical condition.

Causes

The exact cause of PE is a complex interaction of psychological and biological factors.
Psychological factors:
  • Anxiety and Stress: Performance anxiety, general anxiety, and high-stress levels (from work or relationships) are common contributors.
  • Relationship Issues: Communication problems or unresolved conflicts with a partner can play a significant role.
  • History: Early sexual experiences characterized by haste (e.g., to avoid being caught), a strict upbringing about sex, or a history of sexual trauma can establish a pattern.
  • Depression and Confidence: Feelings of guilt, depression, or poor self-esteem can affect sexual function.

Biological factors:

  • Chemical and Hormone Levels: Irregular levels of certain brain chemicals (neurotransmitters) like serotonin and dopamine, or hormones such as testosterone and those related to the thyroid, may be involved.
  • Inflammation or Infection: Problems with the prostate or urethra can contribute to PE.
  • Erectile Dysfunction (ED): Men with ED may rush through sex to ejaculate before losing their erection, forming a difficult habit to break.
  • Genetics: Lifelong PE may have a genetic predisposition.
  • Penile Sensitivity: Increased sensitivity of the penis has been suggested as a possible cause in some cases.

Treatment and Management

Treatment for PE often involves a combination of approaches and may include the partner for the best outcome.
  • Behavioral Techniques: These are often the first line of treatment and aim to build tolerance and control over ejaculation.
    • Start-and-Stop Method: The man or partner stimulates the penis until the man feels he is near orgasm. Stimulation is stopped until the sensation passes, then resumed. This is repeated multiple times before allowing ejaculation.
    • Squeeze Technique: Similar to the start-and-stop method, but when the man is close to ejaculating, the partner or the man himself gently squeezes the head of the penis for several seconds until the urge to ejaculate lessens.
    • Other self-help options: Masturbating an hour or two before sex, using thicker condoms to reduce sensation, or trying to distract oneself (though this may reduce pleasure for both partners).
  • Medications: Oral medications or topical numbing agents can help delay ejaculation.
    • Topical Anesthetics: Creams or sprays containing lidocaine or prilocaine can be applied to the penis 10 to 15 minutes before sex to reduce sensation. A condom should be used to prevent the numbing effect from transferring to the partner.
    • Oral Medications: Certain selective serotonin reuptake inhibitors (SSRIs), which are a type of antidepressant, can be prescribed off label to delay orgasm. Dapoxetine (Priligy) is an SSRI developed specifically for on-demand use for PE and is available in some countries.
    • Other Medications: Tramadol (a pain reliever) or medications for erectile dysfunction may also be used in some cases, often in combination with SSRIs.
  • Counseling and Therapy: Talking with a mental health professional, certified sex therapist, or couple’s counselor can help address underlying psychological or relationship issues, reduce performance anxiety, and improve communication.
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Delayed Ejaculation

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This can be a huge issue for those guys that suffer with this. It leads to psychological issues and even breakdown of relationships. Treatment for delayed ejaculation depends on its cause and may involve a combination of approaches like adjusting medications, counseling and other therapies. Options include psychological therapy, adjusting or switching medications (such as SSRIs), and addressing lifestyle factors like alcohol or drug use. Some men may also benefit from physical therapies or specific drugs like testosterone replacement, bupropion, or cabergoline, depending on the underlying cause and a doctor’s recommendation. 
Delayed ejaculation affects an estimated 1% to 4% of sexually active men, though a recent study suggests the prevalence may be higher, possibly between 5% and 10%.

Diagnosis:

Some studies use a specific timeframe to define delayed ejaculation, such as a man taking 30 minutes or longer to ejaculate, which may lead to higher reported numbers. 

Medical and pharmaceutical treatments

  • Medication adjustment: If a medication like an SSRI is the cause, a doctor may recommend switching to a different antidepressant or adjusting the dose.
  • Testosterone replacement: If low testosterone is a contributing factor, testosterone replacement therapy can be used.
  • Other drugs: Other medications that may be used include bupropion, cabergoline, yohimbine, and cyproheptadine, which may be prescribed to counteract the effects of other drugs or address the issue directly.
  • Topical anesthetics: Products containing lignocaine or prilocaine can be applied to the penis to reduce sensation and delay ejaculation. 

Psychological and behavioral treatments

  • Psychotherapy: Counseling with a psychologist, psychotherapist, or sex therapist can help address psychological issues like anxiety, stress, or relationship problems that may contribute to delayed ejaculation.
  • Couples counseling: If the issue affects the couple’s dynamic, counseling together can be very beneficial.
  • Behavioral techniques: A therapist may suggest techniques like using sexual aids, exploring erotic fantasies, or trying different sexual positions and techniques to increase stimulation. 

Lifestyle and other considerations

  • Reduce or eliminate alcohol and drugs: Limiting or stopping the use of alcohol and non-prescription drugs can help resolve delayed ejaculation if they are a contributing factor.
  • Manage underlying medical conditions: Treating any underlying medical issues, such as neurological problems, can also help.
  • Penile vibratory stimulation (PVS): This may be an option for men with decreased penile sensitivity. 

When to see your GP

  • It is best to consult a healthcare professional to determine the cause and appropriate treatment.
  • See a doctor if delayed ejaculation is an ongoing issue, if you have other health problems, or if you take medications that could be the cause.
  • Do not stop taking any prescribed medication without first speaking to your doctor. 
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Dr Richard Marsden – Urologist

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Richard Marsden

Many of my older patients in Bundaberg will remember Richard. Richard was a well-known and respected Urologist in Bundaberg for many years. He was the only Urologist in Bundy and very committed to regional QLD. This legend passed away on the 5th of November.

I owe my big move from South Africa to Australia to him. I met him at the bi-annual UROSA (Urology Society of South Africa) conference at Sun City in 2005. We struck up a conversation and by the end of this I was given a business card and told to contact him if I was keen to take over his practice in Bundaberg. He was in the process of retiring. It took me a few weeks to realize what an opportunity he had given me.

My wife and I flew out to Bundaberg a couple of months later to do our LSD-trip (look, see and decide). A trip most South Africans do before we make the huge decision to uproot our families for the unknown. Australia held a huge promise of safety, freedom and a future for our daughters. We flew into Bundaberg and fell in-love with the town. It reminded us of the East Coast of South Africa (the then Natal province) with its ocean, sugarcane and humidity.

Richard and Carol welcomed us. Richard showed me his routine and introduced me to the operating room and ward staff. We learnt that Richard was also an immigrant, from the UK. He spent his childhood years during WW2 in Johannesburg, South Africa. He joined his parents in Melbourne after the war after which they returned to the UK. He embarked on his medical career in London. He too made the decision to re-locate to Australia with his 2 daughters. Natasha and I made the heavy decision that this was where we wanted to raise our girls.

Thank you, Richard!

Pelvic floor rehabilitation post prostatectomy

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Pelvic floor physiotherapy after a prostatectomy helps regain bladder control and addresses erectile dysfunction through exercises and other therapies. A physiotherapist can create a personalized plan, which may include pre- and post-operative pelvic floor muscle training (Kegels), bladder retraining, and, in some cases, treatments like focused shockwave therapy for erectile dysfunction. 

What pelvic floor physiotherapy involves

  • Pelvic floor muscle training: A physiotherapist will guide you on how to perform exercises (like Kegels) to strengthen the pelvic floor muscles. This can significantly improve urinary incontinence and support bladder control.
  • Bladder retraining: This involves a combination of exercises, tracking bladder use, and scheduling toilet breaks to improve bladder control and reduce urgency or leakage.
  • Individualized assessment: Each person’s recovery is unique, so a physiotherapist will conduct a comprehensive assessment to create a treatment plan tailored to your specific symptoms and needs.

When to start

  • Pelvic floor exercises can be started before surgery or soon after the catheter is removed.
  • Starting pelvic floor rehabilitation before surgery is recommended by some organizations, as it can help with recovery. 

Why it’s important

  • The prostate gland sits below the bladder, and its removal can weaken the surrounding pelvic floor muscles and surrounding structures.
  • This can lead to issues like urinary incontinence (leaking), urgency, and erectile dysfunction.
  • Pelvic floor physiotherapy helps by strengthening the muscles that support bladder and sexual function. 

Getting started

  • It is highly beneficial to see a physiotherapist, as they can provide guidance and ensure you are performing exercises correctly.
  • You can start with basic exercises on your own, but a physiotherapist can help you get more benefit from your training. 

 

I use 3 groups of physiotherapy practices depending on your location:

1. Wesley Hospital Physiotherapy

Women and men’s physiotherapy | Allied health | The Wesley Hospital

2. Bodyworks Physiotherapy in Kallangur – Rashiq Patel

BODYWORKS PHYSIOTHERAPY

3. Coral Coast Physiotherapy in Bargara, Bundaberg – Reuben Wharerau

Bargara Physiotherapy | Coral Coast Physiotherapy Bargara

 

Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Men’s Health Doctor – help recover erectile function

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Erectile dysfunction (ED) is the inability to get or keep an erection firm enough for sexual intercourse. It’s common, affecting more than 1 in 10 men, and can be caused by both physical and psychological factors. It becomes a reality for those guys embarking on surgery for their prostate cancers.

What is Erectile Dysfunction?

  • : Difficulty achieving or maintaining an erection sufficient for sex.
  • : More common with age; affects up to 10% of men under 40, and nearly all men over 85.
  • : Temporary ED can result from stress, fatigue, or alcohol, while persistent ED may signal underlying health issues

Causes

  • : heart disease, diabetes, high blood pressure, obesity, smoking, and certain medications.
  • : Stress, anxiety, depression, or relationship problems.
  • : Lack of exercise, poor diet, and excessive alcohol use

Treatment Options

  • : Exercise, healthy diet, quitting smoking, reducing alcohol.
  • : Oral drugs like sildenafil (Viagra), tadalafil (Cialis), or vardenafil.
  • : Counselling for psychological causes, sex therapy.
  • : Vacuum erection devices, penile injections, or implants

Erectile Function recovery after prostate cancer surgery

I have just the man to help you. Dr Michael Gillman has over 25 years’ experience as a medical practitioner.

Dr Gillman has specific expertise in male sexual health and male sexual dysfunction. He is a Fellow of the Royal Australian College of General Practitioners and a professional affiliate member of Australasian Chapter of Sexual Health Medicine (AChSHM) which has been established within the Adult Medicine Division of the Royal Australian College of Physicians.
Above all this he is a GOOD man with a good sense of humor! He has been known to resurrect many ‘old-fellows’. See what he can do for you. Follow the link below
Click to see his website for more information
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Bribie Island Consulting

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Ramsay rooms on Bribie Island

  • as part of my service to my Caboolture area patients, I also drive out to my Bribie Island patients
  • Once a month for a full day
  • Cozy rooms
  • Good service provided by Caboolture private hospital for the community of Bribie
  • Convenient for my Bundaberg patients to be seen 100 km before Brisbane
  • Phone my rooms for an appointment there: 07) 3371-7288
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Centre for Men and Families Australia

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Movember focusses on MEN and their mental health, not just Prostate Cancer!

Here is a safe place to go if you don’t have support you need.

Why CFMA Exists

Men in Australia are in crisis, killing themselves and others at fair higher rates than what is acceptable, and experiencing a wide range of challenges mostly stemming from a lack of emotional literacy. This crisis is costing our nation in many measurable and immeasurable ways, personally, socially and financially.

Therefore, The Centre for Men and Families exists to create a safe community for men to connect, learn, be loved and belong, so that they can journey deeper and experience transformation of the heart and bring the gift of who they truly are into the world, moving from being a source of dysfunction to a source of life and fulfilment for themselves, their families and our society.

“Our Dream”

Our dream is that every man in this country would have access to a group of mates that they can walk with shoulder to shoulder through life’s best and life’s worst. Our dream is that every man in this country would have a safe place where they can really talk about what’s going on, where they can share their story without the fear of judgment and find themselves heard and unconditionally loved. Our dream is that every man could experience the extraordinary strength that comes through being authentic about their weaknesses. Our dream is that every man in this country could be supported to recognise and embrace their hurts, disappointments, and limitations and find healing and wholeness. And our dream is that every man who finds healing and wholeness would pass on that generative wisdom to their families, society, and the next generation of males.

That’s our dream.

Over the next five years, The Centre for Men and Families will create a safe space for every single man in this country to have their experiences heard and honoured; a space where they can talk – really talk – and their story is welcomed without judgment; a space where they are free to recognise and embrace their hurts, disappointments, and limitations; a space where they are supported to transform their woundedness and pain by drawing on the very best of contemporary knowledge and ancient wisdom; a space where they are shown how to handle both their power and pain so as to be safe; and, above all, a space where they can find a group of mates to belong to and be real with.

Every. Single. Man.

 

Centre for Men & Families Australia | CFMF

 

Movember

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MOVEMBER

It’s that time of the year where we support the people in our lives that suffer with conditions that are treatable and early intervention can make a huge difference:

  • Prostate cancer
  • Testis cancer
  • Penile cancer
  • Depression and suicidal thoughts

What can we do?

  • Awareness is key
  • Regular GP visits with
    • regular PSA testing for guys older than 50
    • any urinating symptoms that bother
  • Regular self-examination of testes
  • Depression that you cannot beat
    • Seek support, friends and family
      • break the barriers and TALK
    • Men’s groups, see link below – Centre for Men and Families
    • Psychology
    • GP

So, get involved! If you spot a loved one suffering, speak up!

For more information:

Centre for Men & Families Australia | CFMF

Movember – About Us – The Movember Foundation