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It is crucial that prostate cancer is detected early to increase the chances of survival. ~Mrs Sarah Collen, Policy Manager, European Association of Eurology (EAU) ~Professor Dr Hein Van Poppel, Chairman, EAU Policy Office
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We need to think differently about how we can make health services work for men. ~Michelle Terry, CEO, Movember
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Urinary retention: a hidden problem for one in three men over 50 Excellent bladder function isn’t something we think about regularly however, it is important to be aware of the signs and symptoms of urinary retention.
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Why we need to do more to support male health care needs
healthy bladder will quietly and efficiently store wee until the right time to empty. However, bladder misbehaviour can develop gradually over time and it’s often only when men experience overflow leaks and urinary tract infections that urinary retention is identified. Unfortunately, urinary retention is a major cause of bladder problems for one in three men over 50.
Rather than blaming men for their precarious state of health, we need to think differently about how we can make health services work for them.
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en are twice as likely as women to die from COVID-19 and as a result, it has had a significant impact on male life expectancy in many countries around the world. One of the reasons men are more vulnerable to COVID-19 is due to their naturally weaker immune response to the virus. They are also likely to have underlying conditions such as hypertension, lung disease or diabetes which put them more at risk. Aside from COVID-19, men are more likely to die from preventable and treatable non-communicable diseases, such as heart disease and lung cancer. Prostate cancer is now the most common cancer in men in the UK, while testicular cancer is the most commonly diagnosed cancer in younger men (aged 15-34). Men are also more likely to adopt unhealthy lifestyles such as smoking, drinking and keeping an unhealthy weight. All of which are linked to serious illnesses. Social and economic consequences of the pandemic for men In addition, the ongoing social and economic consequences of the pandemic have had a huge impact on men’s mental health. Movember research conducted earlier this year found that over half (52%) of men were suffering from poor wellbeing and a quarter (26%) met the World Health Organization’s criteria for depression.
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In the UK, three out of four suicides are by men and it remains the leading cause of death for men under the age of 44. When it comes to using health services, studies from around the world have shown that men are less likely than women to seek healthcare or medical advice and this is particularly true when it comes to asking for help with mental health problems. Making health services work for men Although Movember has made tremendous progress over the last 18 years in changing attitudes around men’s health and improving treatment, there is still much more work to be done. Men and women think about, talk about and act on their health differently. Therefore, to reach men effectively, health services and programmes must take account of these differences so that they can be tailored to meet men’s needs, enabling them to live longer, healthier and happier lives. To learn more about Movember’s work or donate, visit movember.com
WRITTEN BY
Michelle Terry CEO, Movember
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WRITTEN BY Sarah Hillery Urology Lead Nurse at York & Scarborough NHS Trust and Vice President, BAUN
Urinary retention awareness Urinary retention (when the bladder keeps back urine as the person tries to urinate) has many causes, but most commonly occurs in men due to a blockage at the bladder outflow such as enlarged prostate or urethral stricture (a tight band of scar tissue within the urine pipe). Other causes include the action of some common medicines and neurological conditions. Here, the bladder muscle or the urethral sphincter function is affected rather than there being a physical blockage. For most men however, benign prostatic hyperplasia (BPH) is the leading cause of urinary retention. Men with BPH may notice that their flow isn’t as powerful as it once was or are going more regularly to the toilet to pass small amounts. Initially, the symptoms relate to the increased resistance at the bladder neck when the bladder squeezes to empty, the bladder muscle has to work harder and over time may lose the ability to empty fully.
For most men however, benign prostatic hyperplasia (BPH) is the leading cause of urinary retention. Acute and chronic urinary retention An acute episode of urinary retention can happen after a man has been experiencing gradual onset bladder problems or occasionally completely out of the blue. Acute retention represents a sudden difficulty in voiding the bladder with the accumulation of large volumes of urine over a period of hours accompanied by the inability to urinate which can be exceptionally painful. Chronic urinary retention, however, may develop over months and years and although the volumes retained by both types of cases may be identical, what is intolerably painful in the acute situation may feel entirely undetectable in the chronic. Due to the amounts retained building up gradually during chronic urinary retention, which can sometimes be painless, the bladder adapts and stretches to accommodate the extra volume. Aside from pain, a very real risk of large volume urinary retention is that of back pressure up to the kidneys via the thin-walled ureters. This can cause significant kidney damage if not identified quickly however, the pressure can be relieved by inserting an indwelling urinary catheter. For this reason, it is important to be aware of changes in your bladder function and see your GP if problems occur.
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The emerging importance of digital technology in surgeon training Innovative apps and digital resources are bringing fresh approaches to the way surgeons learn new techniques.
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raditionally, surgeons learn procedures via observation, supervision and practice, but over the last two decades that has evolved to include simulation trainers and surgical video. These tools are used to better prepare surgeons for their cases and to help with patient communication about procedures. Today, mobile platforms such as the Touch Surgery™ App, are available on mobile devices that can enable surgeons to review cases and learn new procedures – both of which had clear benefits during COVID-19 when face-to-face training was restricted – as well as enable experienced surgeons to maintain and update their skills. High-level training Urological surgeon Hiten Patel says apps help deliver high-levels of training, which has been shown to be transferrable to the operating theatre, while helping improve patient safety and surgical outcomes. “The aim is to maintain a patient focus, increase accuracy and deliver good quality care with minimal risk to patients,” he adds.
Image provided by Medtronic Digital Surgery
The aim is to maintain a patient focus, increase accuracy and deliver good quality care with minimal risk to patients.
Medtronic Digital Surgery created the Touch Surgery™ app, which covers urological procedures, in addition to cardiothoracic surgery, general surgery, and dentistry. It can be used to train surgeons in open, keyhole or robotic techniques. Urological procedures available on the app include catheterisation and transperineal MRI-targeted prostate biopsy. The simulation of catheterisation takes the user through how to use an endoscope to look at the bladder through the urethra, known as cystoscopy. This is the most common procedure performed by urologists. The simulation of transperineal MRI-targeted prostatic biopsy guides the user step by step through the process of gathering a prostate sample to help diagnose prostate cancer. Benefits for healthcare practitioners Professor Patel explains that with the need for precision and accuracy,
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the Touch Surgery™ App aims to shorten learning curves and increase knowledge transfer, with the hope to improve surgical standardisation and patient outcomes around the globe. “It can also help keep the patient informed as we can show patients a simulation of their operation in a non-graphic way,” he says. App technology can teach healthcare practitioners to perform procedures as well as demonstrating non-technical skills involved in pre-procedural set up to the operating team, such as patient positioning. “We know that if a team works well together, the patient is safer,” he adds. “The app is a tool which has the potential to benefit the surgeon, training surgeon, the hospital team delivering the surgery and the patient.”
INTERVIEW WITH Matteo Amodio RN Senior Medical Science Liaison, Medtronic Digital Surgery
INTERVIEW WITH Hiten Patel MD, PhD Professor of Urology, Surgeon and Executive Principal Medical Advisor, Medtronic Digital Surgery
Cognitive task trainer and digital ecosystem The app is a cognitive task trainer, using high-definition computer graphics, that enables users to rehearse and test themselves on procedures. Matteo Amodio, who has a specialist urology nursing background, explains that as a data-driven business using artificial intelligence analytics and augmented reality technology, Medtronic Digital Surgery has two products supporting surgical training in urology and other disciplines. The app features over 200 surgical simulations across 21 specialties, while Touch Surgery™ Enterprise – which consists of a cloud-based storage platform – can capture videos in real-time and store them for surgeons for future reference, training of students or to demonstrate points to patients. The Enterprise solution includes the DS1 computer in operating theatres that facilitates recording and transferring of surgical video onto the cloud. With enhanced AI, the powerful computer captures videos of operations and uploads for post-op review.
WRITTEN BY Mark Nicholls
Professional development Various Touch Surgery™ App simulations have been academically validated by over 19 independent peer-reviewed publications1 for their groundbreaking approach to training, including accreditation by the Royal College of Surgeons of England, enabling users to claim Continuous Professional Development (CPD) points.2 Healthcare professionals are also able to upload and reflect on their cases, in order to obtain CPD points. “Users can access it anywhere and at any time. They can rehearse a procedure, even moments before stepping into the operating theatre.”
Paid for by Medtronic
References: 1. Details of individual simulation validation available here: https://www.touchsurgery.com/peer-reviewed-research 2. Accredited by The Royal College of Surgeons of England: https://digitalsurgery.com/2019/10/03/cpd/
Prepare, practice, and teach surgical procedures — anytime, anywhere — with the free-to-download, academically validated and accredited Touch Surgery™ mobile app. Touch Surgery™ Enterprise is not intended to direct surgery, or aid in diagnosis or treatment of a disease or condition. Touch Surgery™ App has been validated by peer reviewed journals for specific procedures and is accredited for CPD points only.
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Spread paid for and approved by Besins Healthcare (UK) Ltd This content was originally published on 30th November
Empowering men to take control of their own health
The gender gap: why men should be more interested in health All evidence suggests that men in the UK need to be more clued up about health and we need to help empower them to take ownership of it.
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tudies show in the 20-40-year age group, women are twice as likely to visit their GPs. Women visit the pharmacist annually 18 times, compared to just four times for a man and men are also less likely to have dental, eye and hearing checks. One in five men die before retirement The male ostrich-like approach to wellbeing has a devastating impact on life expectancy. Worldwide, men die around seven years earlier than women, one in five men in the UK die before the age of 65 and three out of four suicides are male. The reasons for male lack of engagement, says Dr Janine David, are multifactorial. “Sexist as it sounds, women tend to be the ones bringing in children for health issues, and, of course, women need to attend for contraception and maternity care. Women are, therefore, more familiar with using health services.” There is also a perception, she adds, ill health is detrimental to the requisite macho image society expects. To prevent the surge of premature male deaths, men need to be empowered to take ownership of their health. “We need to encourage men to visit their GP as soon as they have any health concerns, and as GPs we need to make the most of each consultation,” says Dr David. INTERVIEW WITH Dr Janine David MRCGP FECSM GPWSI Men’s Health Medical Director, Men’s Health Wales SPREAD WRITTEN BY Janet Fricker
Find out more at menshealthwales.com
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Low testosterone – no reason to feel ashamed The hormone testosterone conjures up negative images linked to body builders, sports doping and male machismo, but it shouldn’t be forgotten as it plays a vital role in men’s wellbeing, making it important to identify men with low levels.
T INTERVIEW WITH Professor Mike Kirby, FRCP Editor Trends in Urology & Men’s Health
estosterone is a hormone produced naturally by the body that has an essential role in the development of male sexual characteristics, it also affects most major organs including the brain, skin, muscle, bone, heart and kidneys,” says Professor Mike Kirby, an expert in men’s health. Testosterone deficiency occurs when, either the testes are unable to produce sufficient testosterone for normal function, or the pituitary gland’s ability to produce luteinizing hormone (which stimulates testosterone production) is diminished. “We know chronic diseases, like type 2 diabetes, abdominal obesity and chronic anaemia are all associated with men having testosterone deficiency,” explains Professor Kirby. Most men maintain adequate testosterone into old age The most common symptoms for testosterone deficiency are erectile dysfunction, loss of early morning erections and low sexual desire. Other tell-tale signs include fatigue, loss of muscle mass, weight gain, loss of body and facial hair, anaemia and mood changes. “Men often attribute these symptoms to ageing, but it’s important to realise they’re not a normal part of ageing and should be investigated,” says Professor Kirby. The European Male Ageing Study (EMAS), which evaluated the
biochemistry and symptoms of a random sample of 3,369 European men aged 40 to 79, found around 1 in 50 had testosterone deficiency. Although levels decrease with age (falling by about 1.5% per year after 30), the good news, says Professor Kirby, is that three-quarters of men maintain adequate levels into old age. Men suspected of having testosterone deficiency, because of symptoms such as those described, should have blood tests. If these tests confirm testosterone deficiency, there are many treatments available.
Men often attribute these symptoms to ageing, but it’s important to realise they’re not a normal part of ageing and should be investigated. Impact on relationships Although men may feel there is a stigma attached to being diagnosed with testosterone deficiency, there needs to be an understanding that it can be associated with other serious conditions such as cardiovascular disease and diabetes. “Testosterone deficiency is also important to address because it impairs quality of life. For many of the reasons outlined above” says Professor Kirby.
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Testosterone deficiency may be a key player in type 2 diabetes Tackling testosterone deficiency may help to reduce the toll of type 2 diabetes (T2D) and cardiovascular disease (CVD) in men.
INTERVIEW WITH Jonny Coxon GP Partner and Specialty Doctor in Gender Medicine; President, British Society for Sexual Medicine
H INTERVIEW WITH Professor T. Hugh Jones Consultant Physician and Endocrinologist, and Hon. Professor of Andrology; President of the Androgen Society; Committee member of the Association of British Clinical Diabetologists (ABCD); European Association of Urology (EAU) guidelines panel on ‘Sexual and Reproductive Health’
ugh Jones, Professor of Andrology at the University of Sheffield, says that naturally produced testosterone improves glucose control in multiple ways. “It stimulates the efficiency of insulin receptors, increases glucose transport across cell membranes and glucose metabolism in cells.” Professor Jones, who has just become President of the International Androgen Society, has a long-standing interest in links between testosterone deficiency and T2D. His research has shown that 40% of men with T2D suffer from symptomatic testosterone deficiency, and T2D men with testosterone deficiency had more than twice the risk of early death compared to men with T2D and normal testosterone levels. Yet men who have had their testosterone deficiency treated for six years, achieved the same survival as T2D men without testosterone deficiency. Prediabetes, a condition affecting huge numbers of the population, can be better tackled by managing testosterone deficiency. Prevention of type 2 diabetes Strong evidence is building to demonstrate that managing testosterone deficiency in men with prediabetes, alongside lifestyle weight management programmes may prevent the progression to type 2 diabetes, whilst also demonstrating significant reductions in waist circumference and body fat. Professor Jones is also interested in associations between CVD and testosterone deficiency. “Here we think that naturally produced normal levels of testosterone protect against lipid being deposited in the arteries,” he explains. Significant further research is ongoing to study how CVD outcomes are affected by the safe management of testosterone deficiency. “These, and other studies, will be critical in the future for helping doctors decide how best to manage men with testosterone deficiency especially those who have other chronic conditions” says Professor Jones.
Creating dialogues between men and their doctors General practice provides the gateway to improving male health, so men need to step up and make an appointment if they have any symptoms concerning them.
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amily doctors need to be Financial incentives to support proactive and make the most health services of any visit from male patients Undoubtedly GPs need more because this may be the one support. Astonishingly, there are opportunity they have to positively no National Institute for Clinical impact that man’s health. Excellence (NICE) guidelines on Despite men representing 50% of erectile dysfunction or testosterone the population, says Dr Jonny Coxon, deficiency. “If NICE issued guidance President of the British Society for many more GPs would be prompted Sexual Medicine (BSSM) and a GP to automatically think about men’s from Brighton, GPs can sometimes health issues,” says Dr Coxon. lack experience GPs are learning interacting with men simple strategies on sensitive health to make men feel issues. Men typically more comfortable, Men typically do not express do not express their including making their concerns as easily as concerns as easily as waiting rooms women, so GPs need more conducive, women, so GPs need to learn to learn that a direct offering telephone that a direct approach may be conversations that approach may be needed to get them to open up. suit working hours needed to get them to open up. and providing space for initiatives like “men sheds” where Maintaining the connection men meet to discuss health issues. Communication difficulties particularly hold for intimate sexual health matters. “With sexual health, it’s helpful for GPs to think through phrases that work for them. Men can be reluctant to bring the topic up, but once given the opportunity to talk they’re grateful,” says Dr Coxon.
Awareness of testosterone deficiency has been key for my health Phil Morris had to fight to get his testosterone deficiency recognised, but treatment helped him to regain his spark. INTERVIEW WITH Phil Morris Founder, Testicular Cancer UK, & Patient
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t the age of 29, Phil Morris was diagnosed with testicular cancer. After surgery to remove his right testicle and chemotherapy, he thought life would return to normal. But a year later he still suffered excessive fatigue. “I went from being a really chirpy lad to feeling like a zombie sitting on the sofa all day,” Phil remembers, who also noticed other symptoms including low mood, weight gain and hot flushes. “Despite
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being just 30 I’d no sex drive and felt really old,” he says. Challenging access to treatment The GP prescribed antidepressants, but they had no effect. Then he read an article discussing how after surgery the remaining testicle cannot always produce sufficient testosterone. Phil’s GP followed up with blood tests which initially proved inconclusive. However, with further advice from a hospital consultant, who was treating him for a kidney stone, an appropriate course of management was identified. After a few years, he felt sufficiently well so he decided to stop treatment. However, when symptoms soon
returned, he sought help again and this time he was diagnosed with both testosterone deficiency and high blood sugar, indicating a danger of developing type 2 diabetes. Both issues have since been addressed and Phil is glad that he sought help when he did. Seeing his doctor for his symptoms and deciding on an appropriate course of management has been key for his health. If you are affected by any of the issues in this article or want more information, please talk to your doctor.
Find out more at testicular canceruk.com
BHUK/2021/100 Date of preparation: November 2021
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A proactive approach to male continence Bladder and bowel problems affect people of all ages, with profound consequences on quality of life. It is estimated that 14 million men, women, young people and children are living with bladder problems.
WRITTEN BY Karen Irwin Specialist Nurse and Service Manager, Bladder and Bowel UK
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t is great to see female continence discussed with increasing sensitivity and openness. But it is similarly important that we recognise the significance of male continence issues. There is less guidance and research around men’s bladder and bowel health than women’s, yet a high percentage of men experience urological problems. Male incontinence is often age-related, with one in three older men reported to experience bladder problems. Seeking help from a healthcare professional The urinary system is vital to health and wellbeing. Problems cause significant disruption and disturbance and sometimes indicate more serious underlying issues. Many continence difficulties can be managed or treated. Therefore, it is important to seek help. A GP is a good first contact. Doctors and nurses will be able to discuss symptoms sensitively and suggest a range of options. Urinary frequency is common and includes needing to pass urine at night. This can be extremely disruptive for the individual and their household. It is not inevitable with aging and can be treated. Emotional impact of incontinence Urinary incontinence, or involuntary leakage, can involve a few drops to a full bladder. This can occur due to not managing to reach the toilet quickly enough or being taken unawares. Incontinence products can be helpful, but may result in loss of self-esteem, depression and loss of independence. Incontinence can affect relationships and employment prospects, but there are positive steps that can be taken to avoid or treat it.
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The urinary system is vital to health and wellbeing. Problems cause significant disruption and disturbance and sometimes indicate more serious underlying issues. A slow urinary flow can be frustrating. This issue is most common in men over 50 but can occur in anyone. It may be related to enlargement of the prostate gland or narrowing of the urethra. These can slow urinary flow and lead to poor or incomplete bladder emptying. More serious issues include pain or passing blood with urine. Neither of these are normal. While in many cases there may be nothing to worry about, you should always contact your GP straight away. Don’t suffer in silence It is important to emphasise that you do not need to try and manage alone. There is treatment and support for many of these issues. A proactive approach may reduce the daily burden of bladder problems. At Bladder & Bowel UK, we encourage people to seek help and offer advice and guidance on how to take steps to get life back on track. Bladder & Bowel UK offer support for bladder and bowel health for everyone. They offer confidential advice from specialist nurses and product experts, and information on preventing and dealing with bladder and bowel issues can be found online at bbuk.org.uk
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Incontinence can affect relationships and employment prospects, but there are positive steps that can be taken to avoid or treat it. ~Karen Irwin, Specialist Nurse and Service Manager, Bladder and Bowel UK
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Men are encouraged to seek advice over urinary problems
permanent implants to lift and retract the obstructing prostate tissue, thus increase the opening of the urethra without cutting. Available on the NHS, the UroLift System does not require heating, cutting, removal, or destruction of prostate tissue.7-11 It is performed under local anaesthetic or general anaesthetic as a day-case.12 Mr Barber, who has treated over 600 patients with this procedure, says: “The UroLift System may help bridge the gap between medication and standard surgery such as TURP, which may have more significant side effects. It can lead to rapid symptom relief while preserving sexual function.*13 “It is a straightforward procedure; there is typically no long stay in hospital required, and it has a risk profile better than reported for TURP. After the procedure, patients are commonly back to normal activity within days.”7,12
While prostate cancer is a major concern among men as they get older, difficulties experienced in passing urine are often more likely to be associated with an enlarged prostate, often referred to as BPH (benign prostatic hyperplasia).1
INTERVIEW WITH
Mr Neil Barber Consultant Urological Surgeon, Frimley Health NHS Foundation Trust WRITTEN BY
Mark Nicholls
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leading urologist and a patient recommend men to seek medical advice at the first sign of urinary difficulties. Both surgeon Neil Barber and patient Norman Linter stress the importance of early intervention to help lead to better clinical outcomes and lower urinary tract symptoms. Mr Barber, who is Clinical Lead for Urology at Frimley Health NHS Foundation Trust in Surrey, says men should speak to their GP if they have urinary symptoms. “The most common cause of urinary symptoms in men over the age of 50 is an enlarged prostate” he adds.
Symptoms of BPH can include an urgent need to urinate or an increase frequency to urinate many times during both the day and night, trouble starting to urinate, weak or dribbling urine stream; and a feeling the bladder is never fully empty.3,4 As the prostate grows because of BPH, it constricts the urethra and this pressure prevents urine from flowing properly, causing bothersome urinary symptoms.5 “Historically men have put up with it, despite the impact on quality of life,” explains Mr Barber. “But we are in an era now where there are multiple treatment options for BPH to improve those symptoms and quality of life.”
Similar symptoms BPH and prostate cancer can both make the prostate gland, which sits below the bladder, increase in size and usually produce similar symptoms. However, BPH, which can affect half of men in their 50s, - is benign.2
Less-invasive approach Depending on the stage of the condition such as prostate size and severity of symptoms, treatment can range from medication to invasive surgery. There is a proven minimally invasive procedure, which utilises
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Seeking advice and support ** Retired engineer Norman Linter, 73, from Surrey, had problems with passing urine and after being diagnosed with BPH was offered the UroLift System treatment. He went into hospital at 8.30am, had the procedure at 9.30am on a Friday morning and was back home by 4pm. “There was some discomfort on Saturday, but on Sunday morning I played golf and have had symptom improvement ever since,” he says. “I did not need a catheter, my sexual function was not impacted and even my discomfort from the procedure lasted only 24 hours or so.” “My advice to men who have problems with urination is to speak to their GP. If there is anything wrong, even for a short period of time, seek advice. My enlarged prostate was causing me problems. People should ask their consultant for more information.” *No instances of new, sustained erectile or ejaculatory dysfunction in the LIFT pivotal study This article is sponsored by the manufacturer of the UroLift System References ** Individual results may vary 1. Prostate cancer UK: https://prostatecanceruk.org/ prostate-information 2. Berry, J Urol 1984 3. Rosenberg, Int J Clin Pract 2007 4. Vuichoud, Can J Urol 2015 5. AUA BPH Guidelines 2020 6. Tubaro, Drugs Aging 2003 7. Roehrborn, J Urol 2013; 8. Mirakhur, Can Assoc Rad J 2017 9. McVary, J Urol 20156 10. Gilling, Can J Urol 2020 11. Kadner, World J Urol 2020 12. Shore, Can J Urol 2014 13. Roehrborn, Can J Urol 2017 The UroLift System is Indicated for the treatment of symptoms of an enlarged prostate up to 100cc in men 50 years or older. As with any medical procedure, individual results may vary. Most common side effects are temporary and include pain or burning with urination, blood in the urine, pelvic pain, urgent need to urinate and/or the inability to control the urge. Rare side effects, including bleeding and infection, may lead to a serious outcome and may require intervention. Speak with your doctor to determine if you may be a candidate.
Find out more at urolift.co.uk
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