The advent of MRI-guided prostate biopsy has revolutionised this process. By using high-resolution Magnetic Resonance Imaging (MRI) before the procedure, urologists can now identify specific areas of concern and target them with millimetre precision, ensuring a more accurate diagnosis while reducing the discomfort of unnecessary sampling.

The Prevention: Lifestyle Tips

While you cannot change your genetics, you can influence the health of your prostate environment:

Mr. Collins Approach

While many clinics might move straight from a raised PSA to an invasive biopsy, by integrating this advanced biomarker assessment with MRI interpretation and PSA density, Mr Collins ensures that patients are never rushed into over-treatment for insignificant conditions, nor are they left in the dark about aggressive biology. 

Book an Appointment

FAQs

Based in Manchester and Cheshire, Mr Gerald Collins is currently accepting private consultations for the assessment of kidney masses, haematuria, and general urological concerns. With 29 years of experience, he provides the clarity and expertise needed to move from uncertainty to a confident treatment plan.

The post MRI-Guided Prostate Biopsy: Precision in Diagnosis appeared first on Gerry Collins Urology.

The Stockholm3 (STHLM3) model represents a major shift toward precision medicine. It is an advanced, risk-based blood test designed to refine detection by combining protein biomarkers, genetic markers, and clinical data into a sophisticated algorithm. By looking beyond a single number, it provides a much clearer picture of an individual’s true biological risk.

Relevant Fact:

Clinical studies involving over 90,000 men have demonstrated that the Stockholm3 test can reduce unnecessary biopsies by up to 52 percent while detecting nearly double the number of aggressive cancers in men with low PSA values (between 1.5 and 2.9 ng/ml) who might otherwise have been missed.

Symptoms

Early-stage prostate cancer often presents no symptoms at all. However, as the prostate enlarges, whether due to benign growth (BPH) or malignancy, you may notice:

• An increased urgency to urinate, particularly at night (nocturia).
• A weak or interrupted urinary flow.
• Difficulty starting to urinate or straining to empty the bladder.
• The presence of blood in the urine or semen (haematuria).
• Persistent pain in the back, hips, or pelvis, which can sometimes indicate more advanced disease.

If you experience these symptoms, it is essential to seek a specialist evaluation rather than relying solely on a standard PSA result.ent.

Mr. Collins Approach

While many clinics might move straight from a raised PSA to an invasive biopsy, Mr. Collins uses the Stockholm3 test as a critical “reflex test”. By integrating this advanced biomarker assessment with MRI interpretation and PSA density, he ensures that patients are never rushed into over-treatment for insignificant conditions, nor are they left in the dark about aggressive biology. 

Book an Appointment

Causes & Risk Factors

While the exact cause of most kidney cancers remains unclear, certain factors can increase your risk:

FAQs

Based in Manchester and Cheshire, Mr Gerald Collins is currently accepting private consultations for the assessment of kidney masses, haematuria, and general urological concerns. With 29 years of experience, he provides the clarity and expertise needed to move from uncertainty to a confident treatment plan.

The post Understanding the Stockholm3 Test appeared first on Gerry Collins Urology.

1. Confirming the Trend

The first step following an abnormal PSA result (generally >4.0 ng/mL, though age-adjusted) is often repeat testing.

• Confirmation: NCI and AUA guidelines recommend repeating the PSA test in 6 to 8 weeks to account for transient elevations caused by recent exercise, ejaculation, or minor infection.
• PSA Change: Recent research suggests that if a repeat test shows a decline of >20%, the risk of clinically significant cancer is lower, and a biopsy may potentially be avoided.
• PSA Velocity: While a rapidly rising PSA is a red flag, the AUA cautions that “PSA velocity” (the rate of change over time) should not be the sole reason for a biopsy; it must be considered alongside other risk factors.

2. Risk Assessment and “PSA Density”

To improve diagnostic accuracy, clinicians look beyond the total PSA number:

• PSA Density: This is the PSA level divided by the volume of the prostate (measured via ultrasound or MRI). A higher PSA density is a stronger predictor of cancer than the PSA level alone, especially in men with large prostates.
• Clinical Findings: A suspicious finding during a Digital Rectal Exam (DRE), such as a firm lump or irregularity, significantly increases the urgency for further investigation regardless of the PSA level.
• Risk Calculators: Tools that incorporate age, race, and family history help determine the probability of “clinically significant” prostate cancer (Grade Group 2 or higher).

3. The Role of Imaging (mpMRI)

Before proceeding to a biopsy, advanced imaging is now frequently used as a “gatekeeper” or triage tool.

• mpMRI (Multiparametric MRI): The European Association of Urology (EAU) and NCI support using mpMRI to identify suspicious areas within the prostate.
• Avoiding Biopsy: If an MRI is clear (PI-RADS 3 or less) and other risk factors are low, a doctor and patient may choose to forgo a biopsy and continue observation.
• Targeted Biopsy: If the MRI identifies a suspicious lesion (PI-RADS 4 or 5), it allows for a “targeted biopsy,” where needles are precisely guided to the area of concern, increasing the likelihood of detecting aggressive cancer.

4. When is a Biopsy Appropriate?

A prostate biopsy is the only definitive way to diagnose cancer. It is generally recommended when:

• The PSA remains elevated after a confirmatory test.
• The PSA density is high.
• The mpMRI shows suspicious lesions.
• A DRE reveals an abnormal lump.
• Shared Decision-Making: For men aged 55–69, the decision must weigh the benefit of early detection against the risks of the procedure (infection, bleeding) and the potential for “overdiagnosis” of slow-growing tumours that may never cause harm.

Summary Checklist for Further Testing

Mr Collins Approach

Mr Gerry Collins views a PSA result not as a definitive verdict; he incorporates your prostate volume, your age, and the Free to Total PSA ratio to build a risk-stratified map. By using advanced tools like the Stockholm3 biomarker test and MRI-guided interpretations, he filters out the benign causes of PSA elevation, such as inflammation or BPH, ensuring that only those who truly need an intervention proceed to biopsy. 

Book an Appointment

Based in Manchester and Cheshire, Mr Gerald Collins is currently accepting private consultations for the assessment of kidney masses, haematuria, and general urological concerns. With 29 years of experience, he provides the clarity and expertise needed to move from uncertainty to a confident treatment plan.

The post When Further Tests are Needed: Guidance on Prostate Imaging and Biopsy appeared first on Gerry Collins Urology.

Here are the primary reasons your PSA might be high without the presence of malignancy:

1. Benign Prostatic Hyperplasia (BPH)

As men age, the prostate naturally enlarges. This non-cancerous growth is the most common cause of elevated PSA. BPH produces approximately 0.1ng/ml of PSA per cc of tissue.

2. Prostatitis and Infections

Inflammation of the prostate (prostatitis) or a Urinary Tract Infection (UTI) can cause a massive temporary spike in PSA levels. It takes up to 6 weeks for PSA to return to baseline after an infection.

3. Recent Ejaculation

PSA is found in high concentrations in seminal fluid. Ejaculating within 24 to 48 hours of a blood test can cause a small, temporary rise in serum PSA levels. Most guidelines suggest abstaining from sexual activity for two days before your test.

4. Physical Trauma or Vigorous Exercise

• Exercise: Activities that put pressure on the prostate, such as vigorous cycling can irritate the gland and raise levels.
• Injury: A fall or direct impact to the perineal area can cause a temporary spike due to trauma to the prostate tissue.

5. Medical Procedures and Examinations

Any recent “urological instrumentation” can interfere with results. This includes:

• Insertion of a urinary catheter.
• Prostate biopsies or surgery.
• Bladder examinations (cystoscopy).
• Even a Digital Rectal Exam (DRE) can cause a minor, though usually negligible, increase.

6. Age and Prostate Size

PSA levels naturally increase as you get older. This is why doctors use “age-adjusted” ranges. For example, a PSA of 4.5 might be suspicious for a 45-year-old but considered normal for a 70-year.

What happens if your PSA is high?

Because PSA levels fluctuate, a single high result is rarely enough for a diagnosis. If your level is raised, your doctor may recommend:

• A Repeat Test: To see if the level drops naturally after a few weeks.
• mp-MRI Scan: A detailed scan used to look for suspicious areas within the prostate. A clear MRI (reported as low risk) has a 90% chance of ruling out significant cancer.
• PSA Density: Dividing your PSA level by the volume of your prostate (measured via scan) to see if the level is appropriate for your prostate’s size.

At this point, a decision is made as to whether a biopsy is required.

Mr Collins Approach

Mr Gerry Collins views a PSA result not as a definitive verdict; he incorporates your prostate volume, your age, and the Free to Total PSA ratio to build a risk-stratified map. By using advanced tools like the Stockholm3 biomarker test and MRI-guided interpretations, he filters out the benign causes of PSA elevation, such as inflammation or BPH, ensuring that only those who truly need an intervention proceed to biopsy. 

Book an Appointment

Based in Manchester and Cheshire, Mr Gerald Collins is currently accepting private consultations for the assessment of kidney masses, haematuria, and general urological concerns. With 29 years of experience, he provides the clarity and expertise needed to move from uncertainty to a confident treatment plan.

The post When PSA is Not Cancer: Understanding High Results appeared first on Gerry Collins Urology.

The challenge in modern urology is the mildly raised PSA level between 4 and 10 ng/mL. In this range, the majority of men do not have clinically significant cancer. This creates a diagnostic dilemma in choosing those who require further investigation and/or biopsy. To move beyond a “one size fits all” interpretation, we must look at PSA derivatives, such as age-specific ranges, Free PSA and PSA Density, to understand the unique biology of the individual.

Relevant Fact:

Research published in 2025 indicates that the PSA Density (PSAD) and the PSA-Age Volume index (PSA-AV) significantly outperform standard PSA tests in terms of diagnostic accuracy. In patients with PSA levels below 10 ng/mL, PSAD has shown a specificity as high as 94.7 percent, helping to rule out cancer more effectively than traditional methods.

Symptoms

A high PSA result is often discovered during routine screening before any physical symptoms appear. However, you should consult a specialist even if you do not have any symptoms.

Mr Collins Approach

Mr Gerry Collins views a PSA result not as a definitive verdict; he incorporates your prostate volume, your age, and the “Free to Total” PSA ratio to build a risk-stratified map. By using advanced tools like the Stockholm3 biomarker test and MRI-guided interpretations, he filters out the benign causes of PSA elevation, such as inflammation or BPH, ensuring that only those who truly need an intervention proceed to biopsy. 

Book an Appointment

FAQs

Based in Manchester and Cheshire, Mr Gerald Collins is currently accepting private consultations for the assessment of kidney masses, haematuria, and general urological concerns. With 29 years of experience, he provides the clarity and expertise needed to move from uncertainty to a confident treatment plan.

The post PSA, Free PSA, and PSA Density: What is it? appeared first on Gerry Collins Urology.

The disease typically begins in the germ cells, which are the cells responsible for creating sperm. Most cases are highly treatable and curable, especially when identified in the early stages. However, because it often affects younger men who may not be accustomed to regular health screenings, awareness and prompt action are vital.

Relevant Fact:

In the United Kingdom, approximately 2,400 new cases of testicular cancer are diagnosed every year. Despite this, it has one of the highest survival rates of any cancer, with more than 96% of men surviving for 10 years or more after diagnosis.

Symptoms

The most common sign of testicular cancer is a painless lump or swelling. However, several other indicators should prompt a consultation:

• A Palpable Lump: A small, hard lump, often described as feeling like a pea or a grain of rice, located on the front or side of the testicle.
• Changes in Texture: A testicle that feels unusually firm, hard, or has changed its regular consistency.
• Heaviness: A dragging sensation or a feeling of increased weight in the scrotum.
• Size Discrepancy: While it is normal for one testicle to be slightly larger or hang lower than the other, a significant or sudden change in size should be noted.
• Ache or Discomfort: A dull ache in the lower abdomen or the groin area.
• Late Stage Signs: If the cancer spreads to the lymph nodes or lungs, symptoms may include back pain, a persistent cough, or shortness of breath.

Mr Collins Approach

Having conducted MD research at the Mayo Clinic and Edinburgh University, Mr Collins focuses on what is clinically significant for the individual. This means carefully staging the disease and discussing the nuances of treatment, such as the timing of surgery and the preservation of long-term health, rather than rushing a generic plan. His role as the European Editor of The Prostate Journal at Harvard ensures that his practice is always at the forefront of global oncological research.

Book an Appointment

Causes & Risk Factors

While the exact cause of testicular cancer remains unknown, several factors are known to increase a man’s risk:

The Solution: Treatment pathways

The primary objective of treatment is to remove the cancer while preserving quality of life and future fertility.

Fertility Preservation:
Because treatments can affect sperm production, Mr Collins ensures that “Sperm Banking” is discussed and arranged before any intensive treatment begins, providing peace of mind for future family planning.

How to Prevent?

There is no known way to prevent testicular cancer, as it is not linked to lifestyle choices like smoking or diet. Therefore, the focus is entirely on early detection through self-examination.

• The Monthly Check: You should examine your testicles once a month.
• The Best Time: Perform the check after a warm bath or shower. The heat relaxes the scrotum, making it much easier to feel for anything unusual.
• The Technique: Use both hands to roll each testicle between your thumb and fingers. Get to know what is “normal” for you.
• Identify the Epididymis: Do not be alarmed by a soft, coiled tube at the back of the testicle. This is the epididymis, which stores sperm, and it is a normal part of your anatomy.
• Act Quickly: If you find a lump, do not wait for it to go away. Most lumps are benign cysts or swollen veins (varicoceles), but only a specialist can provide the certainty required.

FAQs

Based in Manchester and Cheshire, Mr Gerald Collins is currently accepting private consultations for the assessment of kidney masses, haematuria, and general urological concerns. With 29 years of experience, he provides the clarity and expertise needed to move from uncertainty to a confident treatment plan.

The post Testicular Cancer: A Guide to Early Detection and Specialist Care appeared first on Gerry Collins Urology.

In the UK, the most common form of the disease is Renal Cell Carcinoma (RCC), which accounts for approximately 80% of cases. While a diagnosis can feel overwhelming, advancements in imaging and surgical techniques mean that many kidney tumours are now caught early, often incidentally during scans for unrelated conditions. At this stage, the disease is highly manageable and often curable.

Relevant Fact:

Every year, over 9,000 people in the UK are diagnosed with kidney cancer. Due to the increased use of modern imaging like CT scans, many of these cases are discovered when the tumours are small and have not yet caused any outward symptoms.

Symptoms

The most significant indicator of bladder cancer is haematuria, which is the medical term for blood in the uIn its earliest stages, kidney cancer rarely presents obvious signs. However, as a tumour grows, certain “red flags” may emerge. You should seek a consultation if you notice:

• Haematuria: Blood in your urine, which may appear pink, red, or the colour of cola.
• Persistent Pain: A dull ache or sharp pain in your side or back (flank) that does not go away.
• A Palpable Mass: A lump or swelling in the kidney area, under the ribs, or occasionally in the neck.
• Systemic Symptoms: Unexplained weight loss, a persistent high temperature, night sweats, or extreme fatigue.

If you notice blood in your urine, it is vital to have it investigated promptly. While it can be caused by infections or stones, it is a primary indicator that requires professional urological assessment.

Mr. Collins Approach

Mr Gerald Collins brings nearly three decades of clinical experience to the management of kidney cancer.
His philosophy is rooted in the “Science and Art” of healing, a perspective shaped by his fifth-generation medical pedigree and his time conducting research at Edinburgh University and the Mayo Clinic in the USA.

Book an Appointment

Causes & Risk Factors

While the exact cause of most kidney cancers remains unclear, certain factors can increase your risk:

The Solution: Treatment pathways

The treatment for kidney cancer is highly personalised, depending on the stage and grade of the tumour. Mr Collins specialises in navigating these complex decisions:

How to Prevent?

While you cannot change your genetics, you can take active steps to lower your risk:

1. Stop Smoking: This is the single most impactful change you can make for urological health.
2. Manage Your Blood Pressure: Have your blood pressure checked regularly by your GP. If it is high, manage it through a combination of diet, exercise, and medication.
3. Maintain a Healthy Weight: A diet rich in fruits and vegetables, combined with at least 30 minutes of exercise most days, helps regulate the hormonal and inflammatory markers linked to kidney cancer.
4. Stay Hydrated: While hydration does not directly prevent cancer, it supports overall kidney function and health.

FAQs

Based in Manchester and Cheshire, Mr Gerald Collins is currently accepting private consultations for the assessment of kidney masses, haematuria, and general urological concerns. With 29 years of experience, he provides the clarity and expertise needed to move from uncertainty to a confident treatment plan.

The post Kidney Cancer: Understanding the Diagnosis and Your Path Forward appeared first on Gerry Collins Urology.

In the UK, approximately 10,000 people are diagnosed with bladder cancer every year. While it is a serious diagnosis, urological medicine has advanced significantly. When identified early, the condition is highly treatable, but it requires a strategic, long-term surveillance plan because of its tendency to recur.

Relevant Fact:

Approximately 8 out of 10 (80%) of bladder cancers in the UK are diagnosed at an early stage, when the cancer is confined to the inner lining of the bladder and is most responsive to treatment.

Symptoms

The most significant indicator of bladder cancer is haematuria, which is the medical term for blood in the urine. It is often painless and may not happen every day.

You should seek an urgent GP appointment or contact NHS 111 if you notice:

• Visible blood in your pee, which may appear bright red, pink, or even a dark brown cola colour.
• Blood that appears once and then disappears, it still requires investigation.
• Frequent urinary tract infections (UTIs) that do not seem to clear with standard treatment.
• A sudden or urgent need to urinate, even when the bladder is not full.
• A burning sensation or pain during urination.

In more advanced cases, patients may experience pain in the lower tummy or back, unexplained weight loss, or a persistent feeling of tiredness. If the cancer has spread beyond the bladder, bone pain or swelling in the legs can also occur.

Mr. Collins Approach

With 29 years of experience, Mr Gerry Collins approaches urology as a combination of rigorous science and delicate art.

He believes the greatest advantage a patient can have is a surgeon who listens, filtering out the clinical noise to focus on what is significant for the individual. His role as the European Editor of The Prostate Journal (Harvard) and his extensive research portfolio (over 100 publications) ensure his patients benefit from the latest global evidence, delivered with the nuance of three decades of surgical practice.

Book an Appointment

Causes & Risk Factors

Several factors can influence the development of bladder cancer. Understanding these is vital for both prevention and diagnosis:

The Solution: Treatment pathways

The treatment strategy depends on whether the cancer is non-muscle-invasive (early) or muscle-invasive (advanced).

Diagnostic Pathway

Diagnosis typically begins with a cystoscopy, where a thin camera is passed into the bladder, and a CT scan. If an abnormality is found, further staging is sometimes performed with an MR scan of the bladder area. Usually then a procedure called TURBT (Transurethral Resection of a Bladder Tumour) is performed. This is both a diagnostic tool, providing a biopsy to determine the grade and stage, and often the first step in treatment.

How to Prevent?

While some risk factors like age cannot be changed, you can take proactive steps to protect your bladder health:

1. Stop Smoking: This is the single most effective way to lower your risk. Even after years of smoking, quitting significantly reduces the accumulation of toxins in your bladder.
2. Stay Hydrated: Drinking plenty of water helps to dilute your urine and ensures that any potentially harmful chemicals are flushed out of your system more quickly.
3. Workplace Safety: If you work in an industry involving chemicals or dyes, strictly follow all health and safety protocols and use personal protective equipment.
4. Eat a Colourful Diet: Focus on fruits and vegetables rich in antioxidants, which may help protect your cells from DNA damage.

FAQs

The post Bladder Cancer: Understanding the Risks, the Signs, and the Strategy appeared first on Gerry Collins Urology.

In many cases, the cancer remains confined to the prostate gland and may never cause significant harm during a man’s lifetime. However, other types are more aggressive and require prompt, strategic intervention to prevent spread to other parts of the body.

Did you know:

In the UK, 1 in 8 men will be diagnosed with prostate cancer in their lifetime. This risk increases significantly to 1 in 4 for Black men, highlighting the importance of tailored screening and early awareness within specific risk groups.

Symptoms

Prostate cancer does not usually cause symptoms until it has spread to other parts of the body; in other words, symptoms are caused by secondaries. Urinary symptoms are usually caused by benign non-cancerous enlargement of the prostate (BPH), which is very common.  The prostate starts to enlarge in the vast majority of men in their 40s.

Nevertheless, you should consult a specialist if you notice:

• An increased need to urinate, especially during the night (nocturia).
• Difficulty starting to pee or straining during the process.
• A weak or interrupted flow of urine.
• A feeling that your bladder has not fully emptied.
• Blood in the urine or semen (haematuria).

In advanced cancer, symptoms might also include persistent back, hip, or pelvis pain, unexplained weight loss, or erectile dysfunction.

Mr. Collins Approach

Mr Gerry Collins views every diagnosis as a unique biological puzzle rather than a routine procedure. Having conducted extensive research at Edinburgh University and the Mayo Clinic, his approach is built on “Clinical Discernment.” This means looking beyond raw PSA numbers to understand the individual biology of each patient.

While MR is the current state of the art imaging, there are significant limitations in that MR cannot easily distinguish between cancer and inflammation (common) and therefore even abnormal MRs need to be interpreted before deciding to proceed to biopsy.

Book an Appointment

Causes & Risk Factors

While the exact cause of prostate cancer remains unknown, several factors increase the likelihood of development:

The Solution: Treatment pathways

Management is categorised by risk groups: low, intermediate, and high risk. Treatment is never “one size fits all” and is dictated by the grade of the cancer and the patient’s overall health.

How to Prevent?

While you cannot change your genetics or age, you can support your prostate health through proactive lifestyle choices:

• Dietary Choices: Incorporate foods rich in lycopene, such as cooked tomatoes, and cruciferous vegetables like broccoli and cauliflower.
• Maintain a Healthy Weight: Evidence suggests that obesity is linked to more aggressive prostate cancers.
• Regular Exercise: Staying active improves overall metabolic health and can help manage hormone levels.
• Smoking Cessation: Smokers may have a higher risk of cancer recurrence and poorer outcomes following treatment.

FAQs

The post Prostate Cancer: A Guide to Risk, Diagnosis, and Measured Management appeared first on Gerry Collins Urology.

For many, the condition manifests as a persistent need to pass urine, often in small amounts, alongside a heavy, aching pressure in the lower tummy or pelvis. While it is more common in women, it significantly affects men as well, often being misdiagnosed as chronic prostatitis. Though there is currently no universal cure, the focus of modern urology is on strategic management: identifying unique triggers and cooling the “biological fire” within the bladder wall.

Symptoms

Because BPS symptoms can mimic other conditions, it is vital to recognise when your symptoms require specialist investigation. You should seek a consultation if you experience:

• Persistent pain in the bladder, lower tummy, or pelvic floor that does not resolve with standard treatments.
• An overwhelming and frequent urge to urinate, even when the bladder is empty.
• Nocturia: Waking up multiple times during the night to pass urine.
• Pain during or after sexual intercourse (penetration for women) or pain during erection or after ejaculation for men.
• Visible blood in the urine (haematuria): This requires urgent assessment to rule out other underlying causes.
• Symptoms that “flare” or worsen in response to specific triggers like stress, certain foods, or the menstrual cycle.

Mr. Collins Approach

With nearly 30 years of experience and a background in rigorous research at Edinburgh University and the Mayo Clinic, he understands that for a patient in pain, the “wait and see” approach only breeds anxiety.

In men, he carefully distinguishes BPS from BPH (enlarged prostate) or prostatitis, ensuring patients are not subjected to unnecessary treatments. By viewing every diagnosis through the lens of neovascularity and bladder biology, he filters out the clinical noise to create a highly personalised, measured intervention plan that respects the patient’s individual baseline.

Book an Appointment

Causes & Risk Factors

While the exact cause of BPS remains a subject of ongoing research, several factors are believed to contribute to the irritation of the bladder wall:

Treatment pathways

Mr Collins focuses on a tiered approach, starting with the least invasive options and progressing to more advanced therapies where necessary.

Medical & Therapeutic Pathways:

• Oral Medications: This includes everyday painkillers, antihistamines to reduce inflammation, or nerve-blockers like amitriptyline to dampen pain signals.
• Bladder Instillations: Often called a “bladder cocktail,” this involves delivering soothing medicine (such as sodium hyaluronate or heparin) directly into the bladder via a thin catheter to protect the lining.
• Neuromodulation: Sacral nerve stimulation (SNS) involves a small device that sends electrical signals to the nerves controlling the bladder, helping to reset the “urgency” signals.
• Specialist Pelvic Physiotherapy: Targeted exercises to relax and coordinate pelvic floor muscles, which are often in a state of chronic spasm in BPS patients.

Surgical & Advanced Pathways:

• Cystoscopy with Bladder Overdistention: A procedure to stretch the bladder under general anaesthetic, which can sometimes desensitise the nerves and improve capacity.
• Resection of Hunner’s Ulcers: If specific lesions (ulcers) are found on the bladder wall, they can be cauterised or removed using a laser.
• Major Surgery: In extreme cases where all other treatments have failed, options such as a reconstructed bladder (neo-bladder) or urinary diversion may be discussed.

How to Prevent?

Managing BPS often starts with proactive changes at home to reduce the frequency of flare-ups:

• The Food Diary: Track your intake to identify personal “triggers.” Common culprits include caffeine, alcohol, spicy foods, and highly acidic items like citrus fruits and tomatoes.
• Bladder Retraining: Gradually increasing the time between bathroom visits can help the bladder learn to hold more urine over time.
• Stress Management: Stress is a known trigger for pelvic pain. Incorporating low-impact exercise like yoga or meditation can help regulate the nervous system.
• Smoking Cessation: Smoking irritates the bladder and restricts blood flow, hindering the natural healing process of the bladder lining.

FAQs

The post Understanding Interstitial Cystitis / Bladder Pain Syndrome (BPS) appeared first on Gerry Collins Urology.

While the symptoms can be distressing, it is important to remember that prostatitis is not cancer.

Did you know

Some studies suggest that as many as 10 percent of adult males suffer from prostatitis at some point in their lives. Despite its prevalence, it remains one of the most challenging conditions to diagnose because its symptoms frequently overlap with other urological health issues.

Symptoms

Because the symptoms of prostatitis can be vague or mimic other conditions, it is crucial to seek a specialist opinion if you experience any of the following:

• Pain or a burning sensation when peeing (dysuria).
• Frequent or urgent need to urinate, especially during the night.
• Pain in the perineum (the area between the scrotum and the anus), testicles, or tip of the penis.
• Discomfort or pain during or after ejaculation.
• A feeling that the bladder has not fully emptied.
• Flu-like symptoms such as fever, chills, and lower back pain (typically seen in acute cases).

Mr. Collins Approach

With nearly three decades of experience, Mr. Collins understands that prostatitis can cause significant “noise” in diagnostic data, such as elevated PSA levels.

His approach filters this noise by integrating advanced risk-stratification tools and a deep understanding of prostate biology. He ensures that every patient receives a strategic, measured intervention rather than a rushed or generic treatment plan.

Book an Appointment

Causes & Risk Factors

The causes of prostatitis are varied and sometimes overlap, making a precise diagnosis essential:

Treatment pathways

Treatment for prostatitis is never “one size fits all.” It is dictated by whether the cause is bacterial or inflammatory.

Medical Pathways:

• Targeted Antibiotics: For bacterial cases, a course of antibiotics is prescribed. While acute cases may resolve in 14 days, chronic bacterial prostatitis may require treatment for four to six weeks to ensure the infection is fully eradicated.
• Alpha-blockers: These medications help relax the muscles where the prostate meets the bladder, improving urine flow and reducing discomfort.
• Pain Management: Specialist analgesics or anti-inflammatories are used to manage pelvic discomfort and swelling.
• The UPOINT Approach: Mr Collins utilises this structured framework to address the urinary, psychosocial, organ-specific, and neurological aspects of the condition simultaneously.
• Acupuncture including moxatherapy

Surgical & Investigative Pathways:

• Flexible Cystoscopy: If symptoms persist, a small telescope may be used to examine the bladder and prostate to rule out other abnormalities.
• Specialised Physiotherapy: For men with chronic pelvic pain syndrome, working with a specialist pelvic floor physiotherapist can help relax overactive muscles.

Lifestyle tips

While you cannot always prevent prostatitis, you can manage the symptoms and reduce the risk of flare-ups through proactive choices:

• Stay Hydrated: Drink plenty of fluids to avoid dehydration and help flush the urinary system.
• Dietary Awareness: Some men find that caffeine, alcohol, and spicy foods irritate the bladder and prostate.
• Warm Baths: “Sitz baths” (soaking the pelvic area in warm water) can help relax pelvic muscles and relieve pain.
• Stress Management: Techniques such as relaxation exercises or mindfulness can be effective, particularly for those whose symptoms are triggered by stress.
• Frequent Ejaculation: Some evidence suggests that regular ejaculation can help clear prostatic secretions and reduce congestion in the gland.

FAQs

The post Understanding Prostatitis: A Guide to Inflammation, Infection, and Precision Management appeared first on Gerry Collins Urology.

In urological practice, we categorise incontinence into several distinct types. Stress incontinence occurs when the bladder is under sudden physical pressure. Urge incontinence, often linked to an “overactive bladder,” involves a sudden, intense need to pass urine. Overflow incontinence occurs when the bladder cannot empty fully, leading to frequent dribbling, while total incontinence refers to a complete lack of storage capacity. Understanding these distinctions is the first step toward effective management.

The Red Flags

Many people tolerate bladder leaks for years before seeking help, often due to embarrassment. However, certain symptoms require a structured clinical evaluation to rule out underlying issues. You should consult a specialist if you experience:

• Sudden, involuntary leakage when you laugh, cough, or exercise.
• An overwhelming, “must-go-now” urge that you cannot suppress.
• Waking up multiple times during the night to urinate (nocturia).
• A weak urinary stream or a feeling that your bladder is never quite empty.
• Constant dribbling of urine throughout the day.
• Pain during urination or the presence of blood in the urine (haematuria).

Mr. Collins Approach

While many clinics may offer a generic pathway, for men, this often involves a deep analysis of prostate health, as an enlarged prostate (BPH) is a frequent driver of overflow and urge symptoms. 

For all patients, Mr Collins integrates advanced diagnostics with a nuanced understanding of pelvic floor biology for a tailored treatment plan.

Book an Appointment

Causes & Risk Factors

Incontinence is often a multi-factorial issue where biology, lifestyle, and medical history intersect. Common causes include:

Treatment pathways

Treatment is tailored to the specific type and severity of the incontinence, moving from conservative measures to more advanced interventions.

Medical and Conservative Pathways:

• Lifestyle Modification: Identifying and reducing bladder irritants such as caffeine, alongside weight management.
• Bladder Training: Learning to increase the time between urges to improve bladder capacity.
• Pelvic Floor Muscle Training (PFMT): Structured exercises to strengthen the muscles that support the bladder and urethra.
• Medication: Anticholinergics or Mirabegron can be highly effective in calming an overactive bladder.

Surgical and Procedural Pathways:

• Sling Procedures: For stress incontinence, a small ribbon of material is used to support the urethra.
• Botulinum Toxin (Botox): Injections into the bladder wall can relax overactive muscles for those with severe urge incontinence.
• Sacral Nerve Stimulation (SNS): A small device is implanted to regulate the nerve signals to the bladder.
• Prostate Management: If the cause is an obstruction, addressing the prostate size can often resolve the urinary leakage.

Lifestyle tips

While some risk factors are outside of your control, you can take proactive steps to maintain bladder health:

1. Hydrate Smartly: Do not restrict fluids too severely, as concentrated urine can irritate the bladder. Aim for steady intake, but reduce fluids two hours before bed.
2. Pelvic Floor Strength: Regular “Kegel” exercises are not just for women: they are vital for men, especially those undergoing prostate treatment.
3. Manage Your Weight: Reducing even a small amount of weight can significantly decrease the pressure on your pelvic floor.
4. Watch the Irritants: If you notice leaks after drinking coffee, tea, or fizzy drinks, try switching to decaffeinated versions or water.

FAQs

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