The symptoms and signs may include:

• Pain in your loin (flank) which can radiate towards back or groin
• Blood in urine can be due to friction of stone within the urinary tract or associated infection
• Non-visible blood in your urine – found only when your urine is examined under a microscope or tested using a sensitive dipstick
• Infection in your urine – stones are a known risk factor for urinary infection
• Ureteric colic – severe pain as a stone passes down towards your bladder from your kidney. This can be intermittent but severe.
• No symptoms – if a stone stays in your kidney, it may not cause any symptoms at all, and may only be found found “by chance” (usually on an X-ray or scan done for another reason)

Most urine infections occur when bacteria enter your bladder through your urethra (waterpipe);

Risk factors include:

• Sexual intercourse
• Passing urine infrequently
• Incomplete bladder emptying
• Stones
• Poorly-draining kidneys
• Congenital anomalies of urinary tract
• Catheters / Tubes / Forign bodies

Most urine infections are caused by a bacterium called E coli . Other types of bacteria may be responsible, and the type of organism can sometimes give a pointer to the underlying problem (e.g. kidney or bladder stones may be associated with a bacterium called Proteus)

Is a urinary infection important or serious in children?

• Urinary infections can make children feel very ill with non-specific symptoms such as vomiting, abdominal pain and a high temperature.
• If infection enters the kidney(s) by reflux, the infection may cause a scar to form in the kidney(s)
• Scarring of the kidney due to infection is permanent; this can cause problems with kidney function and may cause high blood pressure in later life.
• Urinary infections in children must be treated without delay to prevent scarring.
• Urinary infections may be an indicator of problems (abnormalities) within the urinary tract.
• These abnormalities may be a risk factor for future problems, including further infections.

• The commonest cause of blood in the urine is infection (cystitis).
• Proven blood in the urine, whether visible or non-visible (found on a urine test), should always be investigated.
• 1 in 5 adults with visible blood in the urine and 1 in 12 adults with non-visible blood in the urine are subsequently discovered to have bladder cancer.
• Children with blood in the urine rarely have cancer – they usually have infection in the bladder or inflammation of their kidneys (nephritis/pyelonephritis).
• A “one-off” finding of a small trace of blood in the urine on routine testing may not be significant.
• Some drugs (e.g. rifampicin, nitrofurantoin) and foodstuffs (e.g. beetroot) can turn the urine red.

• By the age of 65 years, 50% of men will experience benign enlargement of the prostate. At the age of 90, 90% of men have prostatic enlargement.
• An enlarged prostate alone does not always cause symptoms.
• The severity of the symptoms is not related to the size of the prostate.
• 1 in 3 men will suffer prostatic symptoms during their life.
• 1 in 10 men will require surgical treatment for their symptoms.
• Not all urinary symptoms in men are due to an enlarged prostate – incontinence, pain or blood in the urine may be due to other conditions.
• The risk of prostate cancer is not increased by having benign enlargement of the prostate. You are no more likely to develop prostate cancer than a man without benign prostatic enlargement.
• 30-40% of men with prostatic symptoms do not experience worsening of their condition with time and may not require any treatment.
• If treatment is indicated, this usually involves with drugs which relax the muscle in and around the prostate and/or drugs which shrink the glandular component of the prostate.
• If symptoms are severe, if there is no response to medical treatment or if there are complications of prostatic enlargement, surgical treatment may be indicated
• The risk of acute, painful retention of urine is small (approximately 1 in 100) and it is not always preceded by prostatic symptoms. Acute retention usually requires surgical treatment

• 1 in 7 couples face some form of difficulty having children.
• In 50% of these couples, the problem lies wholly or partly with the male partner.
• Urological investigation may reveal a reversible underlying cause for male-factor subfertility and full assessment by a Urologist is recommended in all cases of male-factor infertility.
• In many cases, the underlying cause cannot be reversed, in which case assisted conception may offer the best chance of pregnancy. This may involve surgical sperm retrieval in advanced cases of infertility.

What is erectile dysfunction?

Erectile dysfunction (impotence) is defined as an inability to obtain or maintain an erection sufficient for penetration and for the satisfaction of both sexual partners.

What should I do if I have problems with impotence?

• Erectile dysfunction can be caused by many factors and may have a gradual or sudden onset. It can be very upsetting and result in a lot of stress and worry. It can feel embarrassing to discuss this with your doctor but it is important that you do, so that you can receive the appropriate help. 
• Erectile dysfunction can also be a sign of other illnesses such as heart disease or diabetes, so it is important that you seek medical advice.

What are the facts about impotence?

Erectile dysfunction is more common with increasing age and is seen in 50 – 55% of men between 40 and 70 years old;

• It is often associated with obesity, high blood pressure, high cholesterol & diabetes which are all significant risks to health in general as well.
• Most treatable causes can be identified by a clinical history, physical examination and routine blood tests.
• Treatment with tablets is often first option for most men.
• Other methods of treatment are only indicated if medication proves ineffective, causes side-effects or cannot be used because of specific medical conditions.

• Premature ejaculation is usually lifelong (it often dates back to the first sexual experience).
• Rarely, premature ejaculation may develop in later life when it is often progressive.
• We do not know accurately how common it is but between 1 in 3 & 1 in 5 men (20-30%) are thought to have premature ejaculation.
• Premature ejaculation is often associated with erectile dysfunction (impotence) and with rapid loss of erection after ejaculation.

• In most children, the foreskin cannot normally be retracted completely before the age of 5. In some, full separation may not take place until the age of 10.
• Injury or infection of the foreskin may contribute to tightening.
• Ballooning of the foreskin (blowing up when passing urine) does occur with a tight foreskin. 
• Tightness of the foreskin may interfere with the normal passage of urine and can, in severe cases, cause acute retention of urine.
• Tight foreskins may encourage tumours of the penis to develop but tumours rarely arise in patients who have been circumcised in childhood.

• PSA is not a specific test for prostate cancer. Raised levels may also be caused by inflammation, benign enlargement or previous surgery
• If your PSA is raised, in some cases your doctor may repeat your blood test, to be sure that the value is still above normal limits, before arranging further investigations.
• If there is a high suspicion of prostate cancer on the basis of the blood tests, you will normally be advised to have biopsy samples taken from your prostate gland.
• Even negative biopsies do not always rule out prostate cancer; further biopsies may be needed if your PSA remains raised or increases with time

Incontinence can be divided broadly into the following types but 90% of patients suffer from stress and/or urge incontinence:

• Stress incontinence – leakage during periods of abdominal pressure (coughing, sneezing, lifting, straining).
• Urge incontinence – leakage which follows an irresistible urge to pass urine.
• Mixed incontinence – combined stress & urge incontinence;
• Overflow incontinence – inability to empty the bladder with resulting overflow of urine.
• Functional incontinence – inability to use the toilet in time due to poor mobility or brain disorders.
• Continuous incontinence – constant leakage of urine due to an inherited or acquired abnormality, or damage to the control mechanisms of the bladder.
• Post-micturition dribble – leakage from the urethra a few minutes after passing urine (not to be confused with terminal dribbling when it is difficult to shut off the stream immediately after passing urine – usually a sign of prostatic obstruction).
• Giggle incontinence – tends only to occur in young girls and normally resolves as the child grows.

The commonest cause of blood in the semen is low-grade infection or inflammation in the seminal tract (particularly in the prostate gland).  

• It is possible, but often unlikely to be caused by sexually-transmissible infection.
• Rarely, it can be due to cancer of the testis or the prostate gland.
• If it is associated with blood in the urine, whether visible or non-visible (found on a urine test), it should always be investigated fully.
• If it is associated with an abnormal prostate gland on rectal examination, or a raised PSA blood level, you will require further evaluation.
• Blood in the semen usually resolves, either spontaneously (by itself) or with the help of anti-inflammatory drugs.
• Recurrence over a long period of time is common.

The preferred term for the male menopause (sometimes called the andropause) is Androgen Deficiency in the Ageing Male (ADAM). The symptoms of ADAM are non-specific and may include:

• Alterations in the circulatory & nervous systems (hot flushes, sweating, insomnia & nervousness).
• Changes in mood and mental function (anxiety, irritability, poor sleep, constant tiredness, poor short-term memory & low self-esteem).
• Changes in virility (decreased physical energy, decreased muscle strength & inability to participate in sporting activities).
• Diminished sexual function (reduced sex drive, poor erections & impaired ejaculation).
• Changes in physical appearance (abdominal weight gain, loss of body hair, diminished muscle mass & loss of height)
• Changes in body metabolism & chemistry (increased LDL cholesterol, increased total body fat, osteoporosis & reduction in the red blood cells in the blood).

• The commonest cause of a missing testicle is that it is retractile and not actually undescended.
• An undescended testis is one which cannot be brought down into the scrotum or felt within the scrotum.
• An undescended testicle is seen in 4% of boys at birth.
• Spontaneous descent occurs in 75% of these boys over the first 3 – 6 months leaving 1% of all boys with an undescended testicle after this time.
• There are several significant risks when a testicle is undescended.
• There is an association with other abnormalities of the urinary tract (kidneys, ureters, bladder & urethra).
• Surgical re-location of the testicle (orchidopexy) is needed in most children with an undescended testicle and is best performed before the child is older than one year..
• In adults, removal of the undescended testicle (with insertion of an artificial testicle, if requested) is usually the treatment of choice.