January/February 2014

For Appointments Call : 08 8267 2200

NEWSLETTER
Nicholas Brook Urology

Latest

Urology News
Welcome to the Nicholas Brook Urology
newsletter January 2014.

Nick Brook Urology on Ward Street

The Ward Street practice has been open for seven months, and we would like
to pass on our many thanks to patients, GPs and specialists for their support in
2013.

New Services in 2014

The practice has been busy, and has expanded clinics to cope with the workload
and to maintain a rapid access service
for urology patients who need to be seen
quickly. In 2014, we will be introducing
the following services to increasingly
provide a medical practice that is fully re-

sponsive to patients need:

Telemedicine consulting for distant/
rural/country patients.
Regular out-of hours consulting on
request, so that patients can see a
Urologist at a time that suits them,
and minimise the impact of clinic

times on their schedule.

A scheduled Nurse-led telephone
service, to check patients are recovering well after treatment.
Employment of further administrative

We very much look forward to working

class service in 2014. Thanks again for
your support.

High Quality Care with

Rapid Access for Patients
Nicholas Brook Urology provides the range
of urological investigations and management for kidney stones, prostate cancer,
kidney and bladder cancer, incontinence
and impotence treatment, laser surgery,
vasectomy, vasectomy reversal and TURP.

Vasectomy Reversal
A vasectomy reversal is an operation to re-join the vasa (the tubes from the testes) in a man who wishes to attempt further pregnancies after a vasectomy.
A small number of men who have a vasectomy want the operation reversed
at some point in the future. Vasectomy
reversal (vaso-vasostomy) is a surgical
operation to re-join the two ends of the
vas on both sides, to re-establish the passage for sperm.

The Procedure

The operation is performed under general anaesthetic, with the aid of a powerful
operating microscope. A cut is made in
the scrotum and the cut ends of the vasa
the ends are joined together with very

New Locations
of services at St. Andrews Private Hospital,
350 South Terrace, Adelaide and at Flinders
Private Hospital, 1 Flinders Dr, Bedford
Park, Adelaide.

The procedure takes about one and a

half hours, and can be done as a day case
procedure.

Success Rates

The success rate is measured as patency. Patency is said to be restored if sperm

reappear in the ejaculate (measured by
semen analysis). Patency is dependent
on a number of factors, including the
length of time since vasectomy, the distance left between the ends of the vas at
the time of vasectomy (a larger distance
sectomy reversal with lower chance of
success), and the degree of scar tissue

around the vasa.

However, the true measure of success
after vasectomy reversal is pregnancy.
The longer the time since vasectomy,
the lower the quality of sperm, and the
lower the pregnancy rate. A major factor,
irrespective of the others, is the fertility
status of the mans partner.

Careful Considerations

These issues need careful consideration,

and can be discussed at length with your
urologist. Please note that patency and
pregnancy may not be achieved after
of your surgeon. For more information,
please contact the Nick Brook Urology
Practice on 08 8267 2200.

mpMRI in the Diagnosis of Prostate Cancer

tial to overdiagnose cancer, which means that small, low-grade cancers that
may never cause problems are detected, and then potentially treated (also know
as overtreatment). The second problem is that some more aggressive cancers
may be missed with investigation. Unfortunately, these two problems are part
and parcel of all tests in medicine.

Standard Approach

aggressive prostate tumours may be

unique on multiparametric MRI. By identifying the presence or absence of these
MRI characteristics, biopsy may be targeted more accurately, or even avoided.

element of overdiagnosis & overtreatment and occasionally more aggressive

cancers can be missed.

As well as identifying aggressive tumours,

MRI may be useful for:
Finding the location of tumours, and
measuring tumour volume
Staging of prostate cancer
Helping to guide biopsy to increase
accuracy

The standard approach to diagnosis of

prostate cancer has consisted of a PSA
blood test and, if necessary, a prostate
TRUS biopsy. These tests, when com-

There has been a lot of interest recently

in the use of MRI to help with the diagnosis of prostate cancer. The hope has
been that by using MRI (known as multiparametric MRI, or mpMRI) along with
PSA tests (and possibly biopsy), the
chance of overdiagnosis, or of missing
aggressive cancers, can be reduced.
It is believed that the characteristics of

Experience Needed

It is important to recognise that mpMRI

is not perfect, and there is a good deal
of debate about its exact role in the diagnosis of prostate cancer. It is certainly
clear that it should be performed in ex-

perienced centres, and that the reporting needs to be standardised.

Further Information

If you would like more information on

mpMRI, please contact the Nick Brook
Practice on 08 8267 2200.

Prostate Cancer Seminar on the 17th February 2014

Nick is chairing a public seminar on Prostate Cancer on the 17th February, run by
the Freemasons Foundation Centre for Mens Health.

Guest Speakers

Speakers will be Dr Anthony Lowe,

CEO of the Prostate Cancer Foundation
of Australia (his topic is Development of
National Clinical Guidelines for Prostate
Cancer and the Melbourne Consensus

Statement on Prostate Cancer Testing)

and A/Prof Ganesh Raj, Urology Surgeon and Researcher, University of Texas
2014 FFCMH Visiting Lecturer (Drug development Targeting the critical driver of

prostate cancer). Further information is

available on this website http://blogs.adelaide.edu.au/mens-health/2013/12/19/
public-seminar-on-prostate-cancermon-17-feb-2014-dr-anthony-lowe-andassoc-prof-ganesh-raj/ where you can
also register for the seminar. This will be
an excellent session, and you are encouraged to come along.

PROSTATE CANCER

The Role of the Clinical Psychologist

Dr Addie Wootten is a Clinical Psychologist with Australian Prostate Cancer Research and The Department of Urology, Royal Melbourne Hospital. She talks
about the psychological impact of prostate cancer on men, and what can be
done to help.

The Psychological impact of

prostate cancer

terms of self-esteem, ability to maintain

social connections and the experience of
anxiety. Self-esteem, masculine identity

impact on psychological and emotional

wellbeing. Many men speak about the
shock, fear, uncertainty and anxiety they
experienced when told they had prostate cancer. Many men also speak about
the diagnosis as feeling like it came out
of the blue as many men are diagnosed
with localised prostate cancer without
any symptoms of warning. Unfortunately
many men experience periods of depression or anxiety following a diagnosis of
prostate cancer and emerging data indicates that men with prostate cancer have
a higher risk of suicide than other men

impacted on by the experience of pros-

A prostate cancer diagnosis, like all diag-

Managing these challenges

emotional impact that prostate cancer

can have on some men.

We know from the research literature

that one of the biggest predictors of psychological distress post prostate cancer
treatment is unrealistic expectations pretreatment. That is, men who are not fully
informed and counseled, pre-treatment,
about the impact of treatment on their
physical functioning (particularly the sexual impact) will experience much higher
levels of distress post-treatment. While
this isnt rocket science the delivery of
adequate information and support prior
to treatment in preparation for these

Prostate cancer can have a

very personal impact

the time. Many men report feeling ill-informed, and unsupported, in navigating

While the initial shock of a cancer diagnosis can take its toll it is often the sidenately all treatment options come with
fects. All treatments will have an impact
on sexual and erectile functioning including changes or loss of ejaculation, changes in orgasm sensation, loss of penile
length and changes to penile sensitivity
ing on the treatment type. These side

So what role does a psycologist play in prostate cancer?

As a clinical psychologist I have the privilege of hearing the very personal experi-

and their partner or spouse. My role in

working with these men and couples is
to explore the personal impact of their
experience and help them weave a new
way of living, whether that be a new way
of being intimate, a new outlook on life or
a new level of emotional awareness.

impact for many men as well as a direct

impact on their intimate relationships.

A large part of my role is to help men

and their partners explore what it might

For many men the loss of sexual funccause of remaining normal sexual desire

treatment before they have treatment. I

try and speak with both members of the
couple before treatment to help them
plan and prepare for life after treatment
and to ensure they fully understand how
this might impact on them personally
and as a couple. These issues are also

loss and associated impact on masculinity and self-esteem. Urinary incontinence

can also have a very personal impact in

Dr Addie Wootten Clinical Psychologist with Australian Prostate Cancer

Research and The Department of
Urology, Royal Melbourne Hospital.
the focus of much of my work after treatment.
A clinical psychologist will also be looking
out for symptoms of anxiety and depression and other mental health concerns
and will provide psychological counseling
that focuses on reducing these symptoms and improving emotional wellbeing.

How to access a psychologist

Seeing a psychologist is not routine in

most practices but there are many psychologists available in Australia. Ask your
specialist or nurse for a referral. If they
dont know of anyone in your local area,
the right person there is an excellent
listing of psychologists on the Australian
Psychological Society website www.psychology.org.au/findapsychologist/
If you would like to read more from this
article, please visit www.NickBrookUrology.com/urology-information/latest-news

DO YOU HAVE
A QUESTION?
Contact us on

08 8267 2200

nick@nickbrookurology.com

CYTOREDUCTIVE NEPHRECTOMY
In Clinical Practice

David Nicol is a Consultant Urological Surgeon at the Royal Marsden Hospital in London where he is also Chief of Surgery.
His clinical work deals with complex kidney and testis cancer including surgery in patients with advanced and metastatic
disease. Here, he explains the use of cytoreductive nephrectomy in metastatic kidney cancer.
had been observed with conventional cytotoxic chemotherapy. Analysis of these
studies suggested that patients who
had a nephrectomy performed prior to
treatment resulted in a better response
to both INF-a and IL-2. The basis for this
was uncertain with possibilities including
who would otherwise expect to live longer, having nephrectomy. Alternatively
it was also proposed that cytoreductive
nephrectomy may exert some biological
munotherapy and thus overall survival.

Which patients with metastatic kidney cancer are suitable for cytoreductive nephrectomy?

Professor David Nicol, Consultant

Urological Surgeon at the Royal
Marsden Hospital, London

David, can you explain what

is meant by cytoreductive nephrectomy?

Cytoreductive nephrectomy refers to the

removal of the primary kidney tumour in
patients who have metastatic disease.
Historically it had been noted that occasional patients experienced spontaneous
regression of metastatic disease when
this was performed. This however only
occurred in a very small number of cases
and general opinion was that cytoreductive nephrectomy as the overwhelming
majority died within 12-18 months from
metastatic disease. In the late 1980s and
early 1990s, drugs which stimulated the
immune system(immunotherapy) had an

Small trials with 2 agents interferonalpha (IFN-a) and interleukin-2 (IL-2)

showed response rates better than what

Cytoreductive nephrectomy is really only

an appropriate option for patients who
are otherwise well. Patients whose performance status is impaired are at high
risk of complications from major surgery
and also generally have poor survival that
is not improved with cytoreductive nephrectomy. Therefore patients who have
or who feel tired and generally unwell
are not considered candidates for cytoreductive nephrectomy. Some patients

including pain and bleeding for which

nephrectomy is recommended. This is
regarded as a palliative intervention to
control symptoms rather than a cytoreductive nephrectomy which is performed
with the expectation that it may improve
survival.

Can you outline the evidence

that cytoreductive nephrectopatients?

There are 2 trials one performed in Europe and another in the United States
that have demonstrated a survival benpatients who are subsequently treated

with IFN-a. These were both randomised

controlled trials - in which patients, who
all received IFN-a were randomly allocated to either cytoreductive nephrectomy
or no surgery. Comparing the 2 groups
which were of equal size revealed that
patients undergoing cytoreductive nephrectomy had a median survival of 14
months compared to 8 months without.
These studies also reinforced the lack
mance status.

gery. Are complication rates

much higher compared to
other forms of kidney cancer
surgery?
Patients with metastatic kidney cancer
usually have quite large primary tumours
with a rich blood supply being a common
feature. Both of these factors can make

a higher risk of complications, particularly major bleeding, compared to other

forms of kidney cancer surgery. Most patients with kidney cancer have relatively
small tumours and are able to have surgery performed either laparoscopically
or robotically with low risk of complications. In contrast cytoreductive nephrectomy, in almost all cases, requires major
open surgery as minimally invasive procedures are usually neither feasible nor
safe. Patients with metastatic cancer are
also generally at higher risk of complications with major surgery. Deep venous
thrombosis and pulmonary embolism

Further Information

If you would like to read more from the

Cytoreductive Nephrectomy in Clinical
Practice article by Professor David Nicol, please visit the Nick Brook Urology
website at www.NickBrookUrology.com/
urology-information/latest-news

Jane Favretto Practice Administrator

Jane has been working in administration since 1987. In more recent years worked as a Special Events and Community Relations
Co-ordinator for the Royal Adelaide Hospital Research Fund
the fundraising arm for the RAH and Hanson Institute. She
has broad experience in administration and fundraising management and brings to the practice her skills and knowledge in
providing a professional, friendly and comfortable setting for
patients and their families.

Matt Carlaw Practice Finance Consultant

Matt has been working as an Accountant in Adelaide since

1997. He has a bachelor of Economics, a Graduate Diploma in
Accounting and has been a member of the Institute of Chartered Accountants in Australia since 1999. From 1997 to 2011
he worked in a number of medium sized accounting practices
providing business and taxation advice to a wide range of small
and medium sized businesses. Since 2011 he has been working
and consulting as a Management Accountant to a small number of Adelaide businesses. He likes to keep things simple and
organized.

Stuart Perryman - Communication Consultant

Stuart is a web designer, online marketer and back-end web developer with over twelve years of professional experience in the
web development and online marketing industry. As the owner of Web Designers Adelaide, a locally based web design and
development company, Stuart specialises in creating websites
ing strategies. Stuart has extensive experience in server-side
and client-side programming, search engine optimisation and
search engine marketing. Stuart is a keen advocate for mobile
web design and web accessibility.

Support Groups and Urological Information

Cancer Australia - http://canceraustralia.gov.au

1800 624 973

Kidney Cancer Australia - http://kidneycancer.org.au

1800 454 363

Prostate Cancer Foundation of Australia (PCFA) - http://www.prostate.org.au

1800 220 099

The Continence Foundation of Australia - http://www.continence.org.au

1800 330 066

Andrology Australia - https://www.andrologyaustralia.org

1300 303 878

Australian Prostate Cancer Research (3D videos) - http://vimeo.com/album/2184688

Macmillan Cancer Information (UK) - http://www.macmillan.org.uk

ONLINE RESOURCE

NickBrookUrology.com
Since the practice opened in June 2013, the website has been central to providing
information for patients and GPs. Stuart Perryman, our Digital Communication
Consultant, has helped keep the website fresh and current.

New Online Articles

We have regularly been adding content

to the various sections of the site, and
it has developed into an exciting and
dynamic resource. We have had regular
Guest Articles from internationally renowned urologists on many topics, and
we would encourage you to read these
if you havent yet. They can be found at
http://www.nickbrookurology.com/urology-information/latest-news

Since it was launched, it has had 16,932

visitors, and 38,011 page views, from 90
countries.

Social Media
and has contributed to 1,654 visits since
June 2013. Please do follow us on twitter
and like us on Facebook to stay in touch
with developments.

FIND US

CALL US

EMAIL US

175 Ward Street,

North Adelaide,
Adelaide, SA 5006

P. 08 8267 2200
F. 08 8267 5664

nick@nickbrookurology.com

OUR LOCATION

Nick Brook Urology

175 Ward Street,
North Adelaide,
Adelaide, SA 5006

Telephone: 08 8267 2200

Fax: 08 8267 5664

Email: nick@nickbrookurology.com
Twitter: nickbrookMD
Website: www.nickbrookurology.com

Disclaimer: This information is intended as an educational guide only, and is here to help you as an additional source of information, along with a consultation from your
urologist. The information does not apply to all patients, and this document cannot be considered to contain all information on urology conditions. Not all potential treat-

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