Conditions We Treat
Renji Hospital's Urology Department offers comprehensive male fertility evaluations and infertility treatments. We specialize in conditions like low sperm count (oligospermia), poor motility (asthenospermia), abnormal morphology (teratospermia), and particularly all forms of azoospermia (no sperm). Our tailored therapeutic approaches address these challenges effectively.
1. Lifestyle Modifications
Adopting healthier habits can enhance fertility: quit smoking/alcohol, avoid prolonged heat exposure (e.g., hot baths), maintain a balanced diet rich in antioxidants, achieve a healthy weight, and exercise moderately. Stress reduction and regular sleep also support sperm production and overall reproductive health.
2. Medications
Hormonal imbalances may be addressed with hormone-regulating medications to restore endocrine function. Antioxidants are often recommended to enhance semen quality and reduce sperm DNA fragmentation. In cases of reproductive tract infections, a targeted course of antibiotics is prescribed to eliminate the infection and improve fertility outcomes.
3. Obstructive azoospermia
Based on ultrasound localization of blockage (including post-vasectomy cases), we perform microsurgical vasoepididymostomy or vasovasostomy with >80% success rates, effectively restoring natural fertility pathways.
4. Non-obstructive azoospermia
Following diagnosis, microdissection testicular sperm extraction (micro-TESE) is performed. Successfully retrieved sperm undergo cryopreservation in our sperm banks for future ICSI cycles, optimizing fertility outcomes.
5. Assisted Reproductive Technology (ART)
IUI places washed sperm into the uterus for mild issues. IVF/ICSI combines egg retrieval with direct sperm injection for severe male factor infertility. Donor sperm may be options for non-obstructive azoospermia.
Varicocele (VC)
Conditions We Treat
At Renji Hospital Urology, we specialize in varicocele treatment - a common condition where enlarged scrotal veins cause discomfort and may affect fertility. Affecting 10%-15% of men (mostly left-sided), it's found in 19%-41% of infertile cases. Our tailored approaches effectively address this reversible cause of male infertility.
1. Conservative Management
Recommended for mild cases: Avoid prolonged standing/heavy lifting, wear scrotal support bands, and adopt a balanced diet (limit alcohol/spicy foods). These measures improve venous return and alleviate symptoms like scrotal heaviness.
2. Pharmacological Therapy
Venotonic medications (e.g., Diosmin, Aescuven Forte) enhance venous tone and microcirculation. Typically prescribed for 1-2 months to reduce pain and swelling, often combined with lifestyle adjustments.
3. Surgical Interventions
Surgery remains the definitive treatment for varicocele. Options include: open surgery (15-20% recurrence), laparoscopic (5-10% recurrence), microsurgical (<1% recurrence, gold standard), and embolization (10-15% recurrence). Microsurgery offers precise vein ligation while preserving arteries/lymphatics.
Peyronie's disease
Introduction
Peyronie's disease (PD) is a benign connective tissue disorder characterized by fibrosis of the tunica albuginea of the penis, typically manifesting as pain during penile erection, curvature deformity, and erectile dysfunction. the incidence of PD ranges from approximately 0.4% to 9%.
Treatment Options
1.Expectant Observation
For PD patients without erectile pain, a penile curvature angle less than 30°, and no interference with sexual function, regular follow-up observation is recommended. No immediate intervention or treatment is required at this stage.
2.Oral Medication Treatment
Traditional oral medications include vitamin E, potassium para-aminobenzoate (Potaba), tamoxifen, colchicine, acetylcarnitine, hexaminolevulinate theobromine, and PDE5 inhibitors. Patients with acute PD may benefit from non-steroidal anti-inflammatory drugs (NSAIDs) and PDE5 inhibitors to alleviate pain symptoms.
3.Local Treatment
This includes intraplaque injection into the corpus cavernosum (e.g., steroids, verapamil, Clostridium collagenase, interferon) and low-intensity extracorporeal shock wave therapy(Li-ESWT).
4.Surgical Treatment
Surgical treatment is indicated for patients with stable penile sclerotic disease (PD), accompanied by significant penile curvature deformity that affects the ability to complete sexual intercourse. surgical approaches can be categorized into three types: plication, graft implantation, and penile prosthesis implantation.
Prostatitis
Introduction
Prostatitis is an inflammation of the prostate that can cause pain or discomfort in the pelvic area and abnormal urination. Incidence rate: 2.2%-16%, nearly half of men will be affected by prostatitis at some stage in their lives. Etiology: infection, immunity, neuroendocrine, urodynamics, psychological factors and certain molecular signaling pathways.
Treatment
1.Supportive treatment
quit drinking, avoid spicy food, avoid holding urine, keep bowel movements smooth; avoid sitting for long periods of time, have regular sex, and do aerobic exercise.
2.Treatment of pain or discomfort
alpha-adrenergic receptor blockers, nonsteroidal anti-inflammatory drugs, herbal preparations, traditional Chinese medicine, physical therapy (pelvic floor magnetic therapy, biofeedback therapy, electrical stimulation therapy, ultrasound therapy, low-energy shock wave).
3.Lower urinary tract symptoms treatment
alpha-adrenergic receptor blockers, M-receptor blockers, physical therapy.
4.Treatment of psychosocial symptoms
psychological support, antidepressant medication (TCA, SSRIs, SNRI), cognitive behavioral therapy.
5.Treatment of associated male diseases
erectile dysfunction, premature ejaculation, male infertility.
6.Electrical stimulation combined with biofeedback therapy
The instrument measures the EMG signal, provides feedback, then electrically stimulates the pelvic floor muscles or the nerves, inducing rhythmic muscle contraction, relieving muscle spasms, improving blood circulation, and alleviating chronic pain.
Premature Ejaculation (PE)
Premature Ejaculation (PE) was renamed as Early Ejaculation, characterized by ejaculation that occurs prior to or within a very short duration of the initiation of vaginal penetration or other relevant sexual stimulation, with no or little perceived control over ejaculation. The pattern of early ejaculation has occurred episodically or persistently over a period of at least several months and is associated with clinically significant distress.
Treatment
1. Oral Medication Treatment
Dapoxetine (30 and 60 mg) is the first on-demand oral pharmacological agent approved for lifelong and acquired PE in our center. Daily use of selective serotonin re-uptake inhibitors (SSRIs), tramadol and topical lidocaine on demand have consistently shown efficacy in PE. PDE5i can be used for PE patients with concomitant ED.
2.Psychological and behavioral therapy
Psychotherapy is more effective for situational premature ejaculation and self-reported premature ejaculation, mainly by helping the patient and his sexual partner to improve the ability to control ejaculation, to enhance confidence in sexual life and to reduce anxiety about sexual life. The combination of psychosexual approaches and medication produced better outcomes than pharmacological interventions alone.
3.Physical Devices
Transcutaneous functional electric stimulation，transcutaneous posterior tibial nerve stimulation and Pelvic Floor Magnetic Stimulator are a form of neuromodulation therapy using non-invasive mechanical device. These physical therapy methods are very safe, and when combined with medication, they are more effective than medication alone for PE.
4.Surgical Option
Due to the irreversibility of dorsal penile nerve block, we developed dorsal penile nerve isolation using decellularized dermal tissue for those patients with PE who have failed conservative treatment, as well as the use of hyaluronic acid glans injections, which has resulted in better clinical outcomes.
Erectile Dysfunction(ED)
Introduction
Erectile Dysfunction(ED) is a common disease characterized by the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. The incidence of ED increases with age, and about 50% of men aged 40 to 70 experience ED of different severity. ED can be categorized into psychological, organic and mixed causes according to the clinical evaluations.
Therapy options
1.Pharmacotherapy
ED pharmacotherapy employs oral PDE5 inhibitors (e.g., sildenafil), intracavernosal alprostadil injections and androgen agents to enhance erectile function. Treatment prioritizes efficacy, safety and patient-specific factors, with PDE5i as first-line therapy. Individualized regimens address comorbidities and preferences to optimize outcomes.
2.Physical Devices
ED physical devices mainly encompass vacuum erection devices (VEDs), low-intensity shockwave therapy (Li-ESWT). VEDs utilize negative pressure for penile engorgement. Li-ESWT promotes neovascularization in vasculogenic ED. These evidence-based alternatives suit medication-refractory cases or patients preferring mechanical interventions.
3.Penile Prosthesis Implantation(PPI)
PPI is the ultimate method of ED treatment, involves surgically placing inflatable or malleable devices. Indicated for severe vasculogenic, traumatic or post-pelvic surgery ED, it offers high patient satisfaction(>85%) and durable function. Preoperative counseling ensures realistic expectations and informed consent of efficacy and risks.
Penile Cancer
Conditions We Treat
Penile cancer is a rare male genital tumor (1%-2% of cases), mainly affecting men over 50. Most cases (>95%) are squamous cell carcinoma, linked to HPV (types 16/18), phimosis, chronic inflammation, and smoking. Symptoms include a painless lump, ulcer, or wart-like growth (often on the glans/foreskin). Advanced stages may cause bleeding, foul discharge, painful urination, and swollen lymph nodes (signaling metastasis).
Treatment
1. Glans-Preserving Tumor Excision
Indicated for early-stage (Tis-T1) localized tumors, particularly those on the foreskin or coronal sulcus. Involves wide local excision to preserve the glans and function. Requires close follow-up due to risk of recurrence.
2. Partial Penectomy
Suitable for tumors invading the penile shaft but not the root (T1-T2). The affected segment is removed, leaving a sufficient stump (≥2 cm) for standing urination and sexual function. May require meatal reconstruction; 5-year survival reaches 80%-90%.
3. Radical Total Penectomy
Used for advanced (T3-T4) or recurrent tumors. Entire penis and surrounding tissues are removed, with perineal urethrostomy performed. Inguinal lymph node dissection is required if metastasis is present. Postoperative psychological support and functional rehabilitation are essential.
4. Robot-Assisted/Laparoscopic Inguinal Lymph Node Dissection (ILND)
Robot-assisted or laparoscopic ILND is indicated for metastatic nodal disease (cN+) in penile/vulvar cancer or lower limb melanoma (confirmed by biopsy/imaging), SLNB-positive high-risk tumors (e.g., pT1b penile SCC), or prophylactic dissection in select high-risk cases (e.g., bulky, high-grade tumors).
Testicular Tumors
Conditions We Treat
Testicular cancer is the most common solid tumor in men aged 15–35. Over 90% are germ cell tumors (GCTs), divided into seminomas and non-seminomas. A painless testicular lump is typical, though some feel heaviness or referred pain. Advanced cases may show metastatic symptoms like back pain (from lymph node spread) or shortness of breath (lung metastases).
Treatment
1. Radical Orchiectomy
Radical Orchiectomy is the surgical removal of the affected testis, epididymis, and spermatic cord through an inguinal incision. It is the standard treatment for testicular cancer or suspected malignancy. Further therapy (e.g., radiation/chemotherapy) depends on pathology and staging.
2. Testis-Sparing Surgery (TSS)
Testis-Sparing Surgery (TSS) preserves testicular tissue for benign tumors (e.g., adenomatoid tumor) or small (<2cm) low-risk malignancies. Intraoperative frozen section confirms pathology; conversion to radical orchiectomy if malignant. Benefits include hormonal/fertility preservation, but requires strict patient selection and follow-up.
3. Retroperitoneal Lymph Node Dissection (RPLND)
Retroperitoneal Lymph Node Dissection (RPLND) is a critical surgical intervention for testicular cancer, primarily used for staging and treating metastasis in non-seminoma (clinical stage I-IIB) or residual masses post-chemotherapy.
4. Sperm Cryopreservation
Offered preoperatively for fertility preservation in patients with reproductive needs.A fertility preservation technique involving freezing and storing sperm for future use. Key indications: Cancer patients pre-chemotherapy/radiation. High-risk occupations/surgeries (e.g., pre-RPLND).
Hematospermia
Conditions We Treat
Hematospermia refers to the presence of blood in semen, which may appear pink, red, or brown. Most cases are benign and result from inflammation, congestion, or minor trauma in the prostate, seminal vesicles, or ejaculatory ducts.
Treatment
1.Drug Therapy for Hematospermia
Pharmacological treatment for hematospermia includes antibiotics (e.g., levofloxacin) for infections (2-4 weeks), hemostatics (e.g., vitamin K) for bleeding control, anti-inflammatories (e.g., ibuprofen) for symptom relief, and 5α-reductase inhibitors (e.g., finasteride) to reduce prostate congestion.
2. Seminal Vesiculoscopy for the Treatment of Hematospermia
Seminal vesiculoscopy is a minimally invasive endoscopic procedure for diagnosing and treating refractory hematospermia (blood in semen). It accesses seminal vesicles through natural openings to visualize and treat bleeding, stones, strictures, or tumors precisely.
Phimosis and Redundant Prepuce: Overview and Treatment Options
Introduction
Phimosis refers to the inability to retract the foreskin (prepuce) over the glans . Redundant prepuce (excessive foreskin) is a condition in which the foreskin covers the urethral opening, but can be turned up to expose the urethral opening and the glans.
- Physiological phimosis is normal in infants and usually resolves by age 3–5.
- Pathological phimosis results from scarring (e.g., balanitis xerotica obliterans—BXO), infections, or forced retraction.
- Complications include poor hygiene, recurrent infections, pain, malignant transformation of tumor and urinary obstruction.
Treatment Options
1) Conservative Management (Topical Steroids + Manual Retraction)
- First-line treatment for mild to moderate phimosis without scarring.
- Topical corticosteroids (e.g., betamethasone 0.05% applied twice daily for 4–8 weeks) reduce inflammation and improve elasticity.
- Gentle manual retraction (after warm baths) helps gradually stretch the foreskin.
- Success rate: ~60–90% in children, lower in adults with scarring.
2) Circumcision (Surgical Removal of Foreskin)**
- Definitive treatment for severe phimosis, recurrent infections, or BXO.
- Preparation – The area is cleaned, and local anesthesia (or general for children) is administered.
- Techniques – Common methods include: Guillotine/Clamp: Foreskin is clamped and excised. Sleeve Resection: Dual incisions remove a ring of foreskin. Absorbable sutures or surgical glue secure the wound.
- Recovery: 2–6 weeks; complications (bleeding, infection) are rare.
Frequently Asked Questions
1) Q: What’s the best age for circumcision?
A: Newborns (0–12 months): Common in some countries; faster healing, lower complication risks; Childhood (before puberty): Often done for phimosis or infections; Adults: Possible at any age if medically needed. The "best" age depends on individual health, cultural factors, and doctor’s advice.
2) Q: Will circumcision affect penile development?
A: No, circumcision does not affect the normal growth or development of the penis. The surgery only removes excess foreskin and does not interfere with the structure or function of the penis itself. Proper care after the procedure ensures healthy healing.
3) Q: Does circumcision affect sexual function?
A: Current medical evidence shows that circumcision generally does not harm sexual function, sensitivity, or satisfaction. Some studies suggest minor changes in sensation, but most men adapt without issues. The benefits (e.g., reduced infection risks) often outweigh potential concerns. Always discuss individual cases with a doctor.
4) Q: When is circumcision medically needed?
A: Circumcision may be recommended if: Phimosis: The foreskin is too tight and cannot retract (even after childhood). Recurrent infections：Frequent UTIs, balanitis (inflammation), or sexually transmitted infection (STI) risks. Medical condition: Like lichen sclerosus or abnormal penile development. Personal/cultural/religious preferences. Note: Not everyone needs it—consult a doctor to evaluate your situation.
Concealed Penis: Overview and Treatment Options
Introduction
Concealed penis (also called hidden or buried penis) is a condition where the penis appears smaller than normal due to excess suprapubic fat, tight skin, or abnormal attachment of penile skin to the underlying structures. It is not a true micropenis (which involves underdeveloped penile tissue) but rather a structural issue that traps the penis beneath the skin.
This condition can occur in infants (due to congenital factors) or adults (often due to obesity, scarring, or prior surgeries). It may lead to hygiene difficulties, urinary problems, and psychological distress.
Treatment Options
1) Weight Loss and Medical Management：In overweight or obese patients, weight loss through diet and exercise may reduce suprapubic fat, partially revealing the penis. However, if excess skin remains, surgical correction may still be needed. For infants, observation is often recommended, as some cases resolve with age. Topical steroids may help if phimosis (tight foreskin) contributes to the concealment.
2) Surgical Correction：Surgery is the definitive treatment for persistent concealed penis. Common techniques include:
- Penile Uncovering (Degloving) – The trapped penis is freed, and excess skin is adjusted. The tight tissue anchoring the penis is loosened.
- Scrotoplasty – If scrotal tissue encroaches on the penis, repositioning may be needed.
- Liposuction(Adult Patients) – Removes excess fat around the penis.
- Skin Grafting/Flap Reconstruction – If there’s insufficient penile skin, grafts or flaps may be used.
3) Most patients recover well, with improved appearance and function. Complications include scarring, infection, or unsatisfactory cosmetic results.
Conclusion
Concealed penis is a treatable condition. Mild cases may improve with weight loss, while surgery offers a permanent solution for severe or persistent cases.
Frequently Asked Questions
1) Q: Why can’t concealed penis be treated with simple circumcision?
A: A concealed penis is not just excess foreskin, it involves: Abnormal attachment of penile skin to deeper tissues, restricting shaft exposure. Insufficient shaft skin, which may worsen if circumcision removes more skin without addressing the underlying issue. Potential complications: A simple circumcision may further bury the penis, making future correction harder. Proper surgical repair involves releasing tight tissues, reshaping the penoscrotal junction, and reconstructing adequate skin coverage.
2) Q: When is the best time for concealed penis surgery?
A: The timing depends on severity and symptoms: Mild cases: Monitor during childhood; some resolve with weight loss or growth. Moderate-severe cases: Surgery is typically done after age 3–5 (once most natural growth occurs) but before puberty to support normal development. Adolescents/adults: Surgery can still be performed if functional or cosmetic concerns exist.Key indications for surgery: Recurrent infections or urinary problems. Significant psychological distress.
3) Q: Does concealed penis affect penile development and function?
A: No. A concealed penis is primarily an issue of external appearance and generally does not directly impair penile development or function. The penis itself is structurally normal—the problem lies in abnormal skin attachment or excess fat coverage, which limits shaft exposure. It does not affect erectile function, urination, or fertility (unless accompanied by other congenital abnormalities). The goal of surgery is to improve appearance and hygiene, not to correct functional problems. Just like double eyelid surgery can make the eyes appear larger and more attractive, it does not affect vision or color perception.
Hypospadias: A Comprehensive Overview and Treatment Options
Hypospadias is a common congenital anomaly of the male genitalia, characterized by an abnormally positioned urethral opening (meatus) along the ventral (underside) aspect of the penis, rather than at the tip of the glans. This condition occurs in approximately 1 in 250-300 male births and represents one of the most frequent congenital malformations in males. The disorder results from incomplete development of the urethra during fetal growth, typically between weeks 8 and 20 of gestation. Along with the misplaced urethral opening, affected individuals often present with ventral curvature of the penis (chordee) and an abnormal distribution of the foreskin, which forms a dorsal hood rather than encircling the glans completely.
Disease Characteristics and Classification
The anatomical presentation of hypospadias varies significantly among patients. The patient's urethral opening can be anywhere from just below the glans to the perineum.
The severity generally correlates with both the degree of penile curvature and the likelihood of associated anomalies. More proximal defects often accompany more pronounced ventral curvature and have higher rates of complications such as undescended testes (7-13%) and inguinal hernias. In severe cases, particularly those with bilateral cryptorchidism, clinicians must consider and rule out disorders of sexual development through chromosomal analysis and endocrine evaluation. Etiology and Risk Factors
The development of hypospadias involves complex interactions between genetic predisposition and environmental factors that disrupt normal androgen signaling during critical periods of genital development:
Surgical Treatment Approaches
The primary treatment for hypospadias is surgical reconstruction. The goals of surgery include: straightening the penis (correcting chordee), creating a urethra that terminates at the tip of the glans, and achieving a normal cosmetic appearance. Optimal timing is generally between 6-18 months of age, allowing completion before the child develops body awareness and gender identity.
1) Tubularized Incised Plate (TIP) Urethroplasty (Snodgrass Technique):The TIP procedure has become the gold standard for distal and many midshaft hypospadias repairs due to its excellent cosmetic and functional outcomes. This technique involves:Preserving and incising the urethral plate longitudinally to widen it.Tubularizing the plate over a catheter to form a neourethra.Using local flaps (often dorsal prepuce) to provide ventral coverage.
2) Onlay Island Flap Urethroplasty:This versatile technique is particularly useful for proximal hypospadias with adequate urethral plate width. The procedure involves:Harvesting an island of inner preputial skin based on a vascular pedicle.Suture this flap to the edges of the native urethral plate to augment the urethra.The flap's blood supply helps prevent necrosis and improves healing.
3) Two-Stage Repair (Bracka Technique): For severe proximal hypospadias or reoperations, a two-stage approach often yields better outcomes. First stage: Complete straightening of the penis by excising all fibrous tissue. Application of a graft (buccal mucosa, preputial skin) to the ventral surface. Allowing6 months for graft maturation. Second stage: Tubularization of the graft to form the neourethra. Glansplasty and meatal reconstruction
4) Transverse Preputial Island Flap (Duckett Procedure):This technique is valuable for proximal hypospadias when the urethral plate is inadequate. Key steps include: Harvesting a rectangular island of inner preputial skin on a vascular pedicle. Tubularizing the flap to create a neourethral tube, Rotating the tube ventrally and anastomosing it proximally and distally.
Postoperative Care and Complications
Following hypospadias repair, careful postoperative management is crucial: Urinary diversion: Most repairs utilize a urethral stent or suprapubic catheter for 10-21days. Dressings: Specialized compressive dressings help minimize swelling and bleeding,Antibiotics: Prophylactic antibiotics are typically given while catheters remain in place.
Common complications include: Urethrocutaneous fistula, Meatal stenosis, Urethral stricture, Wound dehiscence or infection,Persistent chordee.
Most complications can be managed successfully with minor procedures, though complex cases may require additional staged repairs. Long-term follow-up through adolescence is recommended to assess urinary function, cosmetic outcome, and sexual development.
Nonsurgical Considerations
While surgery remains the definitive treatment, several adjunctive approaches may be beneficial:
- Androgen stimulation: Preoperative testosterone or DHT cream may increase penile size in selected cases
- Psychological support: Counseling for parents and, later, the child helps address body image concerns
- Genetic counseling: Recommended for familial cases or those with associated anomalies
With modern surgical techniques, over 90% of patients achieve satisfactory cosmetic and functional results, enabling normal voiding standing up and future sexual function. Early intervention by experienced pediatric urologists or surgeons optimizes outcomes and minimizes psychological impact.