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Welcome to the Macarthur Urology Website. We are a practice of four urologists who service both public and private patients of Southwest Sydney and the Southern Highlands.

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At Macarthur Urology, we aim to provide the best possible patient care with the most up to date techniques including Robotic and Laparoscopic Surgery.

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We provide management of all urological conditions including urological cancer surgery, urinary stone surgery, management of urinary dysfunction.

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Worsening lower urinary tract symptoms are a common component of aging.  This is often due to multiple aspects of the aging process including: benign enlargement of the prostate; changes in the bladder; and changes in the hormonal milieu secreted by the brain.


Male bladder symptoms can be widely divided into obstructive symptoms and irritative symptoms.

  • Obstructive symptoms occur due to enlargement of the prostate gland which lies beneath the bladder.  The prostate grows with age due to multiple factors including lifetime exposure to testosterone and inflammation.  There is also a hereditary component to enlargement of the prostate.  Obstructive symptoms include: hesitancy (difficulty initiating voiding); slow urinary flow rate; incomplete emptying of the bladder; and terminal dribbling (leaking small amounts of urine after feeling that urination has finished – commonly noticed as a couple of drops of urine on the underpants).

  • Irritative symptoms are typically due to overactivity of the bladder.  This may be due to long-term obstruction of the bladder of the prostate, abnormalities of the bladder (such as bladder cancer or stones in the bladder) or due to neurological disease affecting the nerve supply to the bladder (such as stroke, Parkinson’s disease, Multiple Sclerosis or previous surgery affecting the nerves in the pelvis.)  Irritative symtpoms include: frequency (urinating more often than previously and generally only smaller volumes); urgency (having to rush to the toilet when the desire to urinate comes on due to a fear of leakage); and nocturia (being woken up at night-time by the desire to urinate)

Investigations of male voiding dysfunction may include one or a combination of: urine tests (to check for infection or bleeding); blood tests (including PSA); rectal examination; fluid/volume charts (that is keeping a diary of volumes drunk and voided); ultrasound or CT scans; and cystoscopy (camera examination of the bladder and prostate).

In cases of complex voiding dysfunction, or those with a possible neurological component, Video-urodynamics may be necessary.  This functional test is performed by a Urologist in the Radiology Department of Campbelltown Hospital and allows your urologist to assess pressures generated by the bladder during filling and emptying and can assist in diagnosing patients with complex urinary issues.


Treatment options for male voiding dysfunction have changed significantly over the previous decade.  Medical therapy is now the most common first-line approach to male voiding dysfuntion.  Medical therapy (ie tablets) generally fall into one of two groups:

  • Bladder Retraining.   This is offered by our Nurse at Macarthur Urology and is offered to patients who have abnormal voiding behavior, typically in the absence of clear abnormalities.

  • Alpha antagonists.  These relax the smooth muscle capsule of the prostate and in so doing they reduce the degree of obstruction that the prostate causes and generally improve symptoms.  The medications are typically well tolerated with minimal side effects and are safe to take with most other medications.  They can occasionally cause light-headedness and dry ejaculations.  They generally have no effect on erectile function or libido.

  • 5-alpha reductase inhibitors.  These alter the effect of testosterone on the prostate and cause the prostate to shrink.  They also reduce the amount of blood supply that the prostate receives.  These medications improve symptoms but may cause reduced erectile function and sex drive.

  • Combination therapy.  These contain both agents and have been shown to produce a substantial improvement in symptoms.  They produce a mixture of side effects, and a large study has suggested that they may have a role in increasing the risk of prostate cancer, though this has not been substantiated.


  • Surgery.  This is currently reserved for patients whose symptoms are still concerning despite being on medications, or in some instances where medication is unlikely to be successful (such as urinary retention requiring a catheter, bleeding from the prostate, and renal failure due to an inability to pass urinate).  Multiple surgical treatments are available and include:

  • TURP.  This is the gold-standard surgical treatment.  It involves a general or spinal anaesthetic and then insertion of a camera through the waterpipe (urethra) to allow the prostate to be cored out from the inside using an electrical current.  The procedure takes approximately 1 hour and requires a 2-3 night hospital admission with a urinary catheter.  The catheter is then removed to allow an attempt at passing urine prior to discharge from hospital.  This is the most commonly performed surgical procedure for male voiding dysfunction.  Your urologist will advise you about how long you must avoid strenuous exercise or work, but it is usually approximately 3-4 weeks after the operation.

  • Laser Bladder Neck Incision.  This uses Holmium laser to incise the bladder neck in men who have obstruction from this rather than the prostate.  It usually requires a one night hospital stay.

  • Microwave TURP.  This uses microwave energy in order to vaporize the prostate from the inside.  It is a good option in men who have medical problems making them less suitable for a TURP, or those who are on blood thinning medication.

  • Open prostatectomy.  This is reserved for the minority of patients who have a prostate that is too large to be safely treated by any other surgical modality.  It involves an incision of 10cm from the pubic hairline up towards the umbilicus (belly button) and allows the surgeon to core out the prostate manually.