Tom McNicholas has written widely on many aspects of urinary disease. He is particularly in demand for teaching on benign prostatic disease and urinary symptoms. He has major interests in the management of prostate cancer, the treatment of urinary stone disease and in making common urological investigations (especially prostatic biopsy) both painless and safer.
He has written over 150 major scientific papers which can be reviewed in the bibliography. Most recently he has been lead author of the chapter on Benign Prostatic Disease in the latest addition of Campbell’s Urology. This 4 volume textbook is the “bible” for urology and is used by urological experts worldwide. He is one of only a small handful of British urologists to have been recognised in this way.




For men seeking advice on which treatment to choose for their urinary symptoms:



I was just reading patient comments on the NHS Choices website for men enquiring about urinary problems (http://www.nhs.uk/Conditions/Prostate-enlargement/Pages/Treatment.aspx) and found those contributions very useful.

There were a lot of anxieties expressed. I hope these comments help. Some are for reassurance and the others are to resolve uncertainties.

Firstly, TURP can be a brilliantly effective and safe operation if the prostate is enlarged and causing obstruction BUT- its not always the prostate causing the problems! In many younger men the urinary problems are due to muscular problems in the bladder itself or at the neck of the bladder - which is why 'bladder neck incision" can work so well for some of them and has less risk of upsetting ejaculation.


Second, orgasm and the process of ejaculation is different in everyone. Some men don't need the ejaculation as much as others, some need it for full orgasm. Every man needs ejaculation for fertility. Try an alpha blocker drug 1st to see how it suits you and your ejaculation/orgasm (and your partner) before any operation that may permanently damage these processes.


Thirdly, many of us urology specialists (but not all!) are interested in preserving ejaculation and orgasmic sensation as much as possible. Operations can be "customised" to reduce or even avoid this damage completely but you need to find an interested surgeon. Ask them!
Also Urolift has been designed to avoid damage to ejaculation and orgasm and is likely to be approved by NICE as safe and effective for wider use shortly.
Clearly more data will be important to really determine how useful urolift will be.

Fourthly, Cialis (tadalafil) helps both urinary and sexual difficulties. This benefit for the “Viagra like drugs or PDE5Is as they are known was discovered in the UK (in fact by my study published in 2002*) and daily Cialis is now licenced for both uses in the UK.  But even though we doctors would prescribe it for men with urinary difficulties (or urinary and erection difficulties which frequently co-exist and are probably related) prescribing Cialis is caught out by the panic and restrictions brought in when Viagra 1st came out so GPs won't offer it in a hurry unfortunately. You may have to pay for it - or have an expensive and possibly avoidable operation- after which you can get an NHS prescription more easily! NHS arrangements don't always make sense!!


Finally, an experimental treatment developed in Israel and known as Gat-Goren was mentioned. Essentially we need evidence about whether it works or not and whether it is safe or not. Without that we cannot judge if this is a real option or nonsense. My patients who wanted to try it also found it difficult to make the arrangements in Israel. Their health system seems similar to ours so if it works they should have scientific results to show the world by now but I have not yet seen convincing data. Until we do I would advise caution.

That, of course, applies to all “new” treatments you may read about in the newspapers. It is tough to get the data.  Hard work and expensive for small start up companies (no doctor can afford to do the scientific studies now so we rely on commercial enterprises). But until the evidence is in, any man is taking a wild gamble if choosing new therapies just because The Daily Mail reports it (even though their reports helped our early work as well!). Think of them as ‘early sightings” of treatments that MIGHT become available if the evidence develops.

*Sairam K, Kulinskaya E, McNicholas TA et al. Sildenafil influences lower urinary tract symptoms. (1st clinical report). BJU Int. 2002 Dec;90(9):836-9.

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