The original article ‘Diagnosis of penile cancer with ex vivo fluorescence confocal microscopy using the Histolog® Scanner’ was published in BJU International and can be found in full here. 

Objectives

To evaluate the feasibility and diagnostic performance of ex vivo fluorescence confocal microscopy (FCM) using the Histolog® Scanner (SamanTree Medical SA, Lausanne, Switzerland) for the assessment of penile cancer (PeCa) specimens, and to compare FCM-based diagnoses with standard formalin-fixed, paraffin-embedded (FFPE) histopathology.

Patients and Methods

We conducted a single-centre study including 12 patients with clinical or radiological suspicion of PeCa who underwent diagnostic or excisional biopsy between June 2022 and November 2023. Fresh biopsy specimens were stained with a nuclear fluorescent dye and scanned ex vivo with the Histolog Scanner. Digital images were retrospectively reviewed by two uropathologists and compared with conventional haematoxylin and eosin-stained FFPE sections.

The primary endpoint was diagnostic concordance between FCM and histopathology in detecting invasive squamous cell carcinoma (SCC); secondary endpoints included sensitivity, specificity, and overall feasibility of image acquisition.

Results

A total of 29 FCM scans were obtained. Diagnostic image quality was achieved in 28/29 scans (96.6%).

FFPE analysis confirmed invasive SCC in eight patients, differentiated penile intraepithelial neoplasia in three, and an atypical squamous proliferative lesion (ASPL) in one. FCM correctly identified tumour category in 11/12 patients, yielding an overall accuracy of 91.7% (95% confidence interval [CI] 61.5–99.8%).

Sensitivity for invasive SCC detection was 87.5% (7/8; 95% CI 47.3–99.7%), and specificity was 100% (4/4; 95% CI 39.8–100%).

One SCC was misclassified as ASPL on FCM. Median workflow time was ~5 min/specimen.

Conclusions

Ex vivo FCM is a feasible, rapid imaging technique that enables high concordance with histopathology for the diagnosis of PeCa. This pilot study represents the first assessment of ex vivo FCM in penile malignancies and provides preliminary evidence supporting its potential role in intraoperative margin assessment. Larger prospective studies are required to confirm its diagnostic accuracy and clinical utility.

Citation:

Zhang, X., Almeida-Magana, R., Mendes, L.S.T., Lavergne, D.F., Alnajjar, H., Shaw, G., Freeman, A., Muneer, A. and Haider, A. (2026), Diagnosis of penile cancer with ex vivo fluorescence confocal microscopy using the Histolog® Scanner. BJU Int. https://doi.org/10.1111/bju.70239

Learn More about Penile Cancer

Methods

An extensive review was conducted to analyse and compare diagnostic and treatment recommendations from publicly available guidelines published by the American Urological Association, European Association of Urology, Canadian Urological Association, and the International Society of Sexual Medicine. Key similarities and differences regarding PD definition, evaluation, non-surgical treatments, and surgical management were systematically compared.

Results

Areas of general consensus across guidelines include the importance of comprehensive history-taking for PD diagnosis and the role of intracavernosal injection as the ‘gold standard’ for assessing penile deformity prior to invasive intervention. Shared decision-making and thorough patient counselling are universally emphasised. Plication or incision and grafting surgery is generally reserved for patients with preserved erectile function, whereas penile prosthesis implantation is the preferred surgical option for those with erectile dysfunction unresponsive to medical therapy. Non-surgical treatments remain an area of controversy due to limited evidence of efficacy; however, intralesional injections are recognised by all panels as a potential treatment option, especially in the acute phase. Further research intoPD pathophysiology and rigorous outcomes studies are needed to inform novel treatments and refine surgical management strategies.

Conclusion

While major urological societies demonstrate substantial consensus on several aspects of PD evaluation and management,key areas of divergence remain, underscoring the need for further research to guide evidence-based care.

Citation:

Chierigo, F., Fallara, G., Tozzi, M., Salonia, A., Ferro, M., Alnajjar, H.M., Muneer, A. and Pang, K.H. (2026), Guideline of guidelines: Peyronie’s disease. BJU Int. https://doi.org/10.1111/bju.70201

What is Peyronie’s Disease? 

Peyronie’s Disease is caused by fibrous scar tissue (or plaque) that develops under the skin of the penis. Symptoms of Peyronie’s disease include:

• Significant curvature
• Pain
• Erectile dysfunction in some cases 

 There are usually two phases to this condition. The first is the acute phase, presenting with pain and changing curvature. The second is the chronic phase where the plaque hardens, the curve stabilises, and pain often subsides.

 Peyronie’s is treatable. It is important to seek early evaluation by a urologist or andrologist, as treatment is more effective when begun in the early stages.

 You can read more about Peyronie’s Disease on our blog here.

If you’re concerned that you have symptoms that may be Peyronie’s Disease, then please get in touch with us.

Straight to the Point released a new episode on Erectile Dysfunction (ED), hosted by Clinical Nurse Specialist Clare Akers (Coloplast) and Consultant Urologist Dr Fabio Castiglione (King’s College Hospital), with guest Professor Asif Muneer from London Men’s Clinic.

Key topics covered:

• The medical definition of ED and how it differs from other sexual health issues
• Links between ED and conditions like diabetes, cardiovascular disease, and post-prostate surgery complications
• The psychological side — how anxiety and loss of confidence can create a cycle that worsens performance issues
• Over-the-counter pills: what you should know, and why seeing a GP first is recommended
• How to recognise when it’s time to book an appointment

The episode is designed as an accessible starting point for men who are struggling with ED but unsure where to begin. It’s available on Spotify, Apple Podcasts, Overcast, Castro, Goodpods.

The landscape of testicular cancer diagnosis is shifting. With advancements in high-resolution screening, doctors are identifying more Small Testicular Masses (STMs) than ever before. Historically, the presence of a mass often led to radical surgery, but new research and international guidelines are championing a more nuanced, patient-centred approach that prioritises preserving function and psychological well-being.

Not being able to perform in the bedroom can be embarrassing, but erectile dysfunction (ED) is a common global problem – affecting up to one in five men!

It can be a result of medical issues (organic ED), such as vascular disease, nerve damage, hormonal deficiency, pelvic surgery or pelvic trauma. Alternatively, it can be related to psychological factors such as stress, anxiety, relationship issues, or sexual abuse.

ED can also be caused by lifestyle factors, including smoking and drinking alcohol, drug abuse, obesity, fatigue, and sleep disorders – not to mention medications such as antidepressants, diuretics, corticosteroids and medications for heart disease.

At Harley Street Andrology, we specialise in men’s health London-wide and can provide a prompt diagnosis and treatment, including shockwave therapy, to help you regain confidence.

Read on to find out more about this pain-free, minimally invasive, and effective treatment option for erectile dysfunction.

What is shockwave therapy for erectile dysfunction?

Shockwave therapy is a clinically-proven, safe, regenerative therapy used to restore vascular and smooth muscle function which in turn helps to restore penile function.

The procedure is non-invasive and involves the use of an ultrasound probe.

This is moved slowly and gently over the penis while low-intensity energy sound waves are passed through the skin and into the penile shaft.

These shock waves help smooth muscle cells enter a repair mode which helps them to function better and also stimulate the growth of new blood vessels, which helps increase blood flow and allows for a stronger erection.

Shockwave therapy for ED targets the underlying cause of the problem without medication in a way that’s quick, painless, and discreet.

How long does shockwave therapy for erectile dysfunction take to work?

Each session lasts half an hour or less, and you can return to work and your daily activities immediately afterwards.

However, the time it takes for the results of shockwave therapy to become apparent can vary depending on your age and the severity of your condition.

For example, some men may notice considerable improvements in as little as a few weeks, while it may take longer for others.

The benefits of shockwave therapy often take longer to come into effect than pills for ED, but most people know that good things take time.

Combining shockwave therapy with other approaches (i.e. improving fitness, strengthening the pelvic floor, and eating healthier) can also provide longer-lasting results.

How many shockwave treatments are needed for erectile dysfunction?

For the cumulative effects to be felt and for the body to respond to the treatment effectively, the recommended course of shockwave therapy for ED is one session per week for six weeks.

Older patients and men with more severe cases of erectile dysfunction may require additional sessions.

After you’ve had six sessions of shockwave therapy, our urologists will review your progress and determine whether you have achieved your end goal or if a further course of treatment is necessary.

Is shockwave therapy expensive?

With shockwave therapy, you’re investing in a holistic treatment approach.

When compared to more invasive treatment options for erectile dysfunction, such as surgery or stem cell therapy, shockwave therapy is a more cost-effective option for erectile dysfunction.

The total cost of treatment will vary depending on how many sessions of shockwave therapy you need, which will be determined on a case-by-case basis during your initial consultation.

As with most therapies, the more sessions you need, the more you’ll pay.

For a better idea of how much shockwave therapy will cost you, why not book your appointment.

The authors distinguish between undifferentiated PeIN, which is strongly linked to human papillomavirus (HPV), and differentiated PeIN, which is associated with lichen sclerosus (LSc). While topical therapies and cryotherapy are utilised, the research highlights that surgical intervention, particularly circumcision, serves as the primary treatment for most cases.

The findings demonstrate that specialised multidisciplinary care leads to excellent outcomes, with only a small percentage of patients progressing to invasive cancer. Furthermore, the source advocates for HPV vaccination and smoking cessation as vital components of a comprehensive preventative strategy.

While radical orchidectomy remains the traditional standard of care due to the concern that these are malignant lesions, modern advancements in high-resolution ultrasonography have led to the increased detection of these lesions, which are more likely to be benign.

Consequently, testis-sparing surgery (TSS) for specific cases, particularly when tumour markers are negative, or the patient has a solitary testicle, can be offered to preserve fertility and hormone function. The study highlights the role of intraoperative frozen section analysis to differentiate between benign and malignant tissue before proceeding with full organ removal. Despite broad consensus on using ultrasound as a primary diagnostic tool, discrepancies still exist regarding exact size thresholds for surveillance and the necessity of additional biopsies to check for precancerous cells.

Ultimately, the guidelines advocate for a multidisciplinary approach that balances effective cancer control with the preservation of fertility and hormonal function.

Professor Asif Muneer is a leading authority on small testis lesions and manages a high volume of cases from all over the UK. 

Circumcision is a commonly performed surgical procedure involving removal of the foreskin. In adults, it is a safe and effective treatment for specific medical indications.

What is Circumcision?

Circumcision is a surgical procedure that removes the foreskin (the skin covering the glans, or head, of the penis), leaving the glans permanently exposed.

In adults, it’s typically performed to address medical conditions.

• Indications:
  • Phimosis: A tight, non-retractile foreskin causing pain or hygiene issues.
  • Recurrent balanitis: Inflammation of the glans or head of the penis
  • Skin diseases: Chronic inflammation, lichen sclerosus or conditions affecting the foreskin/glans.
  • Warty lesions: Non-cancerous growths on the foreskin.
  • Cancerous/pre-cancerous lesions: Rare conditions requiring removal of the foreskin.
• Outcome: Resolves symptoms and improves hygiene.

At Harley Street Andrology, we offer tailored consultations to determine the best approach for adult circumcision, ensuring safety and comfort.

Why Seek Circumcision?

• Relieves discomfort: Eliminates pain from phimosis or infections.
• Prevents complications: Reduces the risk of recurrent infections or progression of lesions.
• Improves hygiene: Simplifies penile cleaning, lowering infection risk.
• Treats serious conditions: Addresses cancerous lesions, potentially preventing malignancy.
• Boosts confidence: Resolves functional or cosmetic concerns.

Delaying adult circumcision for medical issues can worsen symptoms or complications.

Why Choose Harley Street Andrology?

Professor Asif Muneer is an award-winning, internationally recognised andrologist with 30+ years of experience.

• Advanced Technology — Cutting-edge diagnostics and treatments
• Comprehensive Care — Personalised support from start to finish
• Holistic Approach — Focused on long-term men’s health and well-being

What to Expect During Circumcision

Before the Procedure

• Consultation: We confirm suitability, discuss anaesthesia options, and review medications, especially blood thinners.
• Preparation: You’ll receive TED stockings and possibly a heparin injection to prevent blood clots, depending on your hospital stay.

During the Procedure

• Anaesthesia: General or local anaesthesia, with local penile nerve blocks for post-operative comfort.
• Process: The foreskin is removed using a scalpel technique, and a double-layer closure is performed, leaving a cuff of skin just under the glans. 

After the Procedure

• Recovery: Expect swelling and bruising for a few days and the sutures dissolve after 3 weeks. The glans may feel hypersensitive for 2–3 weeks.
• Care: Keep the area dry for 24–48 hours and change the dressings regularly. Apply Vaseline to ease dryness and sensitivity. Avoid swimming for 2–3 weeks and sexual activity for 3 weeks or until the sutures dissolve.

Circumcision Costs in London, UK

Circumcision at private clinics in London typically depends on the location of the hospital where it is performed. Contact us for further details.

• Source (BAUS)

While most testicular lumps are benign,

it’s crucial to seek prompt medical advice to rule out serious conditions like testicular cancer.

At Harley Street Andrology, we provide rapid diagnostics and personalised care to address testicular lumps, offering reassurance and treatment for men in London, the UK, and beyond.

In this blog, we’ll explain what testicular lumps are, their causes, and why Harley Street Andrology is your trusted choice for comprehensive care.

What is a Testicular Lump?

A testicular lump is any swelling or mass within the scrotum, either on the surface of the testicle, within the testicle itself, or in surrounding structures like the epididymis.

Most lumps are benign (non-cancerous), but a lump within the body of the testicle has a 90% chance of being testicular cancer, particularly in men aged 20–50.

Key facts about testicular lumps:

• The majority are benign, such as hydroceles, epididymal cysts, or varicoceles, and only require treatment if symptomatic.
• Testicular cancer is the most common malignancy in men aged 20–50, but early diagnosis leads to a cure rate exceeding 95%, even if it has spread.
• Lumps attached to the testicle’s surface are usually benign, while those within the testicle are more likely cancerous.
• Risk factors include abnormal testicles (e.g., undescended, injured, infected, or atrophic testicles, often seen in infertility).

At Harley Street Andrology, we prioritise urgent evaluation to distinguish benign from cancerous lumps, ensuring timely care.

Common Symptoms and Causes of Testicular Lumps

Testicular lumps may present with or without symptoms. Common signs include:

• A palpable lump or swelling in the scrotum, often found during self-examination.
• Aching or heaviness in the scrotum, especially with benign conditions like hydroceles or varicoceles.
• Cosmetic concerns, such as visible swelling.
• Rarely, pain or discomfort, particularly with inflammatory causes like epididymitis or torsion.

Possible causes include:

• Cystic (fluid-filled) swellings:
  • Hydrocele: Fluid around the testicle, often benign.
  • Epididymal cyst: A fluid-filled sac in the epididymis (sperm-carrying tubes).
  • Varicocele: Varicose veins above the testicle, causing a “bag of worms” sensation.
• Inflammatory swellings:
  • Epididymitis: Infection of the epididymis, often sexually acquired or due to urinary infections.
  • Testicular torsion: Twisting of the testicle, a medical emergency common in children.
  • Orchitis: Testicular infection, sometimes due to mumps.
• Solid swellings:
  • Testicular cancer: A lump within the testicle itself, requiring urgent evaluation.
  • Sperm granuloma: A nodule post-vasectomy, usually benign.
  • Chronic epididymal inflammation: Persistent swelling from prior infections.
  • Rare infections: Tuberculosis or syphilis (very uncommon).
• Hernias:
  • Groin hernias extending into the scrotum, not originating from the testicle.

If you’ve found a lump, get in touch with our team at Harley Street Andrology for expert assessment to determine the cause and provide appropriate care.

Why Choose Harley Street Andrology?

Professor Asif Muneer is an award-winning, internationally recognised andrologist with 30+ years of experience.

• Advanced Technology — Cutting-edge diagnostics and treatments
• Comprehensive Care — Personalised support from start to finish
• Holistic Approach — Focused on long-term men’s health and well-being

Why Seek Treatment for Testicular Lumps?

Prompt evaluation of a testicular lump is essential to:

• Rule out cancer: Early detection of testicular cancer ensures a cure rate above 95%.
• Relieve symptoms: Benign conditions like hydroceles or varicoceles may cause discomfort or cosmetic concerns, treatable with surgery if needed.
• Prevent complications: Conditions like torsion require immediate surgery to save the testicle, while untreated infections can lead to chronic issues.
• Ease anxiety: A clear diagnosis provides peace of mind.

Delaying assessment can risk progression of serious conditions. At Harley Street Andrology, we offer fast-track evaluations to address your concerns swiftly.

Advanced Diagnosis and Treatment at Harley Street Andrology

We provide comprehensive diagnostics and tailored treatments for testicular lumps, ensuring the highest standard of care.

Diagnosis

• Consultation: We’ll discuss your symptoms, medical history, and risk factors (e.g., undescended testicles, infertility, or prior infections).
• Physical Exam: A thorough scrotal examination assesses the lump’s location, size, and characteristics.
• Tests:
  • Ultrasound: Differentiates benign from cancerous swellings with high accuracy.
  • Blood tests: Tumor markers (e.g., AFP, hCG) for suspected cancer.
  • CT scan: If cancer is suspected, to check for spread.

Treatment Options

• Cystic Swellings:
  • Observation: Benign hydroceles, epididymal cysts, or varicoceles often require no treatment unless symptomatic.
  • Surgery: Hydrocele repair, epididymal cyst excision, or varicocele treatment (microsurgical varicocele ligation or radiological embolisation) for significant symptoms.
• Inflammatory Swellings:
  • Antibiotics: For epididymitis, tailored to the infection source (e.g., urinary or sexually acquired).
  • Emergency surgery: For testicular torsion, to untwist and secure the testicle.
• Testicular Cancer:
  • Orchidectomy: Surgical removal of the affected testicle, with an option for a prosthetic testicle during or after the surgery.
  • Following surgery: Surveillance or chemotherapy guided by the pathology, tumour markers, and CT imaging. Follow up is coordinated with a medical oncologist specialising in testicular cancer and treatment plans are discussed within a multidisciplinary team meeting (MDT meeting). 
• Other Testicular Lesions:
  • Antibiotics: For rare infections like tuberculosis.
  • Small indeterminate testis lesions: These are small lesions in the testicle often detected incidentally. Professor Muneer offers ultrasound localised excision of the lesions so that the testicle can be preserved. 
  • Surgical excision: For symptomatic sperm granulomas or chronic epididymal nodules.

Professor Asif Muneer, ensures an accurate diagnosis and personalised treatment plan, prioritising your health and ensuring preservation of fertility and hormone function.

Testicular Lump Treatment Costs in London

Treatments at private clinics in London typically depend on the procedure and anaesthesia. Contact us for further details.

• Source (BAUS)