Why did you decide to become a Consultant Urological Surgeon ?

The main reason for choosing Urology is because I consider myself quite innovative, and Urology as a subspecialty has innovated and adopted technology quite early compared to any other specialty, certainly in the UK. We're one of the earliest adopters of robotic technology, which is something that appealed to me quite early on in my training and my career.

My subspecialty interest is essentially robotic kidney and prostate cancer surgery. It's very topical now, it's part of the NHS 10 year plan in terms of expanding robotics to other specialties. But within Urology, we have over two decades worth of experience, and what we achieve with that system is way in advance of what other specialties achieve. So it's mainly that forward thinking nature of moving on to the next bit of technology to optimise outcomes for patients that was a big part of choosing Urology.

What are the common symptoms that your patients tend to present with?

The most common symptoms tend to be urinary symptoms. Any change in urinary habit, infections, pain, particularly when it comes to stones in the kidneys or the genital area. Blood in the urine is also common.

However, I have a subspecialty interest in prostate and kidney cancer. Typically, cancers within Urology don't have symptoms, so often that cohort might come either through chance, because they've had investigations for some other reason which has picked up a kidney cancer incidentally, for example, or because they're worried about cancer or men's health and they come for a PSA blood test.

So it's a range in terms of why patients may come and see me. The symptom element often reflects something that might potentially be benign, such as urinary symptoms, incontinence, leakage, a urine infection, or blood in the urine, which we take very seriously. But there is a separate cohort of patients who come in because of a chance finding of potential cancer.

What are the treatments that you're able to offer your patients?

Within Urology, there's a range of things we use in terms of diagnostics: blood tests, urine tests, and scans. We use anywhere from ultrasound through to MRI and CT, and even more subspecialist types of nuclear medicine scans to help with our diagnostic pathway. If that doesn't answer the question we're posing, then we have more invasive diagnostic tests. These can range from camera tests, so cystoscopies, which can be done either under general anaesthetic or local anaesthetic depending on your tolerance, and then more specifically, biopsies of various urological organs. For the prostate, we use a combination of ultrasound and MRI scans to help guide our biopsy techniques. Or, collaboratively with radiologists, we use imaging to biopsy the kidney or other areas, typically in the diagnosis of cancer.

In terms of treatment, I have a broad scope of practice and subspecialise in minimally invasive approaches. I subspecialise in preservation surgery, robotically, for kidney cancer and in robotic surgery for prostate cancer, where you are able to preserve the continence mechanisms and the nerves that supply erectile function for men, to achieve both cancer control and good functional outcomes.

For general urological conditions such as enlarged prostates, we specialise in using the telescope to go through the penis and offer treatments that way, so there are no cuts. Recoveries are often quicker, and we offer minimally invasive treatments for conditions like enlarged prostates. Most of the treatments being offered for my private patients are with a view to minimising the functional problems of surgery and maximising the treatment benefits. We're always looking for the next thing that could help minimise side effects for patients, things like erectile problems and absent ejaculation, whilst maximising their longevity from a urinary symptom perspective.

What are your areas of sub-specialist interest?

I would say that two thirds of my workload are in diagnosing and managing cancer, particularly kidney and prostate cancer. Where I stand out is in the realms of both prostate cancer and kidney cancer using robotic technology.

Within kidney cancer, I subspecialise in kidney preservation treatments, and I operate through a part called the retroperitoneum. This is not through the tummy, but through the side, and what that means is a much faster recovery for patients. Most patients are home either the same day or the next day after major surgery, and they recover within two to four weeks in terms of getting back to normality, because you don't disturb the bowel through this route. That is a particular forte of mine.

Within the realm of prostatectomy, I use the robot to remove the prostate in a way where you preserve a lot of the functional mechanisms like continence and potency. Again, patients are often home the day after surgery and back to normal day to day activity between two and four weeks.

I'm a high volume robotic surgeon, and I'm a Royal College of Surgeons accredited trainer for future robotic surgeons. I run a fellowship programme at St George's Hospital where I train subsequent generations of urologists.