Why did you decide to become a Consultant Urologist ?

I became a Urologist because of the diversity of the specialty. When I started in Urology in 1986, 40 years ago, it was a surgical specialty that also managed the whole pathway, both diagnosis and treatment. That is unlike most other surgical specialties, where the surgeon operates and allied physicians look after the diagnostics: in Gastroenterology you have Gastroenterologists and Gastrointestinal Surgeons, and in Cardiology you have Cardiologists and Cardiac Surgeons. In Urology, the Urologist is a surgeon who also does the diagnostic work, so you are involved in the whole process, from diagnosis through to offering both medical and surgical treatment options. The other reason was how hugely diverse the specialty was. During my house job in Urology we did kidney transplants, major cancer surgery, gender reassignment surgery, microsurgery and endoscopy, all within one specialty. Those diverse applications and treatment options were enduringly fascinating, and they set me on what has become a 40-year road in Urology.

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

The majority of patients who present with prostate disorders have noticed a change in their voiding pattern: a slowing of the urinary stream, getting up at night more often, perhaps hesitancy, or urgency and having to rush to the loo. Men become more aware of these symptoms as they get older, and that prompts them to see their GP and be referred to assess whether they have a significant prostate enlargement or another problem. The other common reason for referral is a routine blood test, either through a health screen or general practice, showing a raised PSA, which prompts referral for further investigation. So it is a combination of urinary symptoms, a raised PSA, or blood in the urine.

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

The diagnostic options are very varied. We are fortunate in the private setting to have access to many new diagnostic and treatment options, and in fact we have pioneered treatments here that have then been taken up by the NHS. The diagnostics are state of the art, particularly for prostate cancer, with new tests and much more specific biopsy techniques that use fusion AI software to target the cancer precisely within the prostate. Very importantly, the right diagnostic tool also makes it possible to offer patients the least invasive, least morbid and most effective treatment options, so it is a critical part of the pathway.

What are your areas of sub-specialist interest?

I am a General Urologist, but my main interest is in prostate disorders, both benign and malignant. My research was on microwave therapy as a minimally invasive treatment for benign prostatic hypertrophy, and I went on to evolve and pioneer robotic surgery for prostate cancer and high intensity focused ultrasound (HIFU), which we subsequently developed as a focal treatment for prostate cancer. Both technologies were pioneered by me at The Princess Grace Hospital more than 20 years ago and have since been adopted as a standard of care for NHS patients and for patients generally in the UK. More recently we have also pioneered transperineal laser ablation (TPLA), a new minimally invasive way of treating both benign prostate enlargement and prostate cancer. It is a single treatment, done as a day case, and can be carried out under local anaesthetic. I introduced it at The Princess Grace Hospital three years ago and we continue to offer it.