Procedures

 

I undertake surgery for most urological conditions such as circumcision, hydrocoele repair, epididymal cyst excision, bladder telescopic operations including cancer growth resections and prostate resections for benign (non-cancerous) growth.

For patients with kidney or ureteric stones, I am one of the highest volume surgeons in the region undertaking the full remit of procedures for stone diseases. We offer a tertiary (from hospitals in the south west of England) referral service; operating on some of the most challenging patients with difficult body habitus, challenging kidney anatomy and large stone burdens.

 

Ureteroscopy & Uretero-renoscopy

This surgery is undertaken under general anaesthesia; passing a telescope into the upper urinary tract. It allows the surgeon to see directly into the drainage part of the ureter and kidney; to make a diagnosis and to treat conditions such as stone disease, obstructions and tumours.

Stones can be fragmented in the ureter or kidney with a LASER fibre passed up through the ureteroscope (semi-rigid or flexible) and fragments can be extracted with graspers or baskets.

Flexible uretero-renoscopy is often used to inspect the inside of a kidney if there is visible blood in the urine and other investigations have failed to provide an adequate explanation or reassurance. If a tumour is found it can be biopsied (a small sample of tissue taken) for microscopic examination although formal treatment will usually be deferred to another occasion. Small tumours can be destroyed by LASER.

Narrowings in the ureter or at the pelvi-ureteric junction (PUJ) can be lasered or dilated. Sometimes a ureteric stent (JJ stent) is placed in the urinary tract following ureteroscopy to allow the oedema to settle and to maintain kidney drainage. This is a softer plastic copolymer tube with unique modifications for the urinary tract with the top end curled up in the renal pelvis and the bottom end curled up in the bladder. It is usually removed easily at a later date under local anaesthetic using a flexible telescope.

For more information, see the following PDF documents: Ureteroscopy & Uretero-renoscopy (209KB) / Ureteric Stents (212KB)

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Percutaneous Nephrolithotomy

PCNL is minimally invasive or “keyhole” surgery for treating kidney stones. This surgery is indicated for patients with larger stones.

Patients undergoing PCNL are admitted to Hospital and can typically expect to be in hospital for about 3 nights. The procedure is performed by a combined team of Urological Surgeon, Radiologist and Anaesthetist. The procedure involves key hole access into the kidney drainage system, fragmentation and extraction of stone(s).

For more information, see the following PDF document: PCNL (199KB)

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ESWL (Shock-wave Lithotripsy)

Stones that form in your kidneys or ureters (tubes leading from kidneys to your bladder) can be broken up without the need for surgery using a technique called extracorporeal shockwave lithotripsy (ESWL).

ESWL uses vibrations that are transmitted into the body and directed on to the stone to break it into small fragments. The sensation felt by the patient varies widely from “just feeling it” through “discomfort” to “pain” – the vast majority being in the middle group. You will be offered painkillers to control pain. (anti-inflammatory suppository & tablets). Some patients maybe offered further treatment with stronger pain relief which maybe sedative.

Not all patients and stones are suitable for shock wave treatment.

For more information, see the following PDF document: ESWL (561KB)

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General Urology Operations

Prostate surgery (TRUP)

Bladder growth resections

Bladder examination by camera (cystoscopy)

Urethral dilatation and urethrotomy

Epididymal cyst removal

Vasectomy (male sterilisation)

 

 

Anaesthesia

 

Dr Ed Morris BSc (Hons), MBBS, FRCA

Consultant Anaesthetist

 

I qualified as a doctor in London in 1992 and trained in anaesthesia in Bristol, the South West, and the USA, becoming an NHS consultant in 2002. I have worked as an anaesthetist with an interest in urology since my appointment and with Joe Philip since his arrival in Bristol, developing anaesthetic techniques to make your hospital stay as pleasant (and short!) as possible. I look forward to meeting you before your operation to talk through the options available and answer any questions you might have. Patients often have different questions or even anxieties and I enjoy spending time explaining what will happen to you while you are under my care.

As well as my interest in anaesthesia for general urological and kidney stone operations (I work with Joe in his NHS practice too) I specialise in anaesthesia for orthopaedic surgery, fertility treatments, and emergency anaesthesia at Southmead Hospital in Bristol. I am an honorary senior clinical lecturer at the University of Bristol and am involved in choosing tomorrow’s doctors as an admissions tutor there. Away from work I enjoy spending time with my teenaged family and being part of my local community in North Bristol.

Occasionally (if I am away) Joe’s patients are anaesthetised by colleagues of mine with similar training and experience – we look forward to meeting you and being part of the team who look after you.

 

FAQs about Anaesthesia

The guide for patients that is provided by the Royal College of Anaesthetists, available here, will answer many of your general questions about anaesthesia. The FAQs below reflect the sorts of specific questions that our patients often have.

 

What sort of anaesthetic will I have?

The nature of urology operations is that most of them are performed most smoothly under a light general anaesthetic. There may rarely be situations where, because of the type of operation or your health, a local or regional anaesthetic may be a safer option. However, I will always discuss this with you in advance and if a local or regional technique is suggested then we can use sedation as well to ensure that you are relaxed throughout the procedure.

 

How will you keep me comfortable after the operation?

Our aim is for you to wake up with little or no pain after your operation and to remain as comfortable as possible afterwards. A specialist recovery nurse will look after you immediately after your operation to ensure that you are comfortable before you go back to the ward, and the anaesthetist will visit you after your operation. We will make sure that a range of painkilling medicines are available for you to take should you need them during your recovery, and will give you tablets to take home with clear instructions on how to use them.

 

Am I likely to feel sick?

Postoperative sickness depends on several factors – the age and sex of the patient, the type of surgery performed, and the anaesthetic drugs used. Most of our patients do not feel sick after their operation, and part of the preoperative discussion will be to assess the risk of you feeling sick and to adjust the type of anaesthetic accordingly, for example by using specific techniques or medicines.

 

What can I do to prepare myself for surgery?

All anaesthetists will tell you the same – please follow the instructions you are given about eating and drinking before surgery very carefully, and if you smoke, please stop! These are the two things which will help to make your anaesthetic as safe and pleasant as possible, to get you through your operation and beyond as quickly and successfully as we can.

 

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Contact

 

Bristol Urology Associates,
85 Alma Road,
Clifton
Bristol BS8 2DP

0117 980 41 18

Copyright © 2016 Joe Phillip Urology