Tuberculosis (TB) TB services in Bristol, North Somerset and South Gloucestershire are provided in partnership with the Bristol Royal Infirmary. Clinics operate at both hospitals, supported by a multidisciplinary team of specialist TB nurses and a pharmacist.

Referrals for assessment for latent TB can be made routinely via the NHS electronic referrals system. Patients thought to have possible active TB should be referred urgently via eRS and a highlighted by a phone call to our secretary – we aim to see such cases within 1 week.

Hospitals referring complex or resistant TB should speak to the ID registrar on call via switchboard on 0117 9505050.

We have excellent links with other specialist teams to provide comprehensive management for TB inpatients and outpatients.

For more information about TB visit www.tbalert.org.

GMC Number: 4606156

Year of first qualification: 1999, Birmingham University

Specialty: Anaesthetics

Clinical interests: Obstetrics, colorectal and vascular surgery

Telephone: 0117 414 0966

GMC Number: 4304423

Year of first qualification: 1996

Specialty: Rheumatology & Osteoporosis

Clinical interests: General rheumatology, osteoporosis, metabolic bone disease

Secretary: Jessica Goodwin

Telephone: 0117 414 2849

Professor Emma Clark is active across all adult general rheumatology services.

Professor Clark has a particular clinical interest in osteoporosis and hypermobility. She runs a dedicated osteoporosis/metabolic bone disease clinic.

She leads on the vertebral fracture assessment (VFA) component of the DXA service.

She is also an active researcher through her post as Reader in Rheumatology, Bristol Medical School, University of Bristol. She runs three research programmes: vertebral fractures, scoliosis and hypermobility.
 

Urology Clinical Research Lead

Jonathan Aning, Consultant Urological Surgeon. 
 

Researchers

Professor Paul Abrams, Consultant Urological Surgeon.
Professor Nikki Cotterill, Professor in Continence Care.
Andrew Gammie, Clinical Engineer
Preksha Kuppanda, Research Associate
Nicola Morris, Laboratory Research Manager
Alan Uren, Specialist Clinical Researcher

Data Administration

Samantha Kearley, Lead Data Administrator
Ruth Taylor, Data Administrator

Research Nurses

Rebecca Cousins, Lead Urology Research Nurse
Emily Perry, Urology Research Nurse
Marta Cobos-Arrivabene, Urology Research Nurse
Victoria Garner, Urology Research Nurse
Sophie Short, Urology Research Nurse
 

 

Consultants

Katherine Warren (Clinical Lead)
Salah Albuheissi 
Jonathan Aning
Stefanos Bolomytis
Helena Burden
Hugh Gilbert
Andrew Harris
Hashim Hashim
Motaz Hassan
Odunayo Kalejaiye
Frank Keeley
Anthony Koupparis
Su-Min Lee
Ahmed Mahrous
Aditya Manjunath
Caroline Ochoa Vargas
Raj Pal
Joe Philip
Farukh Qureshi
Edward Rowe
Ala'A Sharaf
Anthony Timoney
Tim Whittlestone
Zsuzsanna Zotter

 

Cancer Nurse Specialists

Cate Abbey
Helen Chilcott
Sarah Fletcher
Gillian Smith
 

Clinical Urology Nurse Practitioner

Rachel Skews

Urodynamics & Functional Urology Team

Professor Hashim Hashim (Director)
Carolina Ochoa Vargas
Ala'a Sharaf
Alex Bacon
Connie Chew (Nurse)
Dr Andrew Gammie (Clinical Scientist)
Anna Hassine
Shiby Priju (Nurse)
Dr Laura Thomas (Urodynamics Manager)
Rachel Tindle (Clinical Scientist)

 

Consultant Oncologists

Amit Bahl
Amar Chalapalli
Susie Masson
 

Prostate disease is the term uses to describe conditions that can affect the prostate gland.

These can be:

• prostate enlargement
• inflammation of the prostate gland (prostatitis) 
• prostate cancer 

Prostate enlargement

Prostate enlargement is a common condition especially in around a third of men over the age of 50.

If the prostate becomes enlarged it can put pressure on the urethra (a tube that runs from the bladder through the prostate) and make is difficult to pass urine

Symptoms of an enlarged prostate

• difficulty when starting to urinating
• weak flow of urine
• having to strain to pass urine
• peeing more frequently
• having to get up and pee at night

In the first instance it’s recommended that you reduce the amount you drink before bed to see if that eases the symptoms.
Medications, such as alpha blockers, are available to help reduce the size of the prostate and relax the prostate gland muscles.

Only if medication doesn’t ease the problems is surgical intervention an option. The inner part of the prostate gland that’s causing the blockage is surgically removed.

Find out more about prostate enlargement.

Prostatitis

Prostatitis is a condition where the prostate gland becomes inflamed. This can occur as a result of an infection although in most cases no evidence of infection is found.

Symptoms of prostatitis include:

• pelvic pain
• testicular pain
• pain when urinating (usually associated with a urinary tract infection)
• pain when ejaculating semen
• pain in the perineum (the area between the anus and back of the scrotum). This can be worse when sitting.

Prostatitis is treated by a combination of painkillers and medication known as an alpha-blocker.

Find out more about prostatitis.

Firstly, the most important thing to note is that everyone with a bladder problem can be helped and many can be cured.

Urinary incontinence is the  release of urine unwillingly. It can affect both men and women and there are a number of reasons for this and there are also a number of ways it can be treated or managed.

The Continence and Urodynamics Unit at the Bristol Urological Institute (BUI), is a centre of excellence with a national and international reputation in the assessment and treatment of  urinary incontinence. The unit offers secondary and tertiary regional, national and international services for urinary incontinence. Urinary incontinence comes under the umbrella of female urology, neurourology and urodynamics, often termed functional urology.

Clinicians, specialists nurses, continence advisors and physiotherapists come together to run a dedicated incontinence clinic at the BUI.

The service is led by a team of three clinical experts, Prof Paul Abrams, Prof Marcus Drake and Mr Hashim Hashim, who have gained an international reputation for their dedication into developing new diagnostic tools, treatments and devices to help those suffering from what was seen as, until recently, a taboo and unmanageable disease.

Types of Urinary Incontinence

Stress incontinence
This type of incontinence actually does not have anything to do with emotional stress but is related to pressure to the bladder such as being overweight, pregnancy, sneezing, lifting heavy objects, exercise and some medical conditions. Leakage is due to a weakness of the pelvic floor that supports the bladder and the urethra. It is often termed ‘ effort’ incontinence.

Treatments for stress incontinence in women
Non-surgical treatments include:

• Restricting fluid intake
• Stopping smoking
• Reducing weight
• Pelvic floor exercises
• Medications such as Duloxetine

For more information about these treatments visit www.nhs.uk/Conditions/Incontinence-urinary/Pages/Treatment.aspx

For 1 in every 3 women with symptoms of stress incontinence these non-operative treatments can make symptoms much better or cure them completely.

Surgical Treatments for Stress Incontinence at BUI
Surgical treatments include:

• Injection/Bulking agent treatment
• Sling procedures (Natural and Synthetic)
• Colposuspension
• Artificial Urinary Sphincter

For more information about these treatments visit www.nhs.uk/Conditions/Incontinence-urinary/Pages/Treatment-surgical.aspx

Operations for stress incontinence depend on supporting the urethra. There are several  operations to cure this type of leakage, and the BUI is one of the few centres in the United Kingdom that can offer all these treatments. According to the National Institute of Clinical and Health Excellence (NICE), women with stress incontinence should be offered all forms of treatment and not restricted to one type. NICE also recommend that women are discussed in a multidisciplinary team meeting. The surgeons at the BUI are also experts in dealing with tape complications and are the regional centre for such treatments.

Stress Incontinence in Men
The most common reason for men having stress incontinence is due to treatment for prostate cancer. Surgery and radiotherapy can weaken pelvic floor muscles and the urethral sphincter (a ring of muscle that keeps the urethra closed)

Non-surgical treatments include:

• Pelvic floor muscle training (PGMT)
• Bladder retraining
• Medicines

Surgical treatments include:

• Artificial sphincter
• Male Sling
• Urethral bulking
• Penile clamp

For more information about these treatments visit www.nhs.uk/Conditions/Incontinence-urinary/Pages/Treatment-surgical.aspx

Urgency incontinence and overactive bladder (OAB) syndrome
This type of incontinence is characterized by a strong urge to urinate with no ability to stop it and often leads to leaking before reaching the toilet in time. It can affect about 12% pf the population with no known cause or it can be caused by as a result of an injury to nerves or muscles which help control urinary flow but it can also be caused by some medical conditions.

The doctor/nurse will ask you questions about the problem and your general health. He/she may do a physical external examination, perform an internal examination and a urine test will be done to check for infection. You will be asked to complete a 3-day frequency/volume chart to record the time of voiding and volumes of urine passed. A flow test may also be performed. This is a test which involves passing urine into a special machine to measure the strength of flow and to check whether the bladder has emptied completely.

If the symptoms fail to respond to conservative and medical treatment a more invasive investigative test may be performed called urodynamics. This is a special test to measure pressures inside the bladder.

Treatments:

• Change of drinking habits
• Bladder training
• Medication
• Surgery

Surgery for Overactive Bladder
The surgeons at the BUI are the only centre in the South West of England that can offer all forms of treatment for refractory overactive bladder syndrome including Botox injection in the bladder, Sacral nerve stimulation, and major surgery.

Pelvic Organ Prolapse
Mr Hashim is one of a few urologists in the United Kingdom who is fellowship trained in pelvic organ prolapse repair in women and also works closely with urogynaecologists and colorectal surgeons at Southmead Hospital to offer a first-class service for women with prolapse.

Pelvic organ prolapse is the bulging of one or more of the pelvic organs (uterus, vagina and bowel) into the vagina. Pelvic organ prolapse can affect the front, top or back of the vagina.

Symptoms are:

• the sensation (feeling) of something coming down or protruding of the vagina
• discomfort during sex
• problems passing urine 

Some women with a pelvic organ prolapse don't have any symptoms and it’s only discovered during an internal examination such as a cervical screen.

Pelvic organ prolapse isn't life-threatening, but it can affect your quality of life.

The main types of prolapse are:

• anterior prolapse (cystocele) – where the bladder bulges into the front wall of the vagina
• prolapse of the uterus and cervix or top of the vagina – which can be the result of previous treatment to remove the womb
• posterior wall prolapse (rectocoele or enterocoele) – when the bowel bulges forward into the back wall of the vagina

It's possible to have more than one of these types of prolapse at the same time.

Genito-urinary Fistula
A fistula is an abnormal communication between the bladder and the vagina or the urethra and the vagina. This causes women to leak continuously. The BUI surgeons are trained in vaginal and abdominal vesico-vaginal and urethro-vaginal fistula repairs and offer a regional and tertiary service for such repairs.

Andrology & Male Urethral Reconstruction

Andrology is a subsection of Urology which deals with problems affecting the male reproductive system. These conditions may present as emergencies or through our outpatient clinics.

We currently have an experienced team of 4 consultants and a senior specialist Andrology nurse with over 15 years of experience.

We provide care for the whole or Bristol and act as a tertiary referral centre for South-West England.

We also have a long tradition of research following on from the Dr Gingell who did the original UK research on Viagra.

In addition, we have had 4 MDs in collaboration with the cardiac institute researching the various factors causing erectile dysfunction.

Andrology Team

Prof Raj Persad
Mr Salah Al-buhessi
Mr David Dickerson
Mr Rupert Beck
Miss Wendy Hurn

We manage the following conditions:

Priapism
This is an abnormal prolonged erection which requires emergency treatment.

Penile fracture
This is due to a tear in the lining (tunica albuginea) of the penile erectile apparatus. This requires emergency surgical treatment.

Torsion
This is a twist in the tube from which the testis is suspended (spermatic cord). This results in the blood supply to the testis being cut off. It requires emergency surgery to untwist the spermatic cord rapidly or it results in loss of the testis.

Genito-urinary trauma

Erectile dysfunction
This is an inability to either develop or sustain an erection sufficient for sexual intercourse. It is common and often very distressing. It may be due to medical conditions such as diabetes or following surgery for cancer.

Ejaculatory disorders including premature ejaculation
This is an abnormality of the expulsion of semen. It is a very distressing condition and is probably the most common sexual dysfunction in men.

Penile curvature
This condition is either present lifelong (congenital penile curvature) or may develop over time (Peyronie’s disease). Peyronie’s disease is due to scarring of the tunica albuginea thereby creating a plaque.

Urethral stricture disease
This is a scarring condition of the male waterpipe (urethra). This results in difficulty passing urine and emptying the bladder.

We also offer the following treatments:

• Penile prosthesis
  This may be inserted electively or as an emergency. The indications are for end stage erectile dysfunction, prolonged priapism or severe penile curvature associated with erectile dysfunction.
• Surgery for penile curvature
  This is either a Nesbitt’s plication or a Lue procedure. The aim of both procedures is to create a straight and functional penis. Nesbitt’s involves the excision of part of the penile tissue. A Lue involves incision of the Peyronie’s plaque and the insertion of a graft.
• Urethroplasty
  This is the excision and repair of the urethra which has been affected by stricture disease. This may involves the insertion of a graft.
• Penectomy and penile reconstruction
  This is the excision of some or all of the penis due to cancer. Where only part of the penis has been removed, we also offer surgery to re-fashion the penis so it looks as close to normal as possible. This is penile reconstruction. Penile reconstruction may also be offered where the penis or foreskin has been affected by non-cancerous conditions.

Men with non-emergency conditions may be referred to us via their GP through NHS eReferrals to our andrology clinics either at Southmead or at South Bristol.

Useful Links

Sexual Advice Association: www.sda.uk.net
NHS UK: www.nhs.uk/livewell/goodsex

The specialist stone unit at the BUI, Southmead Hospital, Bristol,  provides services for Bristol, the surrounding region, and as a tertiary referral centre for South West England.

After clinical review, our expert stone surgeons suggest management plans that are individually tailored to you, the patient. Management decisions are typically based upon stone factors (type, size and location), kidney factors (number, function, previous surgery) and patient factors (other illnesses or factors that may make surgical intervention higher risk).

The stone services offered through the specialist stone unit includes:

Onsite extra-corporeal shockwave lithotripsy (ESWL)

This treatment uses machine generated shock waves to break up urinary stones. The treatment sessions are carried out as daycase procedures and last for approximately 30 minutes. You should be sent home within 2-4 hours. The stone unit has an onsite lithotripter and a dedicated lithotripsy team who meet weekly to plan stone treatments. We offer an emergency shock wave lithotripsy service and are involved in national trials in stone treatment.

Uretero-renoscopy and laser lithotripsy

This treatment is carried out under a general anaesthetic and involves a thin camera is passed through the urethra, bladder and into the ureter and/or kidney. A tiny laser is then passed through the camera and is used to break up stones into smaller pieces. These procedures are typically carried out as daycase. You may have a plastic tube (stent) left inside to help protect the drainage of the kidney after this procedure.

Percutaneous nephrolithotomy

This treatment is carried out under a general anaesthetic and involves a small incision in the skin near the kidney affected by kidney stones. A needle is then inserted into the kidney by an interventional radiologist under ultrasound guidance. The needle entry is then stretched enough to allow a special camera instrument to pass into the kidney and retrieve the stone fragments. This type of treatment is typically reserved for larger kidney stones (greater than 1.5-2 cm) or stones which are difficult to access with a flexible uretero-renoscope. Following this procedure you would typically stay in hospital for 1 to 5 days.

Laparoscopic and open renal stone surgery

This treatment is rarely used and is always carried out under general anaesthetic. Laparoscopic surgery involves multiple keyhole incisions in the abdomen. An open operation involves a large incision (10-15 cm) over the flank, to expose over the site of the kidney or ureter. This treatment maybe offered, for exmaple, if other stone treatment methods have not been successful or there is little or no remaining kidney function in a kidney with stone disease.

Metabolic stone service

We work alongside our colleagues in the renal (kidney), biochemistry and microbiology departments in order to identify reasons why patients form recurrent kidney stones. The aim of metabolic tests is to prevent stone recurrence.  

The aim of this page is to answer any questions you may have about the Urology One Stop Clinic. There is also a patient information leaflet 

The Urology One Stop clinic has been set up to provide a more efficient service for patients referred to urology.  The aim is to have a clinical consultation and important diagnostic tests done at one visit.  The clinic also brings together members of the multidisciplinary team (doctors, specialist nurses, radiographers) to provide best care for our patients.

At the clinic you will be seen in clinic by a urology consultant, registrar, clinical fellow or specialist nurse.  You may also see a radiographer.

Before you appointment you may be sent some leaflets or paperwork to fill in prior to the clinic, the team will contact you if this is the case by telephone or post to explain what is required of you, it is important to read any leaflets and complete the paperwork so that we have all the information when you attend the clinic. 

You may be asked to attend your GP for a blood test or a urine sample before the clinic, it is important to get this done as it will help to diagnose your problem.

You will see the urology doctor at the time of your appointment but you may be required to go for further investigations, such as ultrasound, CT scans or MRI scans and these may be later in the morning or early afternoon.  Should you require a CT scan you will be advised at the time of your morning clinic appointment to drink 1 litre of water before the CT appointment and have nothing else to drink or eat 4 hours before the CT scan.  We will try and get all investigations done on one day, but on occasions, we may have to ask you to come back on a different day for further investigations.

Please bring anything to clinic that will help us to understand your problem better. For example a list of your current medication prescribed by your GP and any medications you have bought yourself such as herbal remedies.  If you are being referred from another hospital, please bring any relevant correspondence.

In order for us to try and diagnose your problem on the day of the clinic you may need to undergo a few tests during the clinic visit.  Most people that attend the clinic will be asked to provide a urine sample on their arrival in the clinic.  Below is a list of additional tests that you may undergo during your clinic visit.  Further information about these tests are detailed in the patient information leaflet - link above. 

• Urine test:  this will be required during the clinic, the nurses will ask you when they require it.  Please do not pass urine without asking the nurses if they need a sample first.

• Blood tests: it may be necessary to take some additional blood tests

• Flow rate: this is a test which measures the rate of your urinary flow.  You will need to have a full bladder and will be asked to pass water into a special machine.  It is not advised that you attend the clinic with a full bladder but it may be required while you are in the clinic.

• Patient questionnaire about urinary symptoms: You may be asked to fill in a questionnaire about how bothered you are by urinary symptoms.

• Flexible cystoscopy: This is a telescopic examination of the bladder.  A small flexible scope is passed through the urethra (water pipe) and the bladder is filled with water to allow the doctor to examine the lining of the bladder. 

• Ultrasound: An ultrasound scan is a painless test that that uses sound waves to create images of organs and structures inside your body.  You will be given instructions about appointment times and how to get to the radiology department where these scans are carried out. 

• X rays: X rays are a type of high energy radiation.  They are used to diagnose problems such as kidney stones.  You will be given instructions about how to get to the radiology department where these scans are carried out. 

• CT scan: A CT scanner is a special kind of X ray machine. Instead of sending out a single X ray through your body, several beams are sent at the same time from different angles.  They allow doctors to view images of the internal structures of your body.  They do not hurt.  Patients who have visible blood in their urine may have a CT scan in the afternoon of their one stop appointment.  These patients will be advised to drink 1 litre of water 1 hour before the appointment time but have nothing else to eat or drink (except the water) for 4 hours before the appointment time.  Depending on the clinical circumstances, you may be asked to come back for a CT on a different day.  .  You will be given instructions about appointment times and how to get to the radiology department where these scans are carried out. 

• MRI scan: An MRI scanner is a large magnet and creates images for the doctors to view looking in detail at your internal anatomy.  Patients who attend the one stop clinic where there is a possible diagnosis of prostate cancer may have an MRI scan in the afternoon after their morning one stop clinic appointment.  The doctor who requests the MRI will ask you specific questions about whether you have any metal implants in your body.  The MRI doesn’t hurt but some patients find it noisy.  Depending on the clinical circumstances, you may be asked to come back for an MRI on a different day.  You will be given instructions about appointment times and how to get to the radiology department where these scans are carried out. 

• Prostate biopsy: A number of patients who have had an MRI prostate organised at their one stop appointment may undergo a prostate biopsy on a different day.  A prostate biopsy is where small samples of prostate tissue are taken from your prostate gland to be examined under a microscope.  This is carried out when there is a suspicion of prostate cancer.  The biopsies are carried out in most cases after an MRI has been performed so that any suspicious areas can be targeted.  The prostate is accessed through the rectum (trans rectal) or through the perineum (the area behind the testicles).  You will either be informed about which approach is more suitable for you either at the clinic appointment or when you are contacted with the MRI results.  You will be given a prescription for antibiotics to take 2 hours before the procedure.

We try to see people within 2 to 3 weeks of receiving a referral letter if your GP is concerned about a possible cancer diagnosis.  We try and see all patients within 6-8 weeks of referral. Please remember that you must be referred by your GP.  We are not able to accept self-referrals.

If you are booked for surgery, you may be asked to attend one of our pre assessment clinics. This is designed to streamline your admission by making sure that you are medically fit for the procedure.  You may be asked to have an ECG (heart trace), blood tests and X rays. You will be informed of any follow up investigations or appointments which follow the initial one stop clinic consultation.