Men's Healthcare - Q1 2021 by Mediaplanet UK&IE

Q1 / 2021

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Men’s Healthcare

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Finding new treatment options for bladder cancer Bladder cancer affects over 10,000 people a year in the UK. A minimally invasive treatment offers hope to patients who wish to preserve their bladder or those who cannot undergo major surgery.

W INTERVIEW WITH Mr Ahmed Ali Consultant Urological Surgeon, Frimley Health NHS Foundation Trust

INTERVIEW WITH Mr Ben Ayres Consultant Urological Surgeon, St George’s University Hospitals NHS Foundation Trust

WRITTEN BY Mark Nicholls

Find out more at synergo-medical.com

hile bladder cancer is the fourth most common cancer in men behind prostate, colorectal and lung cancer, about 80% of cases are the highly treatable non-muscle invasive bladder cancer (NMIBC), with a survival rate around 90%. Consultant urological surgeons Ahmed Ali and Ben Ayres are keen to see increased public awareness of related risk factors - such as smoking - and symptoms, particularly blood in the urine or needing to pass urine more often, so patients can visit their GP and be referred to specialists for investigation and treatment.

Many bladder cancers are curable; we can treat while preserving the bladder, so we do not have to perform radical surgery. Risk of recurrence Mr Ali, from Frimley Health NHS Foundation Trust in Surrey, also underlines the need for a proactive approach and for men over 60 - who are four times more likely to get bladder cancer than women – to do a urine test to spot for early signs of the disease. “A urine sample could lead us to detecting it before it is too late,” he adds. “Many bladder cancers are curable; we can treat while preserving the bladder, so we do not have to perform radical surgery.” Treatment for bladder cancer is endoscopic excision, following CT scan and a camera investigation, to remove the cancer when at the non-invasive stage. The disease does have raised levels of recurrence but to avoid that, chemotherapy or immunotherapy is administered into the bladder to stimulate the body’s response to fight the cancer. However, while BCG has been an

effective treatment since the mid1970s for higher risk patients, it fails in up to 40-50% of cases, meaning patients may have to have their bladder removed. While that surgery has risks and lifestyle impacts for patients, Mr Ayres, from St George’s University Hospitals NHS Foundation Trust in London, says: “With modern techniques, robotic surgery and enhanced recovery programmes, cystectomy is an operation that more people get through without significant complications.” Searching for alternative solutions However, in patients where cystectomy could be particularly risky, those unwilling to have surgery, or for immuno-compromised patients where BCG is not suitable, consultants need to look for new solutions. Trials are ongoing in this area, and Synergo® is one of a few potential options. Designed to help eradicate cancer and preserve bladder function, Synergo® delivers a tri-modality of Radiofrequency-Induced Thermochemotherapy and features a dedicated applicator incorporating a miniature antenna which generates microwave non-ionising energy to the bladder tissue. The same applicator instills cold chemotherapy into the bladder. In 2014 researchers discovered that radio-frequency (RF) has cancerlethal effects. Its combination with chemotherapy makes the drug more infiltrative selectively into cancer cells. The RF also heats the bladder to above normal temperature for improved outcomes. The name Synergo® originates from this synergistic tri-modality. The hour-long therapy is delivered using a lubricating gel containing local anaesthetic, in an outpatient setting over a set of six to eight weekly sessions. A few more subsequent sessions may be given every couple of months in order to retain a tumour-free status.

With modern techniques, robotic surgery and enhanced recovery programmes, cystectomy is an operation that more people get through without significant complications. Improving long term outcomes Mr Ayres adds: “On the whole, it is well tolerated by patients, and if they do not respond to it, they may still have a cystectomy. Case selection of patients is very important. In our experience about two-thirds of patients who have failed BCG and have this treatment remain disease-free at two years, and 40-50% have a good response long-term some up to 10 years - with follow-up.” As with all treatments there are advantages and disadvantages which must be discussed with one’s consultant. A cystectomy is a lengthy operation, requires high dependency post-operative care, and may greatly impact patients’ lifestyles and quality of life when their bladder is removed. In many cases also adjacent organs might need to be removed. From an oncological perspective, however, such radical surgery is considered the definitive cancer treatment. Conversely, Synergo® consists of a series of treatments, with regular follow-ups, with some risk of the cancer coming back. If that happens the cancer may need to be removed again. Some of the patients, might be advised to have their bladder removed. It may be a last hopeful option for patients who wish to preserve their bladder or those who cannot undergo major surgery.

Six centres currently offer treatment with Synergo® in the UK, including St George’s Hospital and Frimley Park, University College Hospital London, Darent Valley Hospital in Kent, as well as centres in the north-east and the north-west. The treatment, offered in tertiary centres because of the degree of needed expertise to deliver it, has been available since 2001 and the subject of detailed research and trials.

BCG treatment failed or not tolerated — What next? Synergo® is a proven ambulatory treatment combining local radiofrequency and chemotherapy for treating Non-Muscle Invasive Bladder Cancer To learn more please visit : www.synergo-medical.com Discussing treatment options, risks and benefits with your attending physician can help you make the best decision for your condition

THE COOLEST SOLUTION FOR BLADDER CANCER

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Early detection is likely to give you a far better outcome If you’ve had blood in your urine or an increased need to pee, it could be a sign of cancer.

t’s probably nothing serious, but finding cancer early makes it more treatable, so just speak to your GP. The NHS has introduced measures to ensure your safety. Most people who are urgently referred are seen by a specialist within two weeks. As with most health issues, each person may experience a different set of symptoms. If the problem does turn out to be bladder cancer, early detection is likely to give you a far better outcome.

Finding cancer early makes it more treatable, so just speak to your GP. Ruling out other problems Many of the symptoms of bladder cancer are the same as those experienced by people with a urinary tract infection (UTI), urinary stones, cystitis or prostate problems. It is important to use several tests to rule out more straightforward conditions before diagnosing someone with bladder cancer. A cystoscopy is the most important test for diagnosing bladder cancer. It allows the urologist to look inside your bladder and the images might be shown on a large screen. You may be asked whether you would like to see the screen yourself. Many people find this positive but others would rather not look, so don’t be afraid to tell them that if that’s how you feel. Support and information If you suspect that you may have cancer you are likely to be experiencing a whirlwind of emotions. Whatever the outcome, remember that you are not alone.

Bladder cancer – what you need to know Bladder cancer isn’t rare – it’s one of the 10 most common cancers in the UK with, in total, over 20,000 people diagnosed each year and around three quarters of cases occurring in men.

I WRITTEN BY Jackie O’Kelly Action Bladder Cancer UK Patient Support Officer

WRITTEN BY Sarah Bowdage Spencer Action Bladder Cancer UK Patient Support Officer

For support and information, you can: Visit fightbladdercancer.co.uk Email info@ fightbladdercancer.co.uk Call 01844 351621.

WRITTEN BY

Dr Lydia Makaroff PhD CEO, Fight Bladder Cancer

Scan to see the ABC UK Bladder Cancer Symptoms Guide

mportantly, bladder cancer has a high rate of recurrence following treatment - up to 80% - and is one of the most expensive cancers for the NHS to treat. Despite being common and having a high recurrence rate, it only receives a fraction of dedicated cancer research funding. As a result, development of new approaches and treatments for bladder cancer has been slow for the past 40 years. Patients often have to live with long term invasive monitoring and ongoing treatment and, in some cases, life changing major surgery and loss of their bladder. Looking out for symptoms Diagnosis can sometimes be late. People often don’t know what symptoms to look out for and many patients tell us that the first they heard of bladder cancer was when they were diagnosed. As with all cancers, the sooner it’s diagnosed and treated, the better the outcome and so it’s important that you do contact your GP as soon as you notice anything unusual. While symptoms can be hard to spot, the more common symptoms of bladder cancer include blood in the urine (even just once), recurrent urinary infections, and frequency, urgency or pain on passing urine when no infection is found on urine tests by doctors. If, after first contacting your GP, your symptoms don’t improve in a few weeks go back to your GP - don’t ignore it.

Men need to be aware that there are usually easy solutions that can help manage bladder incontinence. Of course, these symptoms may not be bladder cancer, but you should tell your doctor if you notice anything new. Conducting further research ABC UK funds much-needed research into bladder cancer - looking at new ways of testing, treatment or improving the patient experience. As an organisation, we are currently running the second ABC UK patient survey looking at the impact of COVID-19 on the treatment, monitoring and wellbeing of those with bladder cancer.

Action Bladder Cancer UK (ABC UK) is working to raise awareness of bladder cancer and to provide support and information for patients and their families. We provide direct patient support by phone and email and set up and sustain patient support groups around the country (in person or online). Visit our website at actionbladdercanceruk.org

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As healthcare battles to be more efficient and more effective, investing upstream in photodynamic diagnostics could help improve patient outcomes.

W INTERVIEW WITH Mr Param Mariappan FRCS(Urol), PhD Consultant Urological Surgeon, Western General Hospital, Edinburgh

WRITTEN BY Kate Sharma

hen it comes to treating bladder cancer, time is of the essence. But the COVID-19 pandemic has led to delays at every stage of the patient journey. “Last March, we were doing more new non-muscle invasive resections, now we’re seeing far more invasive tumours at first presentation,” explains Mr Param Mariappan, Consultant Urological Surgeon at Western General Hospital in Edinburgh. Mr Mariappan’s observations are backed up by the stats. As of August 2020, the proportion of patients in England waiting at least six weeks for a cystoscopy was 50.2% in comparison to 9% in August 2019 according to NHS statistics. As Mr Mariappan continues, “Unfortunately, with bladder cancer once it’s more advanced the prospect of cure gets less.” Early diagnosis is crucial Diagnosis is key to ensuring patients are put on the correct treatment pathway. Following a cystoscopy and a scan of the urinary tract, patients suspected of having bladder cancer should be offered a transurethral resection of bladder tumour (TURBT). It’s a crucial investigation where abnormal tissue samples are removed and tested, followed by chemotherapy (into the bladder) in appropriate patients. “A good, effective operation at the outset can reduce the chance of future recurrence and get necessary staging information to find out if the patient has a more invasive condition,” he confirms. However, errors can and do occur when using standard white light cystoscopy for the initial diagnosis, and surveillance of non-muscle invasive bladder cancer. As Mr Mariappan observes, “This is where photodynamic diagnosis has a big role to play.”

©Image provided by KARL STORZ Endoscopy (UK) Ltd

The same bladder cancer tumour viewed with white light cystoscopy (left) and KARL STORZ PDD Blue Light Cystoscopy (right)

Utilising photodynamic diagnostics Photodynamic diagnosis (PDD) involves using a catheter to squirt a non-irritant chemical into the bladder prior to TURBT. The chemical induces fluorescence in potentially malignant tissue, which can be seen using a blue light. It has proven to be particularly effective in identifying invisible abnormalities such as papillary lesions and carcinoma in situ. “Initial studies suggest that the pick-up of tumours is about 20% better,” confirms Mr Mariappan. At the moment, PDD is largely used in new bladder cancer patients in select hospitals, but Mr Mariappan would like to see it as standard practice, especially for training. As hospitals face increasing pressures of COVID-19 and a backlog of operations, the need to “invest upstream” has never been greater. “We need to be both effective and efficient,” continues Mr Mariappan. “If you don’t get it right the first time, patients will more likely have to come back, so adjuncts, like PDD, can help reduce repeat operations and recurrence of tumours.” However, like so many things, cost is the deciding factor. PDD comes at a price and the NHS is currently undertaking trials to establish the cost-effectiveness of the intervention. As Mr Mariappan says, “We’re waiting for the results with bated-breath!”

Greater consistency is needed While PDD could lead to better patient care and reduce the need for repeat resections, Mr Mariappan believes there are other considerations. “Bladder cancer has been viewed as the ‘Cinderella cancer,’ for too long,” he explains. In 2002, the European Organisation for Research and Treatment of Cancer published a paper that showed the percentage of patients with a recurrence in the bladder varied substantially between institutions. The only reasonable suggestion was that the quality of the TURBT performed by surgeons differed considerably. The procedure has traditionally been left to junior members of staff to perform, sometimes without adequate supervision and without a standardised approach, which Mr Mariappan believes to be a contributing factor to the variable outcomes. “For many, TURBT is not seen as a ‘sexy operation’. It is the unintentional victim of the lure of other surgery using more technical, expensive equipment,” he says. Mr Mariappan believes that more needs to be done to inspire interest in the field and introduce greater consistency in the way TURBT is conducted. This needs to start from day one – and that means doing everything we can to quickly and accurately diagnose and stage cancer. PDD could have a significant role to play in the process.

Read more at karlstorz.com/gb/en home.photocure.com

OPAL1® Photodynamic Diagnosis URO uk 1.0 03/2021/E-UK

Supporting clinicians in the detection of Bladder Cancer: Adding precision to the process

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6 | Read more at healthawareness.co.uk ©Image provided by Bladder and Bowel Community

Finding new solutions for ABL Accidental bowel leakage (ABL) is a common condition, which people understandably find embarrassing, however, new innovations are helping patients to improve their quality of life.

t is estimated that one in 10 men and women in the UK will experience bowel control problems at some point in their lives. Many are too embarrassed to talk to their GP about it as they consider it ‘a private matter’. In some cases, people are happier to talk about cancer or major surgery than discussing their bowel issues. Accidental bowel leakage is medically referred to as bowel, or faecal, incontinence which results in sufferers experiencing random episodes of faecal leakage, sometimes without realising. Caused by weak or damaged anal sphincter, the condition affects thousands of people. Symptoms of accidental bowel leakage are common in patients with neurological conditions such as multiple sclerosis and those with bowel conditions such as Crohn’s or irritable bowel syndrome. Accidental bowel leakage can also present following pelvic surgery and / or radiotherapy treatment. Finding non-surgical solutions Historically, the only solution for accidental bowel leakage has been pads. Many suffer in silence, withdrawing from all types of social interaction in case someone detects the odour of a bowel accident. However, new innovations now exist which can replace the use of pads. The Renew Insert offers men and women a discreet solution that enables them to continue living their lives with dignity. The Inserts can be used directly with a hygienic applicator. Once inserted they provide a continent seal and can stay in situ between bowel movements. With the help of a Specialist Nurse or Physiotherapist, this new solution can allow patients to help reclaim their normal active lives again. Renew Inserts are a clinically tested product that prevents involuntary bowel leakage. Made from soft, medical grade silicone that adapts to the body for a comfortable fit, designed to be safe to wear day and night. For more information please visit: www.renew-medical.uk

WRITTEN BY

Debbie Gordon Clinical Director, Renew Medical UK

Paid for by Renew Medical UK

The image is of the first ever toilet card using Smartphone Digital Wallet Technology, the new ‘Just Can’t Wait’ card.

Intermittent self-catheterisation changed my life With bladder conditions still being something of a taboo subject, many men live in isolation with depression and anxiety. Something as simple as learning to use intermittent self-catheters can transform a life.

C WRITTEN BY Gemma Savory Community Marketing Manager, Bladder and Bowel Community

urrently in the UK there are 14 million people living with a bladder condition.1 A study conducted by the NHS found that up to 26% have some sort of catheter,2 with males more likely to have a catheter in place,3 yet bladder health and catheters are something which we rarely talk about. David O’Donovan, a 28-year old music producer from Waterford in Ireland, explains how learning to use intermittent self catheters now means he can leave his house without fear. “I have lived with a bladder condition for the majority of my life after being diagnosed with an atonic bladder. This means that the nerve that controls function between the bladder and the brain is not working and causes me to experience urinary retention. “Having a bladder condition can affect my life on a daily basis. I feel that I always need to be close to a toilet. I worry about meeting people, exercising and holding down my job as a music producer. “Before learning to use intermittent catheters, I’d had lots of treatment on my bladder, which had not worked including a suprapubic catheter. Intermittent catheters have changed my life. I now go on walks without fear and meet family and friends. I don’t know why I didn’t do it sooner. Once you get over the initial fear of it, it’s no worse than a pinch and now I could do it in my sleep. I didn’t realise how limited my life was before intermittent catheters. The future for me now looks bright.”

Men need to be aware that there are usually easy solutions that can help manage bladder incontinence. Men shouldn’t have to live in fear We are now in an age where we are being encouraged to be open about our health and wellbeing and this should include our bladder health. Men need to be aware that there are usually easy solutions that can help manage bladder incontinence including something as simple as having the new digital ‘Just Can’t Wait’ card from the Bladder and Bowel Community on their smartphone. This easy to install tool can help to increase confidence whilst out and about. It’s important to make an appointment with the GP and be open about how your bladder is affecting your life so that the condition can be identified and treated appropriately. There is no need to hide away. References 1. Excellence in continence 2018, NHS England 2. Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England, BMJ Journals 3. Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England, BMJ Journals

Find out more information at bladderandbowel.org

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Advocating patient choice is the new normal, so why not in ISC catheters? Lifestyle choices, choices, human ability and a support network are all considerations Lifestyle to think think about about when choosing an ISC catheter, as there is no ‘one size fits all’. to

INTERVIEWWITH WITH INTERVIEW

PamelaWhite White Pamela RegisteredNurse Nurse Registered andHead Headof ofClinical Clinical and Governance&&Regulatory Regulatory Governance Affairs,CliniMed CliniMedLtd Ltd&& Affairs, SecuriCare(Medical) (Medical)Ltd Ltd SecuriCare

Written by: WRITTEN BY

GinaClarke Clarke Gina

Paid for by CliniMed Paid for by CliniMed

Discretion is is key key Discretion There are are plenty plenty of of options options currently currently There available, such as the length and available, such as the length and diameter of the ISC catheter. These diameter of the ISC catheter. These options need to be considered when options need to be considered when assessing patient’s patient’s lifestyle lifestyle and and physical physical assessing capabilities. There have been many capabilities. There have been many recent improvements improvements in in packaging packaging and and recent coatings which allow patients to adapt coatings which allow patients to adapt in using using ISC ISC to to suit suit their their lifestyle. lifestyle. in Pamela White, Registered Nurse Pamela White, Registered Nurse and Head of Clinical Governance & and Head of Clinical Governance & Regulatory Affairs at CliniMed Ltd & Regulatory Affairs at CliniMed Ltd & SecuriCare (Medical) Ltd explains, “A lot SecuriCare (Medical) Ltd explains, “A lot of the time patient choice is caught up of the time patient choice is caught up with the need for discretion. I’ve known with the need for discretion. I’ve known patients walk a mile to find a public patients walk a mile to find a public bin to dispose of their ISC when no one bin to dispose of their ISC when no one is around. This type of problem needs is around. This type of problem needs to be acknowledged by healthcare to be acknowledged by healthcare professionals when the range of ISC professionals when the range of ISC catheters are made apparent.” catheters are made apparent.” “What’s more, there is no reason why “What’s more, there is no reason why a range of ISC products could not be a range of ISC products could not be suggested, one for in the home and suggested, one for in the home and another for outdoors perhaps. Adding another for outdoors perhaps. Adding to that, the final decision should always to that, the final decision should always be down to patient’s choice, so they be down to patient’s choice, so they should feel able to come back and say, should feel able to come back and say, ‘actually this isn’t working for me’ and ‘actually this isn’t working for me’ and try something else.” try something else.” Patient empowerment Patient empowerment White advocates that patients should White advocates that patients empower themselves by doingshould their empower themselves by doing their

hen aa person’s person’s bladder bladder hen does not fully empty, does not fully empty, the next next step step might might be be to to the recommend intermittent intermittent recommend self catheterisation catheterisation (ISC). (ISC). This This can can be be self worrying for the patient, who will have worrying for the patient, who will have to be be educated educated to to insert insert aa catheter catheter into into to their bladder bladder by by aa health health professional. professional. their They will will naturally naturally have have concerns, concerns, They however using an ISC can be very very however using an ISC can be discreet and be managed often with discreet and be managed often with little impact. impact. little For any any patient, patient, this this initial initial discussion discussion For and the amount of choice on offer can and the amount of choice on offer can be overwhelming. Often patients have be overwhelming. Often patients have many questions questions about about the the differences differences many between an indwelling catheter and ISC ISC between an indwelling catheter and the discreet nature of ISC can prove - the discreet nature of ISC can prove to be be transformational transformational for for patients patients as as to there is is no no permanent permanent tube tube along along with with there valve or or drainage drainage bag. bag. aa valve

own research. research. Her own Her first first choice choice would would be the NHS website, but be the NHS website, but there there are are other other quick and and easy quick easy ways ways to to speak speak to a a clinician. clinician. to “What “What some some people people don’t don’t know know is that manufacturers is that manufacturers themselves themselves often staff staff a often a care care line line so so that that patients patients using the products can chat through using the products can chat through their worries without needing an their worries without needing an appointment. This is great to answer appointment. This is great to answer practical questions. The medical practical questions. The medical device sector is heavily regulated, device sector is heavily regulated, so that advice from a manufacturer, so that advice from a manufacturer, either by phone or on a website, can either by phone or on a website, can be recommended to answer those be recommended to answer those frequently asked questions about frequently asked questions about comfort and ease of use. Although comfort and ease of use. Although when it comes to medical issues – when it comes to medical issues – always see a professional first” always see a professional first” she says. she says. For anyone with an ISC who lacks For anyone with an ISC who lacks confidence or dexterity, help in the confidence or dexterity, help in the community is often not far away. community is often not far away. Whether you speak to a urology Whether you speak to a urology nurse specialist, GP, or a continence nurse specialist, GP, or a continence advisor, all should be able to advise on advisor, all should be able to advise on something that is suitable for new or something that is suitable for new or changing needs. What’s more, recent changing needs. What’s more, recent improvements over the last decade improvements over the last decade have dramatically improved patient have dramatically improved patient choice when it comes to the ISCs on choice when it comes to the ISCs on offer, including the coating. offer, including the coating.

Choice Choice should shouldbe beat atthe theheart heart As recommended by As recommended byNICE NICEguidelines, guidelines, patients patients should should have haveaachoice choicewhen whenitit comes to gel or hydrophilic (activated comes to gel or hydrophilic (activatedby by water) water) coatings coatings and andlength lengthand anddiameter diameter should should also also be be taken takeninto intoaccount. account.These These are often dependent on the are often dependent on thepatient’s patient’s dexterity and need for discretion. dexterity and need for discretion. For instance, some longer catheters For instance, some longer catheters (up to 40cm) can be packaged to (up to 40cm) can be packaged to appear less bulky and for people appear less bulky and for people with disabilities or dexterity issues, with disabilities or dexterity issues, packaging has been adapted to cater for packaging has been adapted to cater for most needs, such as easy opening lids. most needs, such as easy opening lids. White adds, “There is still a taboo White adds, “There is still a taboo surrounding incontinence and for surrounding incontinence and for men especially, the practicalities of men especially, the practicalities of disposing with a catheter can limit disposing with a catheter can limit their enjoyment of activities. For their enjoyment of activities. For instance, men’s toilets aren’t always instance, men’s toilets aren’t always equipped with discreet bins, but there equipped with discreet bins, but there are catheters available that can be are catheters available that can be resealed in the packaging mess-free resealed in the packaging mess-free after use if immediate disposal is not after use if immediate disposal is not possible. These are discussions that can possible. These are discussions that can be had with your medical team, who be had with your medical team, who can provide a variety of different ISCs can provide a variety of different ISCs for suitable occasions. This mix and for suitable occasions. This mix and match approach has patient choice at match approach has patient choice at its heart.” its heart.”

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Paid for by St John and St Elizabeth Hospital

Did you know that same day treatment is available for your kidney stones? We all know that staying hydrated is important, but sometimes genetics and not drinking enough can cause obstructions in our system, known as kidney stones.

INTERVIEW WITH Mr Leye Ajayi MD FRCS(Urol) Consultant Urological Surgeon, HJE

WRITTEN BY Gina Clarke

hile it is normal for most of us to produce some sort of kidney stone that is passed out naturally through our urine, occasionally bigger stones do arise. Not only can these cause blockages of the urinary system, but if left undetected they can affect kidney function and lead to renal failure. Recognising the symptoms Mr Leye Ajayi is a Consultant Urological Surgeon at St John and St Elizabeth Hospital (HJE) in St John’s Wood, North West London. He says, “When a patient presents with kidney stones it’s often something we can spot from across the room. Usually, the patient will have a sharp pain on the left or right side of their body causing them to writhe around in agony, which can result in nausea and vomiting. Other symptoms include a frequent need to urinate and blood in the urine. Kidney stones can be incredibly debilitating which is why we have a large urology team that can provide rapid access, same day treatment.”

Same day treatment options However, at HJE, both self-referred and private patients can access sameday treatment for kidney stones with a walk-in service available. This means no appointments are needed and consultation, imaging, treatment and aftercare are all provided together. The urology team have continued to perform private treatment throughout the pandemic thanks to its state-of-the-art equipment and COVID-safe measures. Patients can also choose their surgery time and are never in the hospital longer than necessary. Unique to HJE, as a charity, every treatment helps fund the on-site hospice that provides free palliative and end of life care to the community. Indeed, with new holmium laser, and Thulium laser Fibre technology, nonsurgical kidney stone treatment in the form of shockwave lithotripsy and miniturised keyhole surgery in the form of Mini PCNL are available. Patients can choose their surgery time and they will never be in the hospital longer than necessary. Kidney stones are fragmented using the latest technology which ensures minimal discomfort for the patient, reduced length of stay in hospital and an early return to work. Mr Ajayi adds, “I would say to anyone suffering from kidney stones to come and see us. We offer individualised, patient centered care using state of the art technology. Not only are we equipped to deal with emergency presentations, but our technology can cut both procedure times and hospital overnight stays by 50%.”

NICE guidelines say that hospitals must offer treatment within 48 hours of a patient presenting.

Cost of treatments: A typical consultation can cost around £1,500, with a full procedure coming in around £7,700. Prices of procedures may vary depending on the complexity of the procedure.

Treatment options After an initial assessment including a Computed Tomography (CT) scan, urine and sepsis check, treatment for the kidney stones can be decided based on size, placement and whether they are currently causing an obstruction. NICE guidelines say that hospitals must offer treatment within 48 hours of a patient presenting, but in a busy NHS hospital the only service available would be the insertion of an emergency ureteric stent, which allows the urine to bypass a blockage. This is only a temporary measure and the patient will need to return to have both the stent and stones removed, a wait that normally takes several weeks to months. The waiting list time would have grown significantly during the global pandemic.

Alongside his NHS work, Mr Ajayi is part of the industry-leading Urology consultant team at St John and St Elizabeth Hospital, employing the latest techniques and equipment to ensure leading diagnosis, intervention and aftercare in London - with all hospital profits funding the on-site hospice. For more information or to make an appointment, please call Isobelle in our Urology team 020 7432 8297 or visit hje.org.uk/urology