I graduated at the University of Malta where I completed my specialisation in Urology. In 2014 I came to UK and worked in various hospitals to sub-specialise in pelvic uro-oncology. For several years, I have been working as an NHS consultant in general Urology and pelvic robotic surgery in Eastbourne hospital which is a referral centre for Sussex major robotic urological interventions. I have developed numerous services for our urological (prostate cancer and bladder cancer) patients with the aim of improving quality of care and becoming one of the best NHS Urology Hospital in UK (South). To become one of the best urologist in UK you have a to have a dynamic highly motivated team, and over the years I have dedicated myself to build and lead such team. My philosophy is 'Ubuntu' - I am because we are.
Together with my team, I performed the first Day Case Robotic Prostatectomy in South of England at our state-of-the-art facility, where cutting-edge technology meets exceptional patient care.
I used the latest robotic-assisted technology to perform precise and minimally invasive procedures, ensuring quicker recovery times, reduced pain, and minimal scarring. But this is not enough as only through working with an enthusiastic team we could deliver such achievement
I have performed the first Ultra-Low abdominal operating pressure (6mmHg) for both robotic prostatectomy (removal of prostate cancer) and radical cystectomy (removal of bladder cancer) in Sussex. Only few surgeons operate at such pressures providing their patients with numerous benefits.
I perform all my surgeries at low abdominal pressure. This means less anaesthetic and surgerical complications, faster postoperative recovery and lower pain scores.
I have analysed MRI prostate scans and operative outcomes from the year 2016 till 2019, and found that PIRADs 5 score is likely related to spread outside the prostate . This lead to bespoke nerve sparing approach with a tangible decrease in positive margin (failure to remove all prostate cancer) and less men needing further treatment.
Introducing a groundbreaking advancement in Robotic Prostate Surgery continence: the Extended Maximum Urethral Length Preservation technique. Developed over years of dedicated research and expertise, this pioneering approach has revolutionised the post-surgery experience for countless patients. I have been collecting data which will be presented shortly. The results speak for themselves.
Together with the enhanced recovery nurses I have established preoperative services to support Urology patients waiting for prostate cancer or bladder cacner surgery. This is an opportunity to understand more about your surgery and how to prepare for it to claim the maximum benefit. Other taregts include improving their health, nutritional status, and fitness.
This is a major undertaking however lessons learnt could be transferred to other surgeries with intention to lower complication rates, faster hospital recovery and return to life.
Experience the difference of a shorter operation time, tailored with your well-being in mind. Our focus on efficiency ensures minimal exposure to anesthesia, reducing potential complications and prioritising your safety above all else.
With swifter procedures, you'll spend less time in the operating room, less hospital stay, more time on your journey to recovery, reclaiming moments that truly matter.
I have been performing robotic surgery since 2017. When it comes to entrusting your health to a robotic surgeon, experience speaks volumes. Choose the seasoned expert who currently performs three robotic prostate surgeries in a day, with an unwavering commitment to excellence. My track record of success and skillful precision in the operating room ensures the utmost confidence in your procedure.
My aim is to reach four surgeries in a day. You can be assured that delivering optimal results and a smoother, faster recovery is what I strive for.
Make the choice that guarantees your well-being in the hands of a practiced and dedicated robotic surgical leader.
I have worked on survivorship programe for cancer patients and learnt there are so many unmet needs.
Lessons learnt from Movember projects I translated them in East Sussex and shortly we will be launching our survivorship programme for our prostate cancer patients and later the plan is to expand to bladder and kidney cancer patients
We are dedicated to achieving the best possible recovery outcomes for our patients undergoing major surgery. I have developed a programme at our department to use fitness trackers, to support your post-operative journey.
Our patient-centric approach recognises the immense value of fitness trackers as essential tools in monitoring and enhancing recovery. These devices empower patients to actively engage in their healing process. The data collected through fitness trackers allows us to monitor critical metrics, including physical activity levels, heart rate, sleep patterns, and stress levels – all crucial components in planning a bespoke recovery process, set attainable goals, and encourage patient empowerment.
I work in a hospital which is the Sussex Cancer Regional Centre catering for a population of 1.5 million.
Choosing your robotic surgeon for your prostate surgery in a high-volume center offers remarkable advantages. With extensive experience in performing numerous robotic prostate surgeries, I deliver unmatched expertise and precision. You can be assured of streamlined processes, faster recovery times, and reduced hospital stays, all supported by cutting-edge technology and a dedicated team. Trust in my team commitment to patient comfort and safety, ensuring exceptional outcomes for your brighter and healthier future.
Dry (on removal catheter) 70%, (with new technique)
Dry (at 1 month) 85%, (with new technique)
Dry (at 6 months) 99% (with new technique)
Positive margin (localised disease) 8% (advanced) 18%
Urinary incontinence (requiring corrective surgery) <1% Wound hernia <1%
Narrowing of bladder neck<1%
Urine leak requiring prolonged catheterisation 1%
Blood transfusion <1%
Rectal or bowel injury 0%
Lymphoedema / lymphocoele<1%
Conversion to open surgery <1%
20% of patients have received radiotherapy as an adjunct to surgery for recurrent disease. The radiotherapy rates are 3% for low-risk cancer, 15% for intermediate-risk cancer, and 33% for high-risk cancer cases.
In October 2020, I took the lead of the non muscle invasive bladder cancer, and created the first guidelines for bladder cancer in East Sussex with the aim to minimise waiting times and ensure adequate delivery care with the latest international standards. Only through working with a dynamic team this could be sustained.
There is a dedicated bladder pathway multidisciplanry meeting where each case is discuss in depth.
Since taking over the care of bladder cancer I shortened the pathway for diagnosis and treatment delivered to well below the national recommended guidelines. This has impacted in the long term as early diagnosis of bladder cancer and treatment (bladder instillations of chemotherpay like mitomycin or epirubicin or immunotherpay like BCG) does decrease the risk of recurrence and progression of the cancer.
Picking up earlier the most aggressive bladder cancer means early radical treatment (radiotherapy or surgery) results in better overall survival.
My thesis was focused on antibiotic stewardship. I reviewed over 400,000 urine cultures and antibiotic sensitivities. The findings paved further antibiotic stewardship principles.
Even though urinary tract infections are commonly associated with females they can happen in males too.
The biggest treath is the development of antibiotic resistsance. It is crucial that non antibiotic treatments are exhausted first.
In the old days cranberry juice/ supplements have been assocaited with alleged natural resolution but studies have shown they do not work.
Lifestyle changes are key. The commonest issue is lack of drinking adequate fluids throughout the day resolves most of the reoccuring infections. Try to orgnaise an infection diary in order to identify any link that is triggering the urinary infection. Make sure to send everytime the urine to the lab to be cultured as it is very important to know what bacteria is causing the infection or to exclude an infection (there are other conditions like interstitial cystitis that can mimic a urinary tract infection).
I continued to build on the enhanced recovery startup for our major urology surgical procedures. This was only achievable through the collaboration of different healthcare professionals.
This lead to better patient outcome, less complications, decrease in pain medication, reduced hospital stay and faster recovery. The lessons learnt from prostate cancer robotic prostatectomy and cystectomy have been extended to all other surgeries.
When I started working in Eastbourne a patient who underwent radical removal of the bladder length of hoispital stay was around 2 to 3 weeks. It took three years of hard work and collaboration and today I am proud to say that the length of stay is between 5 to 7 days.
Currently we are working to establish day case robotic prostatectomy.
We do have a enhnaced recovery teaching day that was halted due to COVID restrictions but from 2023 this will kick back in order to share the lessons learnt with all those who want to see an improvement in their delivery of care.
Localised low risk prostate cancer (majority of Gleason 6 and some of Gleason 7) are enrolled in a structured programme called Active Surveillance. Studies have shown that these types of prostate cancers are often overtreated with minimal benefit in long term.
During the surveillance one is asked to have regular PSA blood tests, interval MRI scans and if needed prostate biopsies. Treatment is offered if your cancer may be progressing, or you decide you want treatment as one may feel uncomfortable to have a cancer that is closely watched.
In the world different hospitals have different surveillance programmes. In East Sussex there was no protocol and I have worked over a period of 8 months designing a protocol to meet the patient needs within national and international guidelines.
Currently we have a dedicated prostate cancer nurse who I support to manage patients with prostate cancer on active surveillance.
I have been selected by Prostate Cancer UK as a prostate clinical champion to undertake projects in improving the quality of care and life of prostate cancer patients. This is a great honour.
Prostate cancer is common. In the UK about 48,000 men are diagnosed each year. Prostate cancer is more common in older men. The risk of prostate cancer at a young age increases if you are Black or have a strong family history of prostate cancer or maternal breast or ovarian cancer.
Being a clinical champion has moulded my leadership skills, helped me understand better the challeneges that different healthcare professionals undergo in trying to ameliorate the quality of care to prostate cancer patients whether its from diagnosis, surveillance, radiotherapy, homrones, surgery or novel treatments.
Self reflection, communication, building networks throughout UK and becoming a better leader translates in better prostate cancer care.
I have trained our surgical care practitioner who performs all the bedside assistance for major robotic surgery for kidney cancer, bladder cancer and prostate cancer. I taught and supported our surgical care practitoiner in learning basic surgery and as well in becoming independent in running their own list of minor urological procedure to cut down on NHS waiting time. I was his supervisor for his two year masters degree.
I currently support and train the urology diagnsotic nurses in managing the two wait week referrals for prostate / bladder cancer. Many patients are referred to our department because od an elevated PSA blood test, suspicious prostate exam, blood with urine who need a fast diagnosis in order to detect cancer early and treat early.
I support the urology cancer nurse specialists (especially the prostate cancer and bladder cancer).
I train junior and senior doctors (the next consultants) both academically and surgically in order to strengthen the future generation of urologists and doctors.
Together with my colleagues we have looked at catheter care delivery in Eastbourne hospital.
This lead to creation of teaching and care practices regarding catheter care ensuring improved quality of care delivery to our patients suffering from prostate and/or bladder issues leading to difficulty in emptying their bladder.
Such achievements will lead to better catheter care, a solid education foundation for our staff and students.
Through a collaborative effort with another hospital, and with my team we have introduced a self-removal approach for catheters in patients recovering from Robotic Prostate Removal.
As a result, patients referred from across the South East for their radical prostatectomy at our Trust can now bypass the need to revisit the hospital for catheter removal post-operation.
This choice not only saves valuable time and reduces clinic visits but also curtails travel expenses and parking costs for patients.
By reducing the number of people in the Urology Clinic, we enhance patient dignity and privacy during their recovery period. It's worth mentioning that patient travel contributes to about five per cent of the NHS's carbon footprint.
I am curretnly setting the protocols and setting up support through all the stages for patients to undergo day case TURBT at our Hospital.
This means that the patient undergoes the procedure and is discharged from the hospital on the same day, without the need for an overnight stay. This approach is possible for selected patients who meet specific criteria, such as having a low-risk tumor and being in good overall health.
The benefits of day case TURBT include lower hospitalisation costs, lower risk of hospital-acquired infections, and greater convenience for the patient.