I graduated in 2004 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 . I have been working as an NHS consultant in general Urology and pelvic robotic surgery since 2019 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.
M.D., M.R.C.S. (Edi), ChM Urology, F.E.B.U, F.R.C.S Urology (Edi)
English, Maltese, Italian
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.
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. This leads to better physiological behaviour during the anaesthetic and surgery, faster postoperative recovery and lower pain scores.
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.
Currently I am working to establish preoperative services to support Urology patients waiting for prostate cancer surgery who would benefit from amelioration of comorbidities, 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.
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.
I have worked in survivorship programe and learnt there are so many unmet needs. Lessons learnt from Movember projects I have 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.