Urodynamics at the Bristol Urological Institute (BUI), Southmead Hospital, Bristol, has a national and international reputation. It is a centre of excellence in urodynamics and offers a full range of urodynamic investigations including:
Flow studies and post void residual measurements (ultrasound scans)
Standard urodynamics
Video urodynamics
Ambulatory urodynamics
Whitaker tests
Sacral neuromodulation
Botox injections (intravesical)
The unit is the busiest in the United Kingdom, performing about 1000 diagnostic urodynamic tests per year. The team also work closely with physiotherapy and GI physiology, to provide a comprehensive service for patients with incontinence or pelvic floor dysfunction.
The team is led by Professor Hashim Hashim, who is the director of the unit and closely supported by Mr Madhu as deputy director. The expert and highly specialised team are regularly involved in teaching urodynamics in the UK, Europe and around the world including the Far East and Middle East and North and South America. The staff in the unit teach on the certificate in urodynamics course accredited by the International Continence Society (ICS) and all are actively involved in research.
Urodynamics Team
Urodynamics Medical Specialists
Consultant Female and Functional Urological Surgeon and Director of the Urodynamics Unit
Professor Hashim Hashim
Professor of Urology
Professor Paul Abrams
Consultant Urological Surgeon
Ms Carolina Ochoa Vargas
Consultant Urogynaecologist
Mr Chendrimada Madhu
Consultant Urogynaecologist
Ms Ifeoma Offiah
The team also has a specialist registrar, senior clinical fellow and clinical research fellow.
Urodynamics Nursing & Clinical Scientists
Laura Thomas
Clinical Physiologist and Urodynamics/GI Pysiology Unit Manager
Cancer of the penis is a somewhat rare condition, which accounts for less than 1% of all the cancers in Europe.
If you have symptoms that suggest penile cancer, the doctor may check general signs of health and may order lab tests.
You may have one or more of the following procedures: biopsy, lymph node aspiration, CT scan, PETCT scan, MRI scans.
If the tests prove you have penile cancer you will then require further treatment. There are several different types of treatment and choosing the right treatment depends upon on many factors.
The treatment options for penile cancer may involve (either alone or as a combination):
Surgery
It is most likely that you will need surgery as part of your treatment. With certain forms of surgery it can be possible to preserve the penis or to perform a reconstruction.
Radiotherapy
In some cases radiotherapy can be used to kill the cancerous cells. This involves directing radiation at the cancer to destroy it. Radiotherapy is not a suitable treatment when the cancer is invading deeply, it can result in the skin on the penis becoming chronically inflamed. This can make it difficult to be certain if the abnormal skin is due to a recurrence of the cancer or a skin reaction to the radiotherapy, which can make follow up assessments difficult and make further sets of biopsies necessary. Radiotherapy can also be used to treat an area where lymph nodes were found to contain cancerous cells from the penile cancer. The most common area is the groin.
Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells. A chemotherapy cream may be used to treat a precancerous growth or a cancer that is very superficial and confined to the glans or the foreskin. This cream is applied to the specific area of the penis as directed by the consultant dermatologist who supervises this treatment. Chemotherapy drugs can also be given by injection for more advanced cancer. A consultant oncologist (Cancer specialist) supervises this form of chemotherapy.
Chemotherapy may be used together with surgery, with radiotherapy or with both treatments.
Bladder cancer is where a growth of abnormal tissue affects the lining of the bladder. Approximately 10, 000 patients are diagnosed with bladder cancer each year, and it occurs when the bladder lining comes into contact with harmful substances. One of the most common causes is cigarette smoke; it is broken down into a harmful chemical which passes out of the body through the urine. It is estimated that half of bladder cancers are caused by tobacco smoke.
The most common symptom associated with bladder cancer is blood in the urine. If you experience this you should see your GP immediately.
If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall, whether the disease has spread, and if so, to what parts of the body. This will involve an operation to remove the growth from the bladder (TURBT) and sometimes a scan of the rest of the body.
Transurethral Resection of Bladder Tumour
Bladder cancer can be easily removed under general anaesthetic using a similar instrument to the one used during cystoscopy. The operation is called Transurethral Resection of Bladder Tumour (TURBT).
The TURBT operation will allow the urologist to inspect the inside of your bladder in more detail and remove the tumour from the inside of the bladder by 'scrapping' it away with a heated wire.
Any suspicious looking areas, lumps, growths or tumours will be removed or sampled and sent to a specialist doctor (pathologist). Once a definite diagnosis has been made a treatment plan will be devised for you.
The majority of bladder cancers are small. They are called superficial bladder cancers and are confined to the inner lining of the bladder only.
Sometimes you may require additional treatments to the operation including intravesical treatments (medicines injected into the bladder) after the operation to prevent recurrence of the tumour.
In some cases the tumour is no longer in the superficial part of the bladder wall and more extensive surgery is required such as a cystectomy (removal of the bladder). This is rare.
Intravesical (Inside the bladder) Treatment
Mitomycin
Mitomycin is a form of chemotherapy placed directly into the bladder. It can be used immediately after surgical removal of bladder cancer (TURBT) but also it can be given over a 6 week course in the outpatient department via a small temporary catheter. Mitomycin reduces the chance of bladder cancers recurring.
BCG Immunotherapy
BCG stands for Bacillus Calmette-Guerin, a living but weakened tuberculosis vaccine developed by Drs. Calmette and Guerin in France in 1921.
It is currently the most effective non-surgical treatment for CIS (carcinoma in situ) and high grade, non muscle invasive cancer.
Intravesical immunotherapy is a substance placed into the bladder to stimulate an immune response. lmmunotherapy stimulates your body's immune system to destroy cancer cells within the bladder and reduces the risk of the tumour re-growing. When it is placed inside the bladder a local inflammatory reaction is created which kills cancer cells.
Treatment involves placing a small amount of fluid, containing a live vaccine, into the bladder through a thin catheter, which is then removed. Treatments are normally given once a week for 6 consecutive weeks.
BCG immunotherapy is not appropriate for all types of bladder cancer and is used mainly for superficial bladders that are high grade. The effectiveness therefore depends on how aggressive (grade) and how deep stage the bladder cancer is. The majority of patients with aggressive (grade 3) superficial bladder cancer and/or carcinoma in situ will respond to treatment.
However, even for those people who have had successful BCG treatment, the bladder cancer may return and require further removal and surgery.
Hyperthermic (heated) Mitomycin C
BUI is currently offering a newer and specialised technique of giving heated mitomycin (chemotherapy agent). This treatment can be an alternative to BCG or a cystectomy in highly selected situations. Patients will be offered this only after discussion at a specialist multi-disciplinary team meeting. Patients can be referred from outside of Bristol for this treatment via their local Consultant Urologist.
The technique involves catheterisation for a period of an hour, whilst heated mitomycin is instilled around your bladder. The staff are specially trained to give this specialised treatment. More can be seen on the video below regarding this treatment. If you want to know whether you are suitable for this treatment, please consult your Consultant Urologist. It can be up to 70-80% effective in preventing recurrent cancer and has an acceptable side effect profile (this includes lower urinary tract symptoms and rash).
Non-invasive bladder cancer
Invasive Bladder Cancer
Sometimes bladder cancer can involve the muscle of the bladder and are termed invasive. This is a serious diagnosis and needs specialist input from surgeons and oncologists to treat the problem. The best results are achieved by combining chemotherapy to shrink the cancer followed by an operation to remove the bladder along with the lymph nodes. Without the bladder, the urinary tract needs to be reconstructed and this can be performed with an ileal conduit which uses a spout of small bowel on the surface of the skin to direct the urine into a collection bag. It is also possible in some patients to make a new bladder from bowel and attach it to the urethra which remains.
Robotic-assisted radical cystectomy
Here at the Bristol Urological Institute we have the most experienced surgeons in the country providing robotic surgery for bladder cancer. They have performed the greatest number of these cases in the UK. The smaller incisions, less blood loss and less anaesthetic requirements mean that patients recover far more quickly than the traditional open operation.
Our consultants Mr Koupparis and Mr Rowe were the first in the country to remove a patient’s bladder due to cancer and reconstruct a new bladder out of bowel using the Da Vinci robotic surgical platform.
We need your support to help give more people in Bristol and the South West the very best urological care here at the BUI. We are part of Southmead Hospital Charity and there are a number of ways you can help. Visit their website www.southmeadhospitalcharity.org.uk
Prostate cancer is the most common cancer in men in the UK. Each year in the UK approximately 30,000 men are diagnosed with prostate cancer. The average age of diagnosis around 75 years old. The risk is higher in those with a family history and African-Caribbean origin.
Prostate cancers range from very aggressive tumours to slow growing tumours. Slow growing tumours are more common and may not cause any symptoms or shorten life.
Early prostate cancer usually causes no symptoms. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup. Prostate cancer is associated with urinary dysfunction as the prostate gland surrounds the prostatic urethra. Changes within the gland, therefore, directly affect urinary function.
Advanced prostate cancer can spread to other parts of the body, possibly causing additional symptoms. The most common symptom is bone pain, often in the bones of the spine, pelvis, or ribs.
Prostate Cancer Treatment
At the Bristol Urological Institute we have some of the most experienced prostate cancer specialists in the country, with a strong research portfolio collaborating with The University of Bristol and The University of the West of England. We work very closely with our oncology colleagues and a team of specialist nurses to provide the most appropriate and up to date treatment for each individual patient.
There are a variety of treatment options and all these options and their suitability for you as an individual can be discussed with your surgeon:
Low-dose rate and high-dose rate brachytherapy
External beam radiotherapy
Active surveillance
High-intensity frequency ultrasound
Robotic Assisted Laparoscopic Prostatectomy
Robotic assisted laparoscopic prostatectomy (RALP) is a minimally invasive, surgical procedure that removes the cancerous prostate gland and related structures. Here at the Bristol Urological Institute we have some of the highest-volume cancer surgeons in the country, many of whom are international teachers for robotic surgery. To perform the operation to remove your prostate your surgeon will be using the Da Vinci surgical robot. This allows the surgeon to perform a keyhole (laparoscopic) operation with improved 3D vision and with finer instrument dexterity.
The Robot is connected to the patient using six small incisions in the abdomen, which the instruments pass through. The surgeon controls the robotic instruments from a separate “console” and is able to perform very precise surgery to remove the prostate but carefully protect the surrounding structures. This type of surgery allows for faster recovery, less pain, earlier discharge and a quicker return to normal daily activities.
There are now many methods of treating stones in the kidney or ureter. Lithotripsy is one method.
Stones can be broken up by focusing pressure waves onto them from a lithotriptor – this is known as "Shock Wave Lithotripsy" – SWL for short.
A lithotriptor is a machine which has the ability to visualise stones either by x-ray or ultrasound.
The energy waves produced by the machine are accurately focused on the stone and travel through the body tissues without damaging them, the energy is dispersed to break up the stone usually reducing it to ‘sand’ or ‘gravel’ – which is then passed in the urine with little or no pain.
The majority of patients are treated as day cases, spending 2-4 hours in the unit.
The Bristol Urological Institute (BUI) was established in 1993 as a charity to promote research into urological diseases and to provide high quality undergraduate and post graduate teaching.
In 2010 the Bristol Urological Institute was incorporated into North Bristol NHS Trust, Southmead Hospital, Bristol.
The Bristol Urological Institute (BUI) now offers a complete clinical service to patients with urological problems and provides teaching and research.
The BUI intends to remain a patient focused organisation providing the best care to patients with urological conditions, and by working with them, to teach healthcare professionals about urology and to build on its research successes over the last 25 years.
Bristol Urological Institute – promoting urology through research, teaching and premier patient care.
We need your support to help give more people in Bristol and the South West the very best urological care here at the BUI. We are part of Southmead Hospital Charity and there are a number of ways you can help. Visit their website www.southmeadhospitalcharity.org.uk
Clinical trials are research studies that look at new ways of delivering medical care and test new drugs or combinations of drugs in patients.
Clinical trials in cancer care is extremely important as a means of exploring and deciding on the most effective and efficient means of treating and diagnosing cancer.
The clinical trials team at North Bristol NHS Trust co-ordinates and support the delivery of clinical trials across a variety of cancers including:
Haematology
Urology
Brain
Head and Neck
Upper Gastro Intestinal
Colorectal
Breast
Lung
Skin
If you are eligible for a study that we are running at North Bristol NHS Trust, a member of the clinical trials team will discuss the study with you in detail.
Participation in clinical trials is voluntary and if you decide not to participate, this will not influence your treatment in any way.
The Acute Oncology Service is in place to ensure that cancer patients at North Bristol NHS Trust have a smoother and more efficient care pathway when they are admitted for an acute complication of their cancer, their treatment or are newly diagnosed during an acute episode of illness.
We help patients with cancer who are acutely unwell due to:
Complications of their treatment e.g. Chemotherapy or Radiotherapy.
Complications of their cancer.
A new diagnosis of cancer where the primary is unknown.
The Acute Oncology Team can:
Provide advice over the phone if you are experiencing complications due to your cancer or treatment.
Offer support and advice for you and your family to help you make decisions about your treatment during the acute episode of illness.
Give advice to other healthcare professionals looking after you.
Help facilitate an early discharge from hospital wherever possible.
Work with colleagues in the community to avoid unnecessary hospital admissions.
Act as a point of contact for the patient and other healthcare professionals during an acute episode of illness.
The Acute Oncology Team consists of Acute Oncology and Haematology nurse specialists and visiting Consultant Clinical Oncologists.
Contact Acute Oncology Team
The Acute Oncology Service can be contacted Monday to Friday, 8am – 5pm
The NGS Macmillan Wellbeing Centre, at Southmead Hospital, offers support and information to anyone affected by cancer. Whether you are someone who has just been diagnosed; in the middle of, or finished treatment, or a friend, family member or carer of someone with cancer.
The Bristol Urological Institute (BUI) patient services replaces the two urological departments of Southmead Hospital and the Bristol Royal Infirmary which combined into a single department in March 2013.
The BUI patient services consist of inpatients at Southmead Hospital and Weston General Hospital and outpatient services at Southmead Hospital, the Bristol Royal Infirmary, South Bristol Hospital, Weston General and other community bases in Bristol and the surrounding areas.
There are 14 Consultant Urologists based at the Bristol Urological Institute (BUI) with other consultants who come from Weston-super-Mare and Swindon Hospitals to provide specialist patient services at the BUI.
Patient Services are organised into the specialist areas of urology:
Andrology (erectile dysfunction)
Cancer services (kidney, prostate, bladder, testicular, penile)
Stones
Incontinence
Specialist investigations (urodynamics)
We only accept referrals from your GP or a hospital consultant. If you have a urological problem, please visit your GP first. Your GP can decide whether referral is necessary or appropriate.
Once you have been referred, you will be able to schedule an outpatient appointment. We may arrange for you to undergo some tests in advance of your appointment to speed the diagnostic process.
If you have concerns about appointments, investigations, admissions or results, contact your Consultant's secretary or if you prefer, you can talk with one of the Specialist Nurses.
We need your support to help give more people in Bristol and the South West the very best urological care here at the BUI. We are part of Southmead Hospital Charity and there are a number of ways you can help. Visit their website www.southmeadhospitalcharity.org.uk
