Urology - Salford Royal

Urology is one of the most varied branches of surgery and includes diseases of the kidneys, bladder, urethra, prostate and male sexual organs.

Our specialist team offers excellent care for patients of both sexes and all ages. 

You may be referred to a urologist to manage conditions such as kidney stones, incontinence (urinary leakage), impotence (erectile problems), infertility (reproductive issues in men), cancer and reconstruction of the genitourinary tract.

You may see a urologist to get treatment for a disease, trauma or congenital abnormality of the kidney, bladder, genitalia or urinary tract, as well for assistance with male sexual and reproductive health.

Urology combines the management of many non-surgical problems such as urinary infections with those requiring surgery such as the correction of incontinence, prostate problems and the treatment of most cancers of the urinary tract.  

One quarter of all surgical referrals to hospital are for urological conditions and urology makes up 10% of GP consultations. Hospital referrals have increased by 20% over the last few years but only 10 to 12% of them lead to surgery. Around 90% of patients are managed by other methods such as lifestyle advice or medication. 

Services

Many people are initially assessed at our core urology one-stop clinic, either as an outpatient or emergency inpatient.

At your appointment, you’ll meet one of our urology team and will typically receive your diagnosis and treatment plan within one or two visits. 

Patients come to clinic with various symptoms such as haematuria (bleeding in the urine), flank pain, a urinary tract infection, scrotal lumps, penile issues (e.g. men who may benefit from circumcision) and suspected cancer. All will be thoroughly investigated by our experts.

Common core urology operations include cystoscopy (bladder examination with a thin telescope), removal of bladder tumours, treatment of some urinary tract stones, circumcision, vasectomy and hydrocele repair (fluid around the testes).

As core urology issues are very common, all urologists are trained in this area and retain their skills even if they have another specialism.

Patients with urinary stone disease receive specialist care and treatment including a wide range of management options.

Our team also undertakes metabolic evaluation of patients with kidney stones to determine the cause and prevent recurring stone formation.

Treatment Options

  • Extra-Corporeal Shockwave Lithotripsy (ESWL)

Salford Royal is one of only two hospitals in Greater Manchester to offer ESWL, a non-invasive technique used to treat kidney and ureteric stones without the need for surgery.

First, the stones are located using either x-ray or ultrasound. Then, high energy shock waves focused on the stones are passed through the body to break them into tiny pieces which will typically pass out of the body when you urinate. The procedure is usually well tolerated with minimal painkillers and can be performed in both elective and emergency situations. 

  • Ureteroscopy & Uretero-Renoscopy

Salford Royal Urology Department is a high-volume ureteroscopy centre and the team are experts at performing this procedure. 

Ureteroscopy is a highly effective, minimally invasive treatment for stones in the ureter and kidney, performed under anaesthetic. A small telescope (ureteroscope) is passed via the water passage (urethra) and bladder up to the ureter or kidney, depending on where the stone is located.

A holmium laser is typically deployed through the telescope to safely break up the stone into small pieces. These will either pass out in the urine or are removed using a stone basket. A temporary internal drainage tube (stent) is often inserted into the ureter at the end of the procedure to aid kidney drainage. 

  • Percutaneous Nephrolithotomy (PCNL)

PCNL is a minimally invasive operation to remove larger stones from the kidney which are not suitable for treatment with a ureteroscope.

Performed under a general anaesthetic, a telescope (nephroscope) is passed into the kidney through a small incision in the back and the stone is broken using either an ultrasonic device or laser. This typically requires a short inpatient stay following the surgery. 

What is the right stone treatment for me?

We take a bespoke approach to managing stones in the kidney and ureter, so you’ll always receive the very best treatment option for your unique circumstances.

Not all urinary stones require treatment and a conservative approach of monitoring your stones may be taken. Where intervention is recommended, we’ll discuss which options will be most appropriate for you and why, considering the relative benefits and risks of each. 

To reduce the risk of future episodes, every stone patient undergoes a set of blood tests and where possible a stone is analysed to determine what it’s composed of. 

You’ll also receive advice about how to reduce your stone formation risk. Some patients may require more detailed evaluation including a consultation in our metabolic stone clinic.  

The Stone Team

Our specialist stone team includes:

  • Consultant Urological Surgeons: Mr J Broome, Mr DG Ross & Professor DC Shackley
  • Consultant Uro-Radiologists: Dr A Cowie & Dr S Suut
  • Consultant Nephrologists: Dr J Ritchie & Dr S Sinha
  • Nurse Specialists
  • Radiographers

 Urologists treat five cancers – prostate, bladder, kidney, testicular and penile cancers. 

The urology department is at the forefront of modern prostate cancer care and offers a full range of specialist tests for patients.

Prostate cancer diagnostics is a rapidly developing area of medicine and, with the recent introduction of MRI scans and new biopsy techniques, can become complex.

Our team of consultants, speciality doctors and specialist nurses are here to guide and support patients through the process.   

If you’re referred to us, your first appointment will be in the dedicated prostate clinic with a consultant or speciality doctor. The team includes Mr Maddineni, Mr Broome, Mr Tolofari, Mr Tumman and Sister Leather. A full assessment will take place and if a prostate biopsy is felt necessary, it will often be performed on the same day. This means you’ll receive your biopsy results in the shortest time possible. 

We were the first unit in the north-west to move entirely to local anaesthetic transperineal prostate biopsy (LA TP). This new technique offers several benefits over the more traditional transrectal route (via the rectum).

Until recently, it was only performed in an operating theatre, under a general anaesthetic. We’re now able to offer this in outpatients with the use of local anaesthetic. Our early experience has shown us that this newer type of biopsy is better able to detect cancer compared to the older transrectal method. We’ve also found that infection rates have reduced and that it’s well tolerated, with an average pain score of only 3/10. 

Over the past few years, the urology team have worked hard to develop a highly efficient prostate cancer pathway to help move you quickly through the process.

For example, an MRI scan will often be performed before you’re seen in clinic. This helps to streamline our patients’ experience and allows us to make a more informed decision regarding prostate biopsies. 

From the point of referral, you’ll be closely supported by our highly trained specialist cancer nurses. You’ll also benefit from the input of our pathway navigator, ensuring you progress swiftly through the various stages of the diagnostic process. 

A proportion of our patients will unfortunately go on to be diagnosed with prostate cancer. Our system enables us to undertake this process in the shortest time frame possible.

After diagnosis, all patients will have their cases discussed at our specialist meeting attended by a range of experts including oncologists, radiologists and pathologists. The aim of this meeting, which is chaired by a world-renowned pelvic cancer surgeon, is to define the best possible treatment options for every individual.

We’ve paved the way in prostate cancer diagnosis over the last few years and have become the first hospital in Greater Manchester to:

  • routinely offer LA TP biopsy
  • entirely move to LA TP biopsy (and away from the transrectal route)
  • adopt the NHSE Rapid Prostate Diagnostic Pathway
  • have a dedicated prostate pathway navigator

We’re continually improving our approach to prostate cancer care and will continue to push the boundaries in this area to enhance outcomes for our patients.  

The female, functional and neuro-urology (FFN) and reconstruction team helps patients with strictures (narrowing) of the urethra, women with bladder symptoms and incontinence, and people of both sexes with neurological disorders, such as spinal injury, spina bifida and multiple sclerosis.

Our five consultant specialists - Mr O’Flynn, Mr Betts, Mr Clarke, Ms Foster and Miss Olson – provide a comprehensive service for both investigation and treatment.

Using a multidisciplinary approach, the team works closely with gynaecology, neurology and neurosurgical colleagues, specialist nurses and physiotherapists to deliver excellent care. This includes holding joint adult spina bifida clinics with our neurosurgical colleagues and joint adolescent spina bifida clinics at the Royal Manchester Children’s Hospital with paediatric urologists. 

You may come to us with one of the following conditions: 

  • primary, recurrent and complex female urinary incontinence  
  • urethral diverticula 
  • male stress incontinence 
  • male and female voiding dysfunction 
  • functional urological symptoms (including those relating to neurological conditions) 
  • urethral strictures 

We also perform a wide range of treatments including:

  • urethroplasty (surgical reconstruction or replacement of the urethra)
  • artificial urinary sphincters
  • complex urological reconstruction including ureteric reimplantation (repositioning the tubes which connect the bladder to the kidneys) and bladder augmentation

Our team offers a highly specialised tertiary service for urethral strictures, post prostatectomy/pelvic radiotherapy incontinence and neuro-urology reconstruction.

We run a well-established, nationally renowned sacro-neuromodulation service for patients with detrusor (bladder) overactivity and voiding dysfunction, which serves people in north-west of England and beyond. We’ve been undertaking sacral neuromodulation for over 20 years.

And we hold a uro-neurology clinic dedicated to the management of bladder problems in patients with neurological disease such as multiple sclerosis, Parkinson’s disease and less common neurological conditions. 

The male counterpart of gynaecology, this subspeciality deals with conditions of male sexual health, including impotence and conditions of the penis.

Salford Royal is a large teaching hospital and the Trust and Urology Department have a long-standing tradition of delivering high-quality medical education.

All the senior doctors within the urology team are GMC-recognised trainers and are involved in the education of urology specialist trainees, junior doctors, medical and nursing undergraduates, and allied health professionals such as physician associates. 

We support doctors in training from a variety of backgrounds, including foundation, surgical and GP trainees, all working and learning within the department. Several team members are also involved in the management of post-graduate medical education at a local, regional and national level. 

We’re committed to providing high quality education and support for all staff working within the department, including those not in designated training jobs. We also encourage staff to develop their skills and to take study leave to further advance these. 

The Urology Department offers a high-quality in-house weekly teaching programme, as well as the existing programmes for year one foundation doctors, and core and speciality trainees. 

This service provides a specialist clinical nursing service and a professional advisory service to the patients registered with a Salford GP.  In addition it provides advice and support to social care agencies, voluntary and the private sector within the City of Salford.

Level 1, Hope Building, Salford Royal

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