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The advantages of robotic surgery are:

• minimised postoperative pain
• quicker recovery time
• reduced blood loss
• less scarring
• reduced time in hospital

Kapil has undertaken international fellowships in Hamburg and Manchester that broadened his robotic surgery experience with international leaders in this field. He uses robotics over straight laparoscopic surgery in areas where there is a clear advantage in working in confined areas or requiring complex movement. These include:

• Robotic radical prostatectomy
• Robotic partial nephrectomy
• Robotic pyeloplasty
• Robotic nephro-ureterectomy
• Robotic ureteric re-implantation

Kidney stones may be treated by non-surgical methods or through surgery such as shock wave lithotripsy, ureteroscopy with laser destruction, or keyhole percutaneous nephrolithotomy (PCNL). Kapil has expertise in each of these methods and will work with you to explore all options to best suit your needs.

– Kidney cancer:

Nearly 4000 cases of kidney cancer are diagnosed each year in Australia. They are often detected incidentally but may present with symptoms such as pain in the side of the body or blood in the urine (haematuria). Small growths in the kidney (less than 3-4cm) have a 20% chance of being benign, and a renal biopsy may help to characterise these lesions further.

If the kidney tumours are malignant, the goal of surgery, where possible, is to remove the cancerous growth and preserve most of the normal kidney. For many kidney cancers, a partial nephrectomy would therefore be a suitable option as this is curative and helps preserve long term kidney function.

Alternative approaches for smaller kidney tumours include active surveillance and ablative techniques (cryo or radio-frequency ablation). For larger masses, removal of the whole kidney (radical nephrectomy) may be required. Kapil has completed a fellowship in a specialty hospital in Manchester under surgeons who have pioneered minimally invasive surgery in the UK, to gain experience in advanced laparoscopy and robotic surgery for such cancer.

– Renal cysts:

Renal cysts are commonly found on scans and are usually inconsequential. Cysts may occasionally have some complex features and require further specialised imaging. Very occasionally, some complex cysts may have a chance of being cancerous and require further treatment or ongoing surveillance. Some cysts may grow in size and cause discomfort, requiring drainage.

– PUJ obstruction:

The PUJ (pelvi-ureteric junction) is part of the urinary drainage system linking the kidney to the ureter and ultimately the bladder. A PUJ obstruction is when there is an impairment of drainage from the kidney to the ureter that is congenital or acquired. This may cause flank pain, stones, recurrent infection and cause long-term kidney loss. If there are pain symptoms or evidence of poor kidney function, unblocking may be required. The best approach is a robotic pyeloplasty, where the impaired segment (PUJ) is removed, with a new join made between the kidney and ureteric drainage system. Kapil is trained robotically and laparoscopically to perform this procedure. Other treatment options in those unsuitable for a pyeloplasty include incision into the PUJ segment (endopyelotomy) or long-term internal stent placement.

– Bladder cancer:

All cases of bladder cancer require an initial trans-urethral resection of bladder tumour (TURBT) to make a diagnosis. Further management will depend upon the depth (superficial or muscle invasive) and grade (high or low grade) of the tumour. For low grade superficial cancer, surveillance alone may be appropriate. For a high-grade superficial cancer, immunotherapy or chemotherapy is often instilled into the bladder along with more intense surveillance. Muscle-invasive disease may require a radical cystectomy where the bladder is removed, along with urinary diversion (formation of stoma or neobladder using the small bowel).

If surgery is not an option, the cancer may be treated with radiotherapy, with or without chemotherapy. Kapil has a particular interest in bladder and prostate cancer working with a multi-disciplinary team to deliver the world’s best care every time.

– PSA testing:

This blood test is used as a screening tool to detect prostate cancer. There are a number of reasons why your PSA may be elevated. Kapil will guide you through the meaning of this result and discuss in detail the merits of further investigations such as an MRI or prostate biopsy.

– MRI:

MRI of the prostate is a valuable tool in the diagnosis of prostate cancer. It provides valuable information regarding suspicious areas within the prostate, along with spread of cancer beyond the prostate. An MRI is usually requested by your urologist if there is a high index of suspicion for underlying prostate cancer.

– Transperineal Prostate Biopsy:

A transperineal prostate biopsy is performed as a day case under general anaesthetic. A needle is passed through the skin between the scrotum and the anus (perineum) to sample MRI reported areas of the prostate as well as all other aspects of the gland in a systematic way.

– Active Surveillance:

If there is a small area of low-grade cancer, Kapil will discuss with you the suitability of regularly monitoring your disease with a protocol that is safe and maximises your quality of life. Active surveillance allows the maintenance of sexual function and continence whilst avoiding potential overtreatment. Treatment for your cancer can therefore be securely delayed as long as possible.

– Robotic radical prostatectomy:

In larger volume or more aggressive cancer, treatment by surgery or radiotherapy is recommended. Kapil has trained in performing robotic radical prostatectomy at the Martini Clinic, the highest volume prostate cancer centre in the world. The centre performs over 2500 prostate surgeries per year and leads the world in its robotic technique, the mainstay for prostate cancer surgery. The surgery removes the entire prostate gland, along with the pelvic lymph nodes if required, and joins the bladder back up to the urethra. The gold standard is to remove the entire cancer whilst preserving closely running nerves that supply erections and ensuring satisfactory long-term urinary continence.

Whilst causing significant lifestyle issues, it may also lead to more serious consequences if left untreated. Kapil can guide you through a full evaluation and arrange necessary tests of the urine and blood, imaging or a camera check (cystoscopy) to help diagnose your condition and exclude prostate cancer or bladder issues. Luckily, there are many management options for an enlarged prostate including lifestyle changes, medications and surgical intervention. Kapil has expertise in non-operative and minimally invasive and laser techniques for treating an enlarged prostate gland.

– Urolift

Urolift is a minimally invasive procedure that pins the prostate tissue back to open a channel allowing the unobstructed passage of urine. It is typically done as a day case under general anaesthetic without the need for a catheter. It is a good option for those that do not wish to take tablets and avoid more invasive procedures. Importantly, the procedure preserves the ejaculation function. Other prostate surgeries can easily be performed after Urolift if required.

– HoLEP

Holmium laser enucleation of prostate (HoLEP) uses a specialised laser through a telescope to remove the entire obstructing prostate tissue and leave an open cavity. This is quickly becoming the standard of care for benign prostate surgery since it remains durable with less bleeding than a TURP. It can be performed on any size of prostate and this minimally invasive technology eliminates the need for an open or robotic removal (simple prostatectomy). The procedure is similarly performed under general anaesthetic and requires a catheter for one to two days post procedure.

– Greenlight vaporisation

Using a high-powered laser through a telescope, the prostate cavity is created by vaporising the tissue. Like the other procedures, this creates an open channel under general anaesthetic with a catheter placed for one to two days. It is unclear whether the long-term results are as durable as HoLEP or TURP, but it remains a good option for those at high risk of bleeding due to medications or blood disorders.

– TURP

During a TURP, a telescope is passed through the urethra and a hot wire is used to shave prostate tissue away and create an open cavity allowing the free passage of urine. This procedure is one of the most durable, is performed under general or spinal anaesthetic and requires one to two days with a catheter.

– Scrotal swelling

Lumps and bumps are common in the scrotum and usually harmless. They may become uncomfortable or large (cysts and hydrocoele), or impact fertility (varicocoele). A number of options are available to treat these conditions including excision, removing the fluid and injecting a chemical to stop the fluid coming back (drainage with sclerosant therapy) or ablation of the varicose veins in the scrotum (varicocoelectomy).