I Need Surgery

This is probably the most important question you can ask, and I'm genuinely glad when patients ask it. It means you're thinking clearly and you're not being passive about your own care.

Surgery is a tool — one of many. It's not automatically better than tablets, lifestyle changes, physiotherapy, or sometimes just careful observation. What makes surgery "necessary" isn't the existence of a problem, but whether surgery is genuinely the best way of solving that problem for you, at this time, given your specific circumstances.

When surgery is often the right answer

Surgery tends to make sense when:

• • Other treatments have been tried properly and haven't worked
• • — we don't jump to surgery when tablets or lifestyle changes might still help
• • The problem is structural and unlikely to improve by itself
• • — for example, a very tight foreskin, a large varicocele affecting fertility, or severe bladder outlet obstruction
• • Waiting carries real risk
• • — for instance, testicular torsion is a surgical emergency; delay causes permanent damage
• • Quality of life is significantly affected
• • — and the surgery has a very high chance of improving things with acceptable risks
• • It's preventive and evidence-based
• • — like removing a suspected bladder tumour for diagnosis and treatment

When surgery is often not the right answer

Surgery is usually not appropriate when:

• • You haven't tried simpler treatments yet
• • — surgery shouldn't be the first step unless there's a specific reason
• • The problem might resolve on its own
• • — many minor urological issues improve with time or simple measures
• • The risks outweigh the benefits for your situation
• • — every operation carries risks, and sometimes the cure is worse than the disease
• • Your expectations don't match what surgery can realistically deliver
• • — we need to be honest about outcomes
• • The main driver is anxiety rather than symptoms
• • — reassurance and explanation might be more helpful than an operation

Questions I ask myself before recommending surgery

When I'm considering whether surgery is appropriate for a patient, I mentally run through this checklist:

1. 1. Have we properly tried and exhausted non-surgical options?
2. 1. Is the diagnosis clear enough to operate with confidence?
3. 1. Is the patient medically fit enough for the procedure and anaesthetic?
4. 1. Does the patient understand what surgery can and cannot achieve?
5. 1. Are the patient's expectations realistic?
6. 1. Would I recommend this operation to a family member in the same situation?

If the answer to any of these questions is "no" or "I'm not sure", then we need to pause and think more carefully.

Remember:

You can always say no to surgery. You can also ask for a second opinion. A good surgeon will never pressure you into an operation you're not comfortable with, and will respect your autonomy even if we disagree about the best course of action.

The "watch and wait" alternative

Sometimes the best surgical decision is to not operate — yet, or possibly ever. Many urological conditions can be safely monitored over time. If you're not in pain, not at immediate risk, and the problem isn't significantly affecting your life, careful observation might be entirely appropriate.

This isn't "doing nothing" — it's active surveillance, with regular check-ins to see if anything has changed. If things deteriorate, we can always intervene. If things stay stable or improve, we've successfully avoided unnecessary surgery.

One of the most common sources of anxiety about surgery isn't the operation itself — it's the anaesthetic. This is completely understandable. The idea of being unconscious, or numb, or "not in control" can feel frightening, particularly if you've never had an anaesthetic before.

Let me explain the different types of anaesthesia we use, what they feel like, and how we decide which is right for your procedure. I'll also address the fears people often have but don't always voice.

The four main types of anaesthesia

1. General anaesthesia (GA) — "Fully asleep"

What it is: You are completely unconscious. You won't see, hear, feel, or remember anything during the operation. It's not like sleep — it's a medically controlled state where your brain activity is suppressed and you cannot be woken by stimulation.

How it works: The anaesthetist gives you medications (usually through a vein in your arm, sometimes also as a gas to breathe) that make you lose consciousness within seconds. You're continuously monitored throughout, and a breathing tube or mask ensures you get enough oxygen. At the end of surgery, the medications are stopped and you gradually wake up in the recovery room.

What it feels like: You'll remember being in the anaesthetic room, then nothing — and then you'll wake up feeling groggy, as though time has jumped forward. Most people describe it as "I blinked and the operation was over." There's no awareness, no dreams (usually), and no pain during the procedure.

When we use it: For major operations, procedures inside the abdomen or pelvis, or any surgery where you absolutely need to be completely still and unaware. Also when local or spinal anaesthesia isn't suitable for medical reasons.

Common fears about GA:

• • "What if I don't wake up?"
• • — This fear is understandable but the risk is extraordinarily low with modern anaesthesia. Serious complications from modern general anaesthesia are extraordinarily rare in routine elective surgery. The anaesthetist's entire job is monitoring you and ensuring safe emergence from anaesthesia.
• • "What if I wake up during the operation?"
• • — Accidental awareness under general anaesthesia is extremely uncommon with modern monitoring equipment helps prevent it. If you're particularly worried, mention this to your anaesthetist — they can use additional monitoring.
• • "What if I say something embarrassing whilst going under or waking up?"
• • — Occasionally people say odd things as the anaesthetic takes effect or wears off. The theatre team has heard everything and thinks nothing of it. You won't be asked to sign anything or make important decisions in this state.

2. Spinal or epidural anaesthesia — "Numb from the waist down"

What it is: Local anaesthetic is injected near the spinal cord, which numbs the lower half of your body completely. You remain awake (or lightly sedated if you prefer) but feel absolutely nothing below the level of numbness.

How it works: You sit or lie curled on your side whilst the anaesthetist injects local anaesthetic into your back (not into the spinal cord itself, but into the fluid or space around it). Within 10-20 minutes, your legs and lower body become heavy, warm, and completely numb. The effect wears off gradually over several hours after the operation.

What it feels like: During the injection, you'll feel some pushing and cold liquid, but it's not usually painful (the skin is numbed first). Once the spinal or epidural works, you can't move your legs and you have no sensation, but you're fully conscious. Some people find this strange; others find it fascinating. You can have sedation if you'd prefer to be drowsy and less aware of what's happening.

When we use it: For operations on the lower abdomen, pelvis, or legs. Sometimes preferred over general anaesthesia for patients with significant heart or lung problems, as it's gentler on the body's systems.

Advantages: Less nausea afterwards, often better pain control in the first 12-24 hours, quicker recovery of mental sharpness (no "brain fog" from general anaesthetic).

Disadvantages: You're aware of the operating theatre environment (though we shield you from seeing anything graphic). Rare risk of headache afterwards (1-2% with spinal). Very rarely, temporary or prolonged numbness or weakness (your anaesthetist will discuss specific risks).

3. Local anaesthesia — "Just the area being operated on is numb"

What it is: Local anaesthetic is injected directly into or around the area being operated on (like a dentist numbing your mouth before a filling). You're completely awake and aware, but the specific area is numb.

How it works: I inject local anaesthetic (usually lidocaine or bupivacaine) around the surgical site. You'll feel the needle going in (a sharp scratch), then the area goes numb within a few minutes. The operation is then completely painless, though you might feel pressure, tugging, or movement.

When we use it: For minor skin procedures, small lumps, vasectomy, some foreskin surgery (like frenuloplasty), and other operations where only a small area needs numbing.

Advantages: No anaesthetist needed, very safe, you can go home quickly afterwards, no grogginess or nausea, and you can drive yourself home (assuming the surgery itself doesn't prevent this).

Disadvantages: You're fully aware of what's happening. Some people find this interesting; others find it anxiety-provoking. If you're very nervous or unable to stay still, local anaesthesia alone might not be the best choice.

4. Local anaesthesia with sedation — "Twilight" anaesthesia

What it is: A combination of local anaesthetic (to numb the area) plus intravenous sedation (to make you drowsy, relaxed, and less aware). This is sometimes called "twilight sedation" or "conscious sedation."

How it works: You're given medications through a vein in your arm that make you feel deeply relaxed, sleepy, and detached from what's happening. The local anaesthetic ensures you don't feel pain. You're not unconscious — you can still respond to questions — but you're not fully aware and often don't remember much afterwards.

What it feels like: Like drifting in and out of a pleasant doze. You might hear voices or be vaguely aware of things happening, but it feels distant and unimportant. Most people describe it as "I was sort of there, but I don't really remember" and find it quite comfortable.

When we use it: For procedures where local anaesthesia alone would work medically, but the patient is anxious or the operation will take a while. It's a middle ground between being fully awake and fully asleep.

Advantages: Combines safety of local anaesthesia with comfort of not being fully aware. Less risk than general anaesthesia, but more comfortable than being completely awake. Quick recovery.

Choosing the right anaesthetic: a conversation, not a prescription

For many procedures, there's more than one safe option. The "right" anaesthetic depends on:

• • The type and duration of surgery
• • Your general health and any medical conditions
• • Your personal preference and anxiety levels
• • What's safest and most practical in your specific circumstances

When patient preference genuinely matters

Take frenuloplasty as an example. Medically, this operation can be done perfectly well under local anaesthesia. It's a small area, the surgery is quick, and most patients tolerate it comfortably when the area is properly numbed.

However, if you're so anxious that you cannot stay still — if the thought of being awake during surgery makes you feel panicked or physically shaky — then local anaesthesia isn't actually the best choice, even though it's technically possible. In that situation, a general anaesthetic (or local with heavy sedation) is safer and kinder, because you need to be still and calm for the surgery to go well.

Equally, I see the opposite situation: patients who are terrified of general anaesthesia. Perhaps they've had a bad experience before, or they're frightened of "not waking up," or they simply cannot bear the idea of being unconscious. For these patients, if the operation can safely be done under local or spinal anaesthesia, I will make every effort to accommodate that preference.

My approach to anaesthetic choice:

Within the limits of what's medically safe and practical, I try to accommodate your preferences. If you have strong feelings about anaesthesia, tell me. We can often find a solution that works for both your medical needs and your emotional comfort.

What I cannot do is offer an anaesthetic that's unsafe for your particular operation or medical condition. But genuine flexibility exists in many cases, and your feelings matter.

What if I'm terrified of general anaesthesia?

This is more common than you might think, and it's not irrational. The fear of losing consciousness, of not being in control, or of "not waking up" is deeply human.

Here's what helps:

• • Talk to the anaesthetist before the day of surgery
• • — they can explain exactly what will happen, answer your specific fears, and sometimes suggest alternatives (like spinal anaesthesia with sedation).
• • Understand the actual risks
• • — modern general anaesthesia is extraordinarily safe. The risk of serious harm is lower than the risk of driving to the hospital.
• • Know that you can ask for sedation first
• • — if the anticipation is the worst part, the anaesthetist can give you calming medication before you go to the anaesthetic room, so you're already relaxed before the general anaesthetic is induced.
• • Remember you can change your mind
• • — even if general anaesthesia was planned, if we can safely do the operation another way and you're very distressed, we can discuss alternatives. I would rather delay or modify the plan than proceed with a patient who is terrified.

What if I'm terrified of being awake?

Some people find the idea of being conscious during surgery unbearable, even if it's just local anaesthesia for a minor procedure. They imagine seeing instruments, hearing conversations, or feeling vulnerable and exposed.

This is equally valid. If you know you cannot cope with being awake, say so clearly. For many procedures, we can offer sedation (so you're drowsy and won't remember much) or general anaesthesia if that's more appropriate.

Being honest about your anxiety isn't a weakness or an inconvenience — it's essential information that helps us plan the safest, most humane approach for you.

Questions to ask about your anaesthetic

• • What type of anaesthetic is recommended for my operation, and why?
• • Are there alternative options, and what are the pros and cons of each?
• • What will I feel, see, or hear during the procedure?
• • How will I feel immediately afterwards?
• • What are the specific risks for me (given my age, health, and medical history)?
• • Can I meet the anaesthetist before the day of surgery to discuss my concerns?
• • If I have a strong preference, how much flexibility is there?

Anaesthesia has transformed from a crude, risky necessity into a sophisticated science. You're in expert hands, and your anaesthetist's job is ensuring your comfort and safety from the moment you go off to sleep (or go numb) until you're fully recovered. Trust that expertise, but also trust your own feelings — and let's talk openly about both.

The physical environment where your operation happens can feel like a mystery if you've never had surgery before. Understanding what to expect — whether you're going to a day surgery unit, an inpatient operating theatre, a private hospital, or an NHS facility — can reduce anxiety and help you prepare appropriately.

Day surgery units vs. inpatient theatres

Day surgery (day-case or ambulatory surgery)

What it means: You arrive on the morning of your operation, have the procedure, recover for a few hours, and go home the same day. You don't stay overnight in hospital.

Which operations are done as day cases? Most minor to moderate urological procedures can be done safely as day surgery, including:

• • Vasectomy
• • Circumcision
• • Frenuloplasty
• • Minor scrotal procedures (hydrocele, epididymal cyst excision)
• • Cystoscopy (flexible or rigid)
• • Some stone procedures

What to expect: Day surgery units are usually bright, modern, and less intimidating than traditional hospital wards. You'll have a bed or recliner in a bay with other day-case patients. The atmosphere is generally calmer and quicker-paced than inpatient care — people are coming and going throughout the day.

Practical requirements: You must have a responsible adult to collect you and stay with you for the first 24 hours after general anaesthetic or sedation. You cannot drive yourself home or use public transport alone. If you live alone or don't have support at home, discuss this with me beforehand — we may need to arrange an overnight stay or additional help.

Inpatient theatre (with overnight stay)

What it means: You're admitted to hospital, have your operation, and stay for one or more nights for observation, pain control, monitoring, or catheter management.

Which operations require inpatient care? More extensive procedures, or operations where post-operative monitoring is important, including:

• • TURP or other prostate surgery (usually 1-2 nights for catheter management)
• • Major reconstructive procedures (Peyronie's surgery, penile implants)
• • Kidney or ureteric stone surgery requiring stents or drains
• • Any operation where significant bleeding risk exists
• • Procedures in patients with complex medical conditions requiring closer monitoring

What to expect: You'll be on a surgical ward (either urology-specific or general surgery, depending on the hospital). Wards can be busy, sometimes noisy, and shared with other patients unless you have a side room or private room. Visiting hours vary by hospital. Nursing staff will monitor you regularly, manage your pain relief and catheter (if you have one), and ensure you're safe to go home.

When you can go home: Discharge depends on specific criteria being met: pain controlled on oral medications, no active bleeding, able to pass urine (if the catheter has been removed), mobile and safe, and someone at home to support you. Don't expect to leave at a specific time — discharge can sometimes take several hours while paperwork and medications are prepared.

NHS hospitals vs. private hospitals: what's the difference?

I work in both NHS and private settings, and I'm often asked about the differences. Let me be clear: the quality of surgery depends on the surgeon's skill and experience, not on whether you're paying privately or receiving NHS care. However, there are practical differences in the experience.

NHS hospitals

Advantages:

• • Large, well-equipped facilities with access to full range of specialists and emergency support
• • High-volume centres where complex cases are managed routinely
• • Integrated care with the same hospital managing pre-op, surgery, and post-op care
• • No direct cost to you at the point of care

Challenges:

• • Waiting times can be significant, particularly for non-urgent procedures
• • Less control over specific timing of your operation
• • Shared wards (though some NHS hospitals have single rooms available)
• • Visiting hours may be more restricted
• • Hospital food and amenities are functional rather than luxurious

Private hospitals

Advantages:

• • Shorter waiting times — you can often choose your operation date within weeks
• • Single en-suite rooms as standard (privacy, quieter, more comfortable)
• • More flexible visiting hours (often 24-hour access for one nominated person)
• • Better hotel-style amenities (food choice, WiFi, entertainment)
• • More predictable scheduling — operations less likely to be delayed or cancelled

Challenges:

• • Cost (unless you have private medical insurance)
• • Smaller facilities — if a serious complication occurs requiring intensive care, you may need transfer to an NHS hospital
• • Sometimes less experience with very complex or rare cases (these are often better managed in high-volume NHS centres)

Does it matter where I have my operation?

For routine urological procedures — circumcision, vasectomy, minor scrotal surgery, uncomplicated prostate procedures — both NHS and private hospitals provide excellent care. The operation I perform is identical regardless of the setting.

For very complex cases (major reconstructive surgery, cancer operations, surgery in patients with multiple medical problems), the NHS often offers advantages because of the breadth of specialist support immediately available on-site.

For straightforward operations where you value convenience, speed, and privacy, private care offers clear benefits — if you can afford it or have insurance.

My role remains the same:

Regardless of whether you're seen through the NHS or privately, I perform surgery to the same standard, with the same care, using the same techniques. My commitment to your safety and outcomes doesn't change based on the payment model. What changes is the surrounding experience — the waiting time, the ward environment, and the administrative process.

What should I bring on the day?

Regardless of where your surgery takes place, you'll need:

• • Any current medications (in original packaging)
• • Comfortable, loose-fitting clothing (tracksuit bottoms or pyjamas, slip-on shoes)
• • Toiletries and personal items if staying overnight
• • Your glasses or contact lenses (if you wear them)
• • Something to occupy you whilst waiting (book, tablet, phone charger)
• • Details of your nominated person collecting you (for day surgery)

What not to bring: Valuables, jewellery (including wedding rings — you'll be asked to remove them), large amounts of cash, or important documents. Hospitals aren't responsible for lost property.

Can I choose where I have my operation?

If you're being treated on the NHS, in most situations you can choose from NHS providers that offer your procedure, subject to reasonable waiting times and local commissioning arrangements. I'll discuss which hospitals I work at and help you decide based on waiting times and personal preference.

If you're paying privately or using private medical insurance, you generally have more choice over the specific hospital, though your insurance policy may restrict you to certain providers. We'll discuss this during your consultation.

The most important factor isn't the postcode of the operating theatre — it's that you feel confident in your surgical team, understand what's going to happen, and are treated with dignity and respect throughout the process. That standard applies everywhere I work.

One of the most common sources of anxiety about surgery isn't the operation itself — it's the anaesthetic. This is completely understandable. The idea of being unconscious, or numb, or "not in control" can feel frightening, particularly if you've never had an anaesthetic before.

Let me explain the different types of anaesthesia we use, what they feel like, and how we decide which is right for your procedure. I'll also address the fears people often have but don't always voice.

The four main types of anaesthesia

1. General anaesthesia (GA) — "Fully asleep"

What it is: You are completely unconscious. You won't see, hear, feel, or remember anything during the operation. It's not like sleep — it's a medically controlled state where your brain activity is suppressed and you cannot be woken by stimulation.

How it works: The anaesthetist gives you medications (usually through a vein in your arm, sometimes also as a gas to breathe) that make you lose consciousness within seconds. You're continuously monitored throughout, and a breathing tube or mask ensures you get enough oxygen. At the end of surgery, the medications are stopped and you gradually wake up in the recovery room.

What it feels like: You'll remember being in the anaesthetic room, then nothing — and then you'll wake up feeling groggy, as though time has jumped forward. Most people describe it as "I blinked and the operation was over." There's no awareness, no dreams (usually), and no pain during the procedure.

When we use it: For major operations, procedures inside the abdomen or pelvis, or any surgery where you absolutely need to be completely still and unaware. Also when local or spinal anaesthesia isn't suitable for medical reasons.

Common fears about GA:

• • "What if I don't wake up?"
• • — This fear is understandable but the risk is extraordinarily low with modern anaesthesia. Serious complications from modern general anaesthesia are extraordinarily rare in routine elective surgery. The anaesthetist's entire job is monitoring you and ensuring safe emergence from anaesthesia.
• • "What if I wake up during the operation?"
• • — Accidental awareness under general anaesthesia is extremely uncommon with modern monitoring equipment helps prevent it. If you're particularly worried, mention this to your anaesthetist — they can use additional monitoring.
• • "What if I say something embarrassing whilst going under or waking up?"
• • — Occasionally people say odd things as the anaesthetic takes effect or wears off. The theatre team has heard everything and thinks nothing of it. You won't be asked to sign anything or make important decisions in this state.

2. Spinal or epidural anaesthesia — "Numb from the waist down"

What it is: Local anaesthetic is injected near the spinal cord, which numbs the lower half of your body completely. You remain awake (or lightly sedated if you prefer) but feel absolutely nothing below the level of numbness.

How it works: You sit or lie curled on your side whilst the anaesthetist injects local anaesthetic into your back (not into the spinal cord itself, but into the fluid or space around it). Within 10-20 minutes, your legs and lower body become heavy, warm, and completely numb. The effect wears off gradually over several hours after the operation.

What it feels like: During the injection, you'll feel some pushing and cold liquid, but it's not usually painful (the skin is numbed first). Once the spinal or epidural works, you can't move your legs and you have no sensation, but you're fully conscious. Some people find this strange; others find it fascinating. You can have sedation if you'd prefer to be drowsy and less aware of what's happening.

When we use it: For operations on the lower abdomen, pelvis, or legs. Sometimes preferred over general anaesthesia for patients with significant heart or lung problems, as it's gentler on the body's systems.

Advantages: Less nausea afterwards, often better pain control in the first 12-24 hours, quicker recovery of mental sharpness (no "brain fog" from general anaesthetic).

Disadvantages: You're aware of the operating theatre environment (though we shield you from seeing anything graphic). Rare risk of headache afterwards (1-2% with spinal). Very rarely, temporary or prolonged numbness or weakness (your anaesthetist will discuss specific risks).

3. Local anaesthesia — "Just the area being operated on is numb"

What it is: Local anaesthetic is injected directly into or around the area being operated on (like a dentist numbing your mouth before a filling). You're completely awake and aware, but the specific area is numb.

How it works: I inject local anaesthetic (usually lidocaine or bupivacaine) around the surgical site. You'll feel the needle going in (a sharp scratch), then the area goes numb within a few minutes. The operation is then completely painless, though you might feel pressure, tugging, or movement.

When we use it: For minor skin procedures, small lumps, vasectomy, some foreskin surgery (like frenuloplasty), and other operations where only a small area needs numbing.

Advantages: No anaesthetist needed, very safe, you can go home quickly afterwards, no grogginess or nausea, and you can drive yourself home (assuming the surgery itself doesn't prevent this).

Disadvantages: You're fully aware of what's happening. Some people find this interesting; others find it anxiety-provoking. If you're very nervous or unable to stay still, local anaesthesia alone might not be the best choice.

4. Local anaesthesia with sedation — "Twilight" anaesthesia

What it is: A combination of local anaesthetic (to numb the area) plus intravenous sedation (to make you drowsy, relaxed, and less aware). This is sometimes called "twilight sedation" or "conscious sedation."

How it works: You're given medications through a vein in your arm that make you feel deeply relaxed, sleepy, and detached from what's happening. The local anaesthetic ensures you don't feel pain. You're not unconscious — you can still respond to questions — but you're not fully aware and often don't remember much afterwards.

What it feels like: Like drifting in and out of a pleasant doze. You might hear voices or be vaguely aware of things happening, but it feels distant and unimportant. Most people describe it as "I was sort of there, but I don't really remember" and find it quite comfortable.

When we use it: For procedures where local anaesthesia alone would work medically, but the patient is anxious or the operation will take a while. It's a middle ground between being fully awake and fully asleep.

Advantages: Combines safety of local anaesthesia with comfort of not being fully aware. Less risk than general anaesthesia, but more comfortable than being completely awake. Quick recovery.

Choosing the right anaesthetic: a conversation, not a prescription

For many procedures, there's more than one safe option. The "right" anaesthetic depends on:

• • The type and duration of surgery
• • Your general health and any medical conditions
• • Your personal preference and anxiety levels
• • What's safest and most practical in your specific circumstances

When patient preference genuinely matters

Take frenuloplasty as an example. Medically, this operation can be done perfectly well under local anaesthesia. It's a small area, the surgery is quick, and most patients tolerate it comfortably when the area is properly numbed.

However, if you're so anxious that you cannot stay still — if the thought of being awake during surgery makes you feel panicked or physically shaky — then local anaesthesia isn't actually the best choice, even though it's technically possible. In that situation, a general anaesthetic (or local with heavy sedation) is safer and kinder, because you need to be still and calm for the surgery to go well.

Equally, I see the opposite situation: patients who are terrified of general anaesthesia. Perhaps they've had a bad experience before, or they're frightened of "not waking up," or they simply cannot bear the idea of being unconscious. For these patients, if the operation can safely be done under local or spinal anaesthesia, I will make every effort to accommodate that preference.

My approach to anaesthetic choice:

Within the limits of what's medically safe and practical, I try to accommodate your preferences. If you have strong feelings about anaesthesia, tell me. We can often find a solution that works for both your medical needs and your emotional comfort.

What I cannot do is offer an anaesthetic that's unsafe for your particular operation or medical condition. But genuine flexibility exists in many cases, and your feelings matter.

What if I'm terrified of general anaesthesia?

This is more common than you might think, and it's not irrational. The fear of losing consciousness, of not being in control, or of "not waking up" is deeply human.

Here's what helps:

• • Talk to the anaesthetist before the day of surgery
• • — they can explain exactly what will happen, answer your specific fears, and sometimes suggest alternatives (like spinal anaesthesia with sedation).
• • Understand the actual risks
• • — modern general anaesthesia is extraordinarily safe. The risk of serious harm is lower than the risk of driving to the hospital.
• • Know that you can ask for sedation first
• • — if the anticipation is the worst part, the anaesthetist can give you calming medication before you go to the anaesthetic room, so you're already relaxed before the general anaesthetic is induced.
• • Remember you can change your mind
• • — even if general anaesthesia was planned, if we can safely do the operation another way and you're very distressed, we can discuss alternatives. I would rather delay or modify the plan than proceed with a patient who is terrified.

What if I'm terrified of being awake?

Some people find the idea of being conscious during surgery unbearable, even if it's just local anaesthesia for a minor procedure. They imagine seeing instruments, hearing conversations, or feeling vulnerable and exposed.

This is equally valid. If you know you cannot cope with being awake, say so clearly. For many procedures, we can offer sedation (so you're drowsy and won't remember much) or general anaesthesia if that's more appropriate.

Being honest about your anxiety isn't a weakness or an inconvenience — it's essential information that helps us plan the safest, most humane approach for you.

Questions to ask about your anaesthetic

• • What type of anaesthetic is recommended for my operation, and why?
• • Are there alternative options, and what are the pros and cons of each?
• • What will I feel, see, or hear during the procedure?
• • How will I feel immediately afterwards?
• • What are the specific risks for me (given my age, health, and medical history)?
• • Can I meet the anaesthetist before the day of surgery to discuss my concerns?
• • If I have a strong preference, how much flexibility is there?

Anaesthesia has transformed from a crude, risky necessity into a sophisticated science. You're in expert hands, and your anaesthetist's job is ensuring your comfort and safety from the moment you go off to sleep (or go numb) until you're fully recovered. Trust that expertise, but also trust your own feelings — and let's talk openly about both.

When most people think of "having surgery", they picture lying on an operating table. But that's actually a very small part of what surgery really involves. Surgery is a journey that begins weeks before the operation and continues weeks or months afterwards.

Understanding this helps you prepare properly, recover more smoothly, and know what to expect at each stage.

Before surgery: Preparation phase

This is where we lay the groundwork for a safe, successful operation. It includes:

1. The decision and consent discussion

We will have talked through:

• • Why this operation is recommended for you specifically
• • What it involves in practical terms
• • The expected benefits and success rates
• • The potential risks and complications
• • What would happen if you chose not to have surgery
• • Alternative treatment options

You should never feel rushed into signing a consent form. If you're uncertain, it's absolutely fine to ask for more time to think.

2. Pre-operative tests and assessments

Depending on the operation and your general health, you might need:

• • Blood tests (to check kidney function, clotting, infection markers)
• • Urine tests (especially for urological surgery)
• • Heart trace (ECG) if you're over a certain age or have heart concerns
• • Sometimes a chest X-ray or other scans

These aren't bureaucratic box-ticking — they help us identify any issues that might affect the surgery or anaesthetic, and fix them beforehand.

3. Medication adjustments

Certain medications need to be stopped or adjusted before surgery:

• • Blood thinners
• • (like warfarin, clopidogrel, rivaroxaban) — we'll give you precise instructions about when to stop
• • Diabetes medications
• • — insulin doses usually need adjusting on the day of surgery
• • Some herbal supplements
• • — things like ginkgo, garlic supplements, or high-dose vitamin E can increase bleeding risk

Important:

Never stop or change medications without discussing it with me or your GP first. Some drugs are absolutely critical and must be continued; others might need careful timing around the operation.

4. Practical arrangements

Before your operation, you'll need to arrange:

• • Time off work (the amount depends on the procedure and your job)
• • Someone to collect you after day surgery or visit you if you're staying in hospital
• • Help at home for the first few days if you're having a more significant operation
• • Childcare or pet care if needed
• • Transport to and from hospital

5. Fasting instructions

You will be given specific instructions about when to stop eating and drinking before surgery. This is absolutely critical for safety under anaesthetic. Typical rules are:

• • No food for 6 hours before your scheduled time
• • Clear fluids (water, black tea/coffee without milk) allowed up to 2 hours before
• • No chewing gum, sweets, or mints during the fasting period

The day of surgery: What actually happens

Understanding the sequence of events can reduce anxiety significantly.

Arrival and admission

You'll check in at the hospital or clinic, usually 1-2 hours before your scheduled operation time. You'll:

• • Complete final paperwork and identity checks
• • Change into a hospital gown
• • Have your blood pressure, heart rate and temperature checked
• • Be asked about allergies and when you last ate or drank

Meeting the anaesthetist

The anaesthetist will review your medical history, explain the anaesthetic plan, and answer your questions. They'll discuss:

• • What type of anaesthetic you'll have (general, spinal, local, or sedation)
• • How you'll feel as you go to sleep and wake up
• • Pain relief plans for after the operation
• • Any specific concerns related to your health

In the anaesthetic room

Before entering the operating theatre, you'll go to an anaesthetic room where:

• • A small needle (cannula) is inserted into a vein in your hand or arm
• • Monitoring equipment is attached (blood pressure cuff, ECG stickers, oxygen probe on your finger)
• • The anaesthetic is administered through the cannula
• • You'll fall asleep within seconds — most people don't remember anything beyond this point

During the operation

You will be completely asleep (or completely numb if you've had a spinal anaesthetic and chosen to stay awake). The surgical team monitors you continuously. I perform the operation according to the plan we discussed, adapting as needed based on what I find.

Modern surgery is done with the utmost care for preserving normal structures, minimising bleeding, and ensuring the best cosmetic result possible.

Recovery room (immediate post-operative care)

After the operation finishes, you're taken to a recovery area where specialist nurses monitor you closely as the anaesthetic wears off. You'll:

• • Gradually wake up (this can take 15-60 minutes depending on the anaesthetic)
• • Be given pain relief if needed
• • Have your blood pressure, heart rate, and oxygen levels monitored
• • Stay until you're stable and comfortable enough to move to the ward or day surgery unit

After surgery: Recovery and healing

This is often the longest and most important phase. Recovery isn't linear — you might feel better one day and worse the next. That's normal.

The first 24-48 hours

Immediately after surgery, you can expect:

• • Pain and discomfort
• • — usually manageable with the painkillers we prescribe; should be improving day by day
• • Fatigue and brain fog
• • — the anaesthetic can leave you feeling tired and "fuzzy" for a day or two
• • Nausea
• • — some people feel sick after anaesthetic; anti-sickness medication helps
• • Restricted movement
• • — depending on the surgery, you might need to limit certain activities

When to seek urgent help after surgery:

• • Severe pain that doesn't improve with prescribed painkillers
• • Heavy bleeding from the surgical site
• • Signs of infection (increasing redness, heat, swelling, pus, fever over 38°C)
• • Inability to pass urine (especially after prostate or bladder surgery)
• • Chest pain or difficulty breathing
• • Swelling, redness or pain in your calf (possible blood clot)

If any of these occur, contact me immediately or go to A&E if it's out of hours.

The first 1-2 weeks

This is the early healing phase. You should:

• • Rest, but not completely immobilise yourself (gentle movement aids healing)
• • Keep the wound clean and dry as instructed
• • Take medications as prescribed, including the full course of antibiotics if given
• • Gradually increase activity as comfort allows
• • Avoid heavy lifting, vigorous exercise, or sexual activity during this period

Weeks 2-6: Gradual return to normal

By this stage:

• • Most pain should have settled significantly
• • Wounds should be healing well (stitches may dissolve or be removed)
• • You can usually return to light work and normal daily activities
• • Sexual activity can typically resume after 3-4 weeks for most procedures (I'll give specific guidance)
• • Full physical exercise and heavy lifting usually allowed after 4-6 weeks

Beyond 6 weeks: Long-term outcomes

The final stages of healing continue for months. Scar tissue matures, swelling fully resolves, and you see the final result of the surgery. Follow-up appointments help us monitor your progress and deal with any late complications.

Complications: What can go wrong and how we manage it

No surgery is without risk. Being honest about complications doesn't mean I expect them — it means I respect your right to make an informed decision.

Common, minor complications

These happen in a small percentage of patients and usually resolve without long-term problems:

• • Bruising and swelling at the surgical site
• • Minor wound infections (treated with antibiotics)
• • Temporary numbness or altered sensation near the wound
• • Mild bleeding or blood in urine (depending on procedure)

Rare but serious complications

These are uncommon but we discuss them because they can occur:

• • Significant bleeding requiring transfusion or further surgery
• • Deep infection or abscess formation
• • Blood clots in the legs (DVT) or lungs (pulmonary embolism)
• • Damage to nearby structures (I take every precaution to avoid this)
• • Anaesthetic complications (extremely rare with modern techniques)

For each specific procedure, I will explain the particular risks relevant to that operation, including rates of complications and how we minimise them.

When things go wrong: honesty, responsibility, and duty of candour

I want to talk about something that matters deeply to me, and which I believe you have a right to understand: what happens when complications occur, and why I will always tell you about them — even when they're minor.

The regulatory framework: duty of candour

In UK medical practice, there's a legal and professional requirement called "duty of candour." It means that when something goes wrong during medical care — particularly if it causes moderate or severe harm — healthcare professionals must inform the patient (or their family) promptly, honestly, and fully. This includes apologising, explaining what happened, what will be done to put it right, and what will be done to prevent it happening again.

Medical students and junior doctors are taught about duty of candour in exams. They're asked questions like: "In which circumstances must you tell a patient that things have gone wrong?" The expected answer focuses on the regulatory threshold — the point at which disclosure becomes legally mandatory.

And that's fine, as far as it goes. Duty of candour is an important safeguard. It establishes a minimum standard of ethical behaviour and protects patients from being kept in the dark about serious complications.

But it's not why I tell you when things go wrong

For me, duty of candour isn't the reason I disclose complications — it's simply the regulatory mechanism that ensures a baseline level of honesty across the medical profession. It's the floor, not the ceiling.

The truth is this: even when something goes wrong that's minor — something that causes no lasting harm, something that's quickly fixed, something below the "threshold" where disclosure is legally required — I will still tell you about it. Immediately. Not because I have to, but because I don't know how to do it any other way.

If I nick a small blood vessel and have to spend an extra few minutes securing it during surgery, I'll mention it when we speak afterwards. If a stitch doesn't sit quite right and I have to redo it, you'll know. If something unexpected is found during the operation, even if it doesn't change the outcome, I'll explain what I saw.

Why? Because you're not a passive object being operated on. You're a person who's trusted me with your body, and that trust demands complete honesty.

What this means in practice

If a complication occurs during or after your surgery, here's what will happen:

1. 1. You will be told promptly.
2. 1. I won't wait for a convenient moment or hope you don't notice. If you're still in hospital, I'll speak to you face-to-face as soon as you're awake and lucid enough to understand. If the complication is discovered later, I'll contact you directly.
3. 1. I will explain what happened in clear language.
4. 1. Not medical jargon designed to obscure, but plain explanation of what went wrong, why it might have happened, and what it means for you.
5. 1. I will take responsibility.
6. 1. If the complication was a direct result of something I did (or failed to do), I will say so. If it was an unavoidable risk that materialised despite proper technique, I'll explain that too. You deserve to know the difference.
7. 1. I will outline what we're going to do about it.
8. 1. Most complications can be managed. I'll explain the plan for fixing the problem, the likely timeline for recovery, and what additional treatment (if any) might be needed.
9. 1. I will apologise when appropriate.
10. 1. If you've suffered harm, distress, or inconvenience because something went wrong during your care, you deserve an apology. Saying sorry isn't an admission of negligence — it's basic human decency.
11. 1. You can ask questions, and I will answer them.
12. 1. You might be shocked, upset, or angry. Those are all reasonable responses. Ask whatever you need to ask, and I'll answer honestly, even if the answers are uncomfortable for me.

The difference between complications and errors

It's important to understand that most complications are not errors. They're recognised risks of surgery that can occur even with perfect technique.

• • A complication
• • is when a known risk of the procedure occurs. For example, post-operative bleeding, infection, or delayed wound healing. These are possibilities we discuss beforehand.
• • An error
• • is when something goes wrong because of a mistake — wrong site surgery, using the wrong medication, operating on the wrong patient, leaving an instrument inside, or technical errors in performing the procedure.

Errors are rare, but they can happen — surgeons are human. When they do occur, the duty of candour is even more critical, because the patient deserves to know that this wasn't an unavoidable risk but a preventable mistake.

But here's what matters: whether the problem is a complication or an error, you will be told. I don't differentiate between "things I legally have to disclose" and "things I can get away with not mentioning." If it happened during your care, it's your right to know.

What if you're not happy with how a complication was managed?

You have every right to question decisions, ask for a second opinion, or raise concerns if you feel a complication wasn't handled properly. This doesn't damage our relationship — it's part of being an active participant in your own care.

If you want to make a formal complaint, you can do so through the hospital's complaints procedure (for NHS care) or through the clinic management (for private care). You can also contact the Care Quality Commission (CQC) or, if you believe there's been serious professional misconduct, the General Medical Council (GMC).

I hope it never comes to that, but knowing your rights and the avenues available to you is important. Good doctors aren't threatened by accountability — we welcome it.

My commitment to you:

Complications are part of surgery. They cannot be eliminated entirely, no matter how skilled the surgeon or how careful the technique. What can be controlled is how we respond when they occur.

I promise you complete honesty, timely communication, and every effort to put things right if something goes wrong. That's not because of regulatory duty — it's because it's the only way I know how to practice medicine.

The key thing to remember: surgery is a partnership. Your job is to follow instructions, report problems early, and be patient with your body as it heals. My job is to perform the operation expertly, anticipate problems, support you through recovery, and tell you the truth — always, and completely.

Depending on where you are in your journey, you might need different types of information. Use the pathway that best fits your current situation.

1. I already know the name of my surgery

For example: circumcision, varicocele repair, TURP, penile implant, sperm retrieval...

Browse the comprehensive procedure list below, or use the quick links to jump directly to your operation's dedicated guide.

Jump to procedure list

2. I've been told I might need surgery, but I'm not sure which one

This is very common. It's often easier to start from the condition or symptom:

• • Urinary symptoms (weak flow, frequency, urgency)
• • Penile curvature or pain
• • Tight foreskin or frenulum problems
• • Varicocele and groin discomfort
• • Male fertility concerns

From each condition page, you'll see the possible surgical options clearly explained, including when we don't recommend surgery.

Browse by symptom

3. I'm preparing for an upcoming operation

If your surgery is already booked (or very likely), focus on:

• • Pre-operative instructions specific to your procedure
• • What to bring on the day
• • How to prepare at home (practical and emotional)
• • What the first days and weeks will realistically look like

You'll find this in the relevant procedure page and the general recovery guidance sections.

See what happens on the day

4. I've already had surgery

If you've recently had an operation with me, you may want:

• • Reassurance that your recovery is on track
• • Guidance on pain, swelling, bruising or stitches
• • Reminders about restrictions and "green light" moments
• • Clarity on when to get in touch urgently

Go directly to the recovery section of your specific procedure page, or use the follow-up care hub if you're unsure where your question sits.

See when to seek urgent help

These operations already have dedicated, in-depth pages on this site. Each guide usually includes: what the procedure is for, who it may help (and who it probably won't), how it's performed, anaesthetic options, risks and potential side effects, what to expect from recovery, and when to worry and when not to.

Penis & foreskin procedures

Circumcision (adult)

Surgical removal of the foreskin, typically performed for tight foreskin (phimosis), recurrent infections (balanitis), or specific medical or personal reasons.

Common reasons: Phimosis unresponsive to steroid cream, recurrent balanitis, paraphimosis, lichen sclerosus.

Read the full circumcision guide

Frenuloplasty

Surgery to release or reconstruct a short, tight, or painful frenulum (the band of tissue connecting the foreskin to the glans).

Common reasons: Frenulum tearing during sex, painful erections, difficulty retracting foreskin, sexual discomfort.

Read the full frenuloplasty guide

Peyronie's disease surgery

Surgical options for significant penile curvature with functional impact, including plaque excision with grafting or plication procedures.

Common reasons: Curvature preventing intercourse, significant deformity causing distress, failed non-surgical treatment.

Read the Peyronie's disease guide

Scrotum, testicles & fertility procedures

Varicocele surgery (microsurgical varicocelectomy)

Microsurgical repair of enlarged veins in the scrotum, performed for symptomatic varicocele and/or impact on fertility.

Common reasons: Abnormal semen analysis, testicular pain or heaviness, visible or palpable varicocele affecting quality of life.

Read the varicocele surgery guide

Sperm retrieval procedures

Surgical extraction of sperm directly from the testicles or epididymis for men with azoospermia (no sperm in ejaculate), in collaboration with fertility teams.

Techniques include: PESA, TESA, micro-TESE depending on the cause of azoospermia and individual circumstances.

Read the fertility & sperm retrieval section

Prostate & bladder outlet procedures

Surgical options for BPH / LUTS

Operations for bothersome lower urinary tract symptoms related to prostate enlargement or bladder outlet obstruction.

Procedures may include: TURP, laser prostatectomy, Aquablation, or bladder neck incision, depending on prostate size and specific circumstances.

Read the LUTS & BPH surgery overview

Erectile dysfunction procedures

Penile implant surgery

Insertion of an inflatable or malleable prosthesis for severe, treatment-resistant erectile dysfunction where tablets and injections are no longer effective or appropriate.

Common reasons: Failed response to all other ED treatments, post-prostatectomy ED, significant vascular disease, Peyronie's with ED.

Read the erectile dysfunction & penile implant section

Didn't find your procedure here?

The list above represents operations with full, dedicated guides. If you're looking for information on a less common procedure, check the "Other procedures" section below, or contact us directly for specific guidance.

Some operations are less common or don't yet have a full standalone page on this site. They still deserve a clear, honest explanation. Below you'll find shorter guides which can grow into full pages if needed.

These mini-guides provide an overview. If you're considering any of these procedures, we'll discuss your specific situation in much greater detail during consultation.

Will surgery affect my sex life or fertility?

How long will I need off work?

Is delaying surgery dangerous?

Can I change my mind after agreeing to surgery?

What if my symptoms come back after surgery?

Do I need someone with me on the day of surgery?

Will I be in pain after surgery?

Myth: "If surgery is mentioned, it means things are bad"

Reality: Surgery is often discussed early so decisions are informed, not rushed. Mentioning surgery as an option doesn't mean it's urgent or that you're in serious trouble — it means we're having a complete conversation about all available treatments.

Myth: "Once you have surgery, there's no going back"

Reality: Many procedures are reversible, adjustable, or staged. For example, a penile implant can be removed if needed, bladder neck incision can be repeated, and even vasectomy can be reversed. Some operations are indeed permanent (like orchidectomy), but I'll always be clear about what can and cannot be undone.

Myth: "Surgery always makes things better"

Reality: Surgery is very effective for the right problem, but it's not magic. Success rates vary by procedure, and some patients don't get the outcome they hoped for. Honest, realistic expectations are crucial — I will never overpromise.

Myth: "Pain after surgery is inevitable and you just have to suffer through it"

Reality: Modern pain control is usually excellent when used properly. You should expect some discomfort, but not agony. If pain is severe or worsening, it's a sign to contact me — not something to "tough out".

Myth: "If I don't have surgery now, I'll regret it later"

Reality: For most non-urgent conditions, delaying surgery to think things over, try other treatments, or wait for a better time in your life is perfectly reasonable. Urgency is the exception, not the rule.

Myth: "Surgeons just want to operate on everyone"

Reality: A good surgeon is just as happy (often happier) when we can avoid an operation. Surgery is a tool, not a goal. If I can solve your problem without surgery, I will. My job is to give you the best outcome, not to fill an operating list.

Myth: "Recovery is always quick if the operation went well"

Reality: Recovery depends on many factors: the operation itself, your age, general health, how well you follow instructions, and sometimes just luck. Two people having identical operations can have different recovery experiences. Patience is essential.

Myth: "I can't ask questions once I've signed the consent form"

Reality: You can ask questions at any time, even after signing consent. If something is unclear or you've thought of new concerns, bring them up. Good surgeons welcome questions — they show you're engaged and thinking carefully.

Myth: "Private surgery is always better than NHS surgery"

Reality: The surgeon's skill and experience matter far more than the setting. Many excellent surgeons work in both NHS and private practice. Private care offers convenience, faster access, and nicer surroundings, but the actual surgery and outcomes are determined by the surgeon's expertise, not the payment model.

Myth: "Complications only happen if the surgeon makes a mistake"

Reality: Complications can occur even with perfect technique. The human body is complex and sometimes unpredictable. Infection, bleeding, or slow healing can happen despite meticulous surgery. What matters is how complications are recognised, communicated, and managed.