What I Do — and How We Get There Together

Whether you're considering surgery or already planning it with me, this page tells you exactly what the process involves — from first conversation to follow-up. No surprises, no small print.

I want you to understand how decisions are made, what happens at every stage, and what your role is in this process. Because surgery is something we do together, not something that happens to you.

The Golden Rule

If you are unsure whether you want surgery, I am sure I will not go ahead.

Uncertainty is not a problem to solve — it's part of the decision. If you leave my clinic still thinking about it, that's not a failure — that's the process working exactly as it should.

Procedures I Perform

I carry out a range of urological and andrological procedures at Chelsea & Westminster Hospital and Nuffield Health Highgate. Each has its own dedicated page with full clinical detail.

Procedures I Perform

Penile & Foreskin

Usually considered for tight foreskin, recurrent infections, scarring, or discomfort during sex. Adult Circumcision · Frenuloplasty

Erectile Dysfunction & Peyronie's

For curvature, erectile dysfunction not responding to medication, or structural changes affecting function. Penile Implant · Nesbit Procedure · Lue Procedure

Testicular & Scrotal

For varicocele causing pain or fertility concerns, or when you've decided on permanent contraception. Microsurgical Varicocelectomy · No-Scalpel Vasectomy

From Consultation to Operating Theatre

Most patients ask the same question: what actually happens between "I think you might need surgery" and the day itself?

Here's the full pathway, step by step. It's designed to give you control, time, and clarity at every stage.

Costs and Insurance

Transparent pricing

I see both insured and self-pay patients, and I'm transparent about costs from the outset. For most procedures, I can give you a clear estimate before you commit to anything.

If you're insured: Your insurance company is billed directly. Depending on your policy, they may cover the full cost, a portion of it, or the full cost minus a fixed amount called an excess. Once your insurer has paid, you will receive a bill only for any outstanding balance.

If you're self-funding: For some selected procedures, I offer a package price that covers the surgical fee, theatre time, and anaesthetist in a single amount. Alternatively, you may receive two or three separate bills — from me, from the hospital, and (if applicable) from the anaesthetist. I'll explain which arrangement applies to your procedure before you commit. You can find more on my practice transparency page or ask Sara.

Financial surprises have no place in surgical care.

The Day of Surgery

Admission and Timing

Your admission time appears on your Carebit booking and in the hospital's own invitation letter. If there's ever a mismatch, the hospital's instructions take priority — they manage the theatre schedule on the day.

Fasting rules

General anaesthetic or sedation: No food for 6 hours and no clear fluids for 2 hours before your scheduled time. The hospital will give you exact timings.

Local anaesthetic: No fasting needed. Eat and drink as normal.

Escort: If you're having a day-case procedure under GA or sedation, you need a responsible adult to take you home. You cannot drive yourself or take public transport alone.

Arrival and the Wait

When you arrive, you'll be admitted to the ward or day-case unit. I see every patient before their operation — but I can only do ward rounds before the morning session and before the afternoon session. If there are several patients on the list, there will be a wait. This is normal, and it's part of ensuring each patient is properly reviewed. I appreciate your patience — the same thoroughness you'd want for your case is what I give to each patient before you.

The Consent Process

Consent

By the time you reach the day of surgery, you'll already have received detailed written information about your procedure, we'll have discussed it at length in clinic, and you'll have had time for follow-up questions.

The formal consent works slightly differently at each hospital:

During Your Stay

Family and Visitors

- Chelsea & Westminster:
- Family members can wait in the private wing lounge and visit you on the ward after your procedure.
- Nuffield Health Highgate:
- Family members are welcome on the ward and can see you as soon as you're back from recovery.

If Plans Change

Occasionally, a planned day-case becomes an overnight stay. This might happen because the surgery was more involved than anticipated, because you need closer monitoring, or simply because you're not feeling well enough to go home safely. This is a clinical decision made entirely for your safety — the hospital will accommodate you, and I'll explain exactly what's happened and why.

Post-Operative Care on the Ward

I review every patient after their operation. If I've already left the hospital, a resident doctor provides on-site cover and I remain available by phone. You are never without medical support.

When Something Goes Wrong

If a complication occurs — whether during surgery or afterwards — I will tell you directly, honestly, and without delay. This is the duty of candour: you have the right to know what happened, why it happened, and what we're doing about it. This is non-negotiable, and it's how I practise.

Going Home

Discharge

When the clinical team is satisfied you're ready, you'll be discharged with take-home medications (TTOs) and a clear post-operative plan covering wound care, dressings, catheter management if applicable, and when you can resume driving, work, and exercise.

A practical point about pain relief

Paracetamol should be taken as 1 gram — that's two standard 500mg tablets — not a single 500mg tablet. This is one of the most common mistakes I see. I generally recommend taking it three times a day for the first few days, staying ahead of the pain rather than waiting for it to arrive. It's far more effective that way.

Warning Signs — When to Contact Me

Emergencies

Emergency care

During your hospital stay:

- Chelsea & Westminster
- has every level of emergency care on site — intensive care, interventional radiology, 24-hour surgical cover. If something goes wrong during your admission, you're in the right place.
- Nuffield Health Highgate
- has excellent on-site emergency protocols. In the rare event of a serious complication requiring multi-specialty intervention, you may be transferred to the Whittington Hospital.

After discharge:

If it is an emergency, call 999 or go to the nearest A&E straight away. Do not wait until you can reach me. An emergency means:

- bleeding that does not stop with firm pressure
- a high temperature with shivering, or feeling very unwell
- being unable to pass urine
- severe pain or swelling, or pain or swelling that is getting rapidly worse

Tell them which operation you had, the date, and that they can contact my team.

If it is not an emergency but you develop a problem after going home and you cannot reach me directly, go to Chelsea & Westminster or Nuffield Health Highgate in person. The teams there know me, they can access your notes, and they can contact me.

Follow-Up

Wound Checks and Photos

For wound reviews between scheduled appointments, I use Carebit's secure photo messaging. You take a photo and send it directly to me through the platform — not to an admin team, not to a generic inbox. This matters because post-operative photos can be sensitive, and I want them handled properly.

What Follow-Up Includes

- Wound care

— dressing changes, clip or suture removal if needed

- Histology

— if tissue was sent for analysis, I discuss the results with you personally and in detail

- Additional consultations

— if you have questions, unexpected symptoms, or just want reassurance, you can request an extra appointment at any time

- Outcome confirmation

— a follow-up to confirm resolution, assess recovery, or plan next steps if something needs ongoing attention

A Quick Call When That's All You Need

For simple, specific questions after your procedure — "Can I fly next week?", "Is this bruising normal?", "When can I go back to the gym?" — I will usually offer you a brief phone call at no charge. If the question turns out to need a proper clinical review or a longer conversation, a virtual consultation may be a better option, and I'll suggest that.

Frequently Asked Questions

It depends on the procedure. A vasectomy or frenuloplasty under local anaesthetic typically takes 20–40 minutes. A microsurgical varicocelectomy takes around 60–90 minutes. A TURP usually takes 45–60 minutes. I'll give you a clear estimate during your consultation — and the time you spend in the hospital is always longer than the time in theatre, because of preparation and recovery.

If you develop a fever, chest infection, vomiting illness, new urinary symptoms, or anything that makes you think you may not be fit for surgery — contact us as soon as possible. It is much better to flag this early than to turn up on the day and have the operation cancelled. A short postponement is always preferable to proceeding when your body isn't ready.

Not always. Many of my procedures can be done under local anaesthetic or sedation. The choice depends on the procedure, your medical background, and your preference. We'll discuss this together, and if there's any doubt, I plan for general anaesthetic so we're prepared for any eventuality.

Most of my operations are day-case — you arrive in the morning and go home the same afternoon or evening. A few procedures require an overnight stay, and occasionally a day-case converts to an inpatient stay if the clinical situation requires it. I'll always tell you what to expect in advance.

Not Sure Where to Start?

If you've been told you might need surgery and you're not sure what's involved — or even whether it's the right option — the first step is always a consultation. No commitment, no pressure — just a thorough assessment and an honest conversation.

Even if you're just exploring whether surgery is right for you.

Ready when you are.

Book a consultation or call Sara to discuss your options.

Book a consultation

When sperm retrieval is needed for assisted reproduction — including cases of azoospermia or failed vasectomy reversal. TeSE / Micro-TeSE

For urinary obstruction from an enlarged prostate that hasn't responded to medication. TURP

Investigations that involve a procedure — usually done in clinic or as a day-case. Flexible Cystoscopy · Penile Doppler Ultrasound

Every surgical journey starts with a proper consultation. We discuss your symptoms, your history, your concerns, and all your options — including doing nothing.

I will never book you for surgery at your first appointment. The only exceptions are genuine emergencies, suspected cancer, or situations where delay would cause you harm. For everything else, you go home with information and take the time you need.

This is your time. There is no clock ticking, no slot expiring, no pressure.

Most patients make their decision within a few weeks — but there is no fixed timeline. Some take longer, and that's completely fine. I encourage you to write down questions as they come up, talk things through with someone you trust, and re-read the information I've given you. If new questions surface, you can email me or book a brief follow-up — whichever feels easier.

When you're ready to proceed, we confirm together — whether at a follow-up appointment, over email, or by phone. Surgery happens only when we're both confident it's the right step.

If at any point you change your mind, that's completely fine. A cancelled operation is never a problem — an unwanted one always is.

Once we've agreed on surgery, I complete an internal request that my PA, Sara, can see. You don't need to go through me — you can contact Sara directly to find a date that works for you. She coordinates between you and the hospital, and she's very good at it.

Most of my procedures are day-case — you arrive in the morning and go home the same day. Some operations require an overnight stay (inpatient admission). I'll always tell you which applies, and there's flexibility if your circumstances or the clinical situation change on the day.

Depending on the procedure, you may have:

- Local anaesthetic (LA)
- — you're awake, the area is numbed. Used for vasectomy, some frenuloplasties, flexible cystoscopy.
- Sedation
- — you're relaxed and drowsy but breathing on your own. Often combined with LA.
- General anaesthetic (GA)
- — you're fully asleep. Used for most larger procedures.

Your comfort and safety are the priority — the anaesthetist's entire role is to monitor and adjust this moment by moment. If there's any doubt about which type you'll need, I plan for general anaesthetic. It's always better to be prepared for GA and step down to something lighter on the day than the reverse.

Before your surgery date, the hospital arranges a pre-operative assessment. This typically involves:

- A nursing interview covering your medical history, current medications, and allergies
- Blood tests, ECG, or other investigations as needed
- Occasionally, a review by a consultant anaesthetist — usually reserved for patients with more complex medical backgrounds

Although this step is run by the hospital team, I remain responsible for your overall care and will coordinate anything that needs attention.

The hospital's admissions team will confirm your date, admission time, and any specific instructions. This comes directly from the hospital, separately from your Carebit booking.

Some procedures require additional steps before the day:

- Surgical Sperm Retrieval (TeSE/Micro-TeSE):
- I'll send you a form that the laboratory needs completed in advance. You'll also need serology blood tests not older than three months — I'll arrange these for you.
- Microsurgical Varicocelectomy:
- I always perform a confirmatory scrotal ultrasound myself before operating. I want to verify the anatomy with my own hands and my own scan, not rely solely on someone else's report.
- Other procedures
- may have their own pre-operative requirements. Everything will be communicated clearly and in good time.

The commonest reasons an operation gets postponed are unexpected illness in the days before, not following fasting instructions, or unresolved medical issues picked up at pre-operative assessment. All of these are preventable — and if anything changes between your POA and the day of surgery, let us know early rather than turning up hoping for the best.

For desk-based work, most patients return within a few days to a week. For physically demanding jobs, it's usually 2–4 weeks depending on the procedure. I'll give you specific guidance in your discharge plan. If you need a fit note for your employer, I can provide one.

You can cancel at any point, for any reason. A cancelled operation is never a problem.

You will see me. I perform all my own operations — I do not delegate surgery to trainees or colleagues without discussing it with you first. I will also see you before the procedure for a final check and after the procedure for a ward round.

Your Health is Our Priority

I'm Having Surgery — What to Expect

What I Do — and How We Get There Together

Procedures I Perform

From Consultation to Operating Theatre

Costs and Insurance

The Day of Surgery

During Your Stay

Going Home

Emergencies

Follow-Up

Frequently Asked Questions

Not Sure Where to Start?

Fertility

Prostate & Urinary

Diagnostics (Procedural)

Step 1 — The Consultation

Step 2 — Reflection

Step 3 — Agreement

Step 4 — Booking

Step 5 — Day-Case or Overnight?

Step 6 — Type of Anaesthetic

Step 7 — Pre-Operative Assessment (POA)

Step 8 — Confirmation

Step 9 — Procedure-Specific Preparation

What Can Delay Surgery

Pre-Theatre Checks

Order of the List

In Theatre

How soon can I go back to work?

What if I change my mind after agreeing to surgery?

Will I see you on the day, or a different surgeon?