London is a unique destination for all patients with urological conditions. Clinical and academic urology is well represented in London. All the university-based urology departments have flourished over the past 10 years, and larger groups of clinicians have fostered rapid subspecialisation, against a background of strong academic portfolios.
Such an environment encourages innovation, and in urology this has often been led by technology. Early adoption of research evidence has led to early uptake of multi-parametric MRI scanning in the diagnosis of prostate cancer. More widespread use of any technique in UK National Health Service (NHS) practice clearly benefits the experience of the same clinicians working in private practice. The old adage that volume drives quality is even more important when applied to new diagnostic and therapeutic techniques. Another example of the early introduction of a novel technology via NHS practice is represented by the Urolift system for treating benign prostatic hyperplasia (BPH). This technique, pioneered and tested in the UK, has just achieved US Food and Drug Adminstration (FDA) approval.
Even in more unusual conditions, cooperation between the public and private sectors can create larger evidence-based practice with outcome measurement. The NHS in England has recently approved micro-testicular sperm extraction in cases of male infertility, due to non-obstructive azoospermia. So, this interface between public and private practice is of often hidden benefit to our private patients.
Most of the Central London university-based NHS providers have substantial facilities for private practice. The private premises at Imperial Private Healthcare offer a comprehensive range of urological treatments, backed by an integrated nephrology and renal transplant service (including renal dialysis) and a large and progressive oncology department.
At the Royal Marsden Hospital in Fulham, which adjoins the Royal Brompton, urological cancer treatments, combining complex open and robotic surgical interventions, aligned with strengths in medical and clinical oncology, have developed rapidly, particularly in the fields of both testicular and renal tumours.
At Guy’s and St Thomas’s, a rapid expansion in the workforce of consultant urologists (numbering 19 in 2017) has allowed further sub-specialisation, and the development of multi-disciplinary working across the sometimes difficult interface of paediatric and adolescent urology. Paediatric cases can be transitioned into specialist adult urological care, and one of the most challenging areas of urological practice, cystinuria, has an international focus at Guy’s, with 200 cases in long-term follow-up.
The theme of multi-disciplinary working has been extended to benign urological conditions in all of the London centres. At St George’s Hospital and University College London (UCLH), the management of patients with urinary tract calculi has correctly achieved more importance, so that endo-urologists, specialised uro-radiologists, nephrologists and microbiologists can combine to plan procedures to achieve better outcomes.
These are important innovations, and have naturally been extended into private practice, so that the private patient arriving in London, referred to one consultant urologist, will have the benefit of a multidisciplinary approach to their condition.
London-based urologists have significant private practices and were some of the first specialists in London to adopt a ‘chambers’ model, in which a group of urologists, who together offer a full range of specialist practice, combine to provide elective and emergency care, often hosted by one of the providers of inpatient and outpatient private care.
HCA Healthcare UK hosts one typical group of urologists in Central London (The London Urology Associates), and other ‘independent’ providers, such as The London Clinic, also offer a broad general urological practice, with an on-call system consisting of London-based consultant urologists.
If the generality of provision of private urological services is both broad and available, what about the ‘super specialists’? London is rich in internationally renowned urological specialists, with leaders in prostate cancer diagnostics and treatment, stone disease, and andrology. Many of these specialists are prominent in the European Association of Urology (EUA), which enriches the opportunities for collaborative research and innovation.
London urologists are also well represented in the United States, where they have made significant contributions to the activities of the American Urological Association. As with many UK-based practices, the urologists can draw from, and contribute to, both the European and North American ‘best practice’ guidelines in urology.
London has a thriving community of consultant urologists, who commit to the four ‘As’ of private practice – we are available, approachable, able and aspirational.