London Urology Service
I am a consultant urological surgeon who treats all aspects of urological conditions, with a specialist interest in complex kidney stone disease and Aquablation Therapy for Benign Prostate disease. As a high-volume kidney stone surgeon, I perform a significant volume of endourology procedures annually. Skill and experience are needed to determine who is best served by which treatment.
Kidney stones are a common condition, affecting approximately 1 in 10 people. Most people are asymptomatic unless the stone moves out of the kidney into the ureter (the pipe that connects your kidney to your bladder). This is called ureteric colic and is one of the most painful urological disorders. The pain typically ‘comes and goes’. The pain starts in the loin and radiates to the groin, and you can have nausea and vomiting. It is diagnosed with a low dose non contrast CT scan and, in some cases, may require an operation to remove the stone. However, most small stones (5mm or less) will pass in the urine on their own.
There are many different treatment options for stones, depending on their size and anatomical location. Common treatments include Extracorporeal Shock Wave Lithotripsy (ESWL) or surgical removal called a ureteroscopy and laser fragmentation. For large stones located in the kidney, a Percutaneous Nephrolithotomy (PCNL) is required.
For dietary advice on reducing the risk of kidney stones, please read the information leaflet download available on the button below.
Urinary symptoms are common in both men and women. In men they tend to develop with age as the prostate gland enlarges with age. Common symptoms include inability to store urine in the bladder with frequency, urgency, nocturia (waking up at night to pass urine), incontinence or voiding symptoms with urinary hesitancy, weak stream, straining the abdomen to void, and an intermittent stream or dribbling at the end of the stream.
Urinary symptoms are called ‘LUTS’ (lower urinary tract symptoms). These are investigated by taking a thorough focused medical history. Men may require a prostate examination to assess the size and any significant abnormality, a uroflowmetry test (passing urine into a special toilet) and measuring the volume of urine left in the bladder by performing a bladder scan.
You may also need to complete a bladder diary (recording the type and volume of fluids you drink and documenting every time you pass urine) or a validated symptom score sheet. A Prostate Specific Antigen (PSA), renal function and urine culture test are essential investigations.
Treatments for urinary symptoms range from lifestyle changes, (eg drinking less tea, coffee or alcohol), to medication, through to surgical options (I offer Aquablation Therapy and TURP – Transurethral Resection of the Prostate).
I would recommend looking at the British Association of Urologists information on urinary symptoms in men using the button link below.
Foreskin problems can affect any age and are extremely common. A tight foreskin can cause problems with erections or during sexual intercourse.
A tight foreskin can be ‘physiological’ (ie it is not associated with any abnormality of the skin), or it can arise from a skin condition or an infection. Penile cancer is very rare.
A circumcision is required for an extremely problematic foreskin or those with a chronic inflammatory condition that has not improved with steroid creams.
Blood in the urine can be non-visible (which is found on the urine dipstick test commonly performed at the GP surgery) or visible blood, which is blood that you can see in the urine. It can be alarming.
Non-visible blood is present in around 2.5% of the population without any concern. Several benign conditions can cause it. It is normal to investigate non-visible blood with an ultrasound scan of the kidneys and bladder, and with direct inspection of the bladder (flexible cystoscopy). Not all non-visible blood needs to be investigated urgently.
However, visible blood, especially in those over the age of 45, should be investigated and you will require a CT scan to look for pathology in the kidneys and ureter and a flexible cystoscopy to inspect the bladder. If a bladder tumour is identified, an urgent procedure is required to remove it endoscopically.
The Prostate is one of four accessory sex glands in a male. It surrounds the urethra (the tube that carries urine from the bladder). Its main function is the production of nutrients (zinc and citrate), which help with survival of the male sperm. It grows as you get older leading to lower urinary tract symptoms.
Prostate cancer is the most common cancer in men. It accounts for 27% of all new cancer diagnoses in men in the UK. Survival rates for prostate cancer are excellent. A PSA blood test is performed to indicate if there might be an abnormality in the prostate. However, it can be raised in several conditions, including infections of the urine or within the prostate, in urinary retention or simply due to an enlarged prostate.
To diagnose prostate cancer, a digital rectal examination, MRI scan and a transperineal biopsy of the prostate are usually required. The treatment of prostate cancer is complex, and it is directed depending on the grade and stage of prostate cancer, but also individual factors need to be considered.
For more information on risks, symptoms, prostate cancer tests, diagnosis and treatments, I would recommend visiting Prostate Cancer UK on the button below.
Urinary tract infections (UTIs) are very common, especially in women. Most UTIs are treated by the GP. If the UTIs are recurrent or persistent, you may be required to see a urologist. Other causes of UTIs include poorly emptying bladders, kidney stones and structural kidney conditions. UTIs usually present with cystitis symptoms which include pain in the lower abdomen, on passing urine, frequency and urgency, and smelly urine. Sometimes you may see blood in your urine.
Some UTIs can cause a kidney infection, which is called pyelonephritis. You may develop a temperature with rigors (shaking), pain in the kidney region, vomiting, and cystitis symptoms; this is considered a more serious infection.
To confirm a urine infection, a dipstick urine test is performed and the urine should be sent to the laboratory for a culture to see which type of bacteria is causing the infection.
I would recommend visiting the British Association of Urologists information page on UTIs using the button below.
Testicular lumps are mostly benign. Epididymal Cysts arise from a structure called the epididymis. These can feel like lumps on the testicle. A hydrocele is fluid around the testicle. To investigate testicular lumps and swellings an ultrasound scan is required. This is extremely sensitive at diagnosing testicular lumps. Not all lumps and swellings need treatment.
Sometimes a urinary infection or a sexually transmitted infection can cause testicular swelling and pain. This is called epididymo-orchitis.
Testicular cancer is the commonest cancer in men aged between 20 and 50 years. It is rare in men over the age of 50. Risk factors for testicular cancer are a history of an undescended testicle and a family history of testicular cancer. The treatments for testicular cancer are extremely effective and around 95% of men survive.
For more information on testicular lumps and how to self-examine, please see the British Association of Urologists information page on the button below.
You have two kidneys located at the back of the upper abdomen. They essentially filter the blood, but they also play a vital role in keeping the body in a steady state. Urologists treat structural abnormalities of the kidney.
Kidney cysts are extremely common amongst the general population and perhaps up to a third of people over 50 develop them. Kidney cancer is the 7th most common cancer, with an average of 13,000 new cases a year in the UK.
Risk factors include smoking, obesity, high blood pressure and a family history of the disease. Most kidney cancers are found incidentally on scans investigating other conditions but can present with loin pain and blood in the urine. The most common treatment for kidney cancer is surgical removal (nephrectomy).
Pelvic Ureteric Junction (PUJ) obstruction is a blockage at the point where the renal pelvis (the funnel-shaped part of the kidney) connects to the ureter (the tube that carries urine to the bladder). This blockage can slow or stop the flow of urine, potentially leading to kidney damage. It’s a common cause of urinary obstruction in children, but can also occur in adults.
Aquablation therapy is an innovative minimally invasive robotic procedure for treating Benign Prostatic Hyperplasia (BPH) that uses a heat-free, image-guided water jet to remove prostate tissue.
Unlike traditional procedures, Aquablation removes excess prostate tissue without using heat, which may reduce the risk of certain side effects.
The best way to schedule an appointment is to make contact with Mr Ajayi’s PA, Simi Balogun, by email or on 020 7432 8333. Alternatively, please fill in this form and we’ll be in touch right away.
