Urology

The main areas of clinical and research interest of mine are the following:

Bedwetting and Incontinence

Urinary Tract infections

Bladder Bowel Dysfunction

Neurogenic bladder dysfunction
Undescended Testes
Congenital anomalies of the kidneys and
urinary tract

Hypospadias and Congenital Penoscrotal
Abnormalities
Hydronephrosis
Vesico-ureteric reflux
Idiopathic and Metabolic Stone disease
Disorders of Sexual Development
Sports-related Genitourinary Trauma
Adolescent & Transitional Care Urology
Patient reported outcomes
Quality Improvement and Patient Safety
Value-Based Healthcare Delivery and
Econometrics

Transitional urology is a multi-faceted process designed to facilitate a patient who is able to accept full responsibility for medical decision-making and care, to move to an adult urological care team.

The majority of groups, such as the International Consultation on Urological Diseases, recommend beginning the process of transition at around the 12 years old (or earlier).

This is to provide ampletime for all parties involved to develop the skills and understanding required by age of 16 to 18 years old, depending on the jurisdiction, which in Ireland is 16 years old. The goal of transition is to provide uninterrupted, developmentally appropriate transfer of medical care to an adult – care model.

The main difference in models of care is that the paediatric model involves a large team from different disciplines, led by a single surgeon. The care approach is usually parent-focused with longer consultation times, good access to psychology and regular follow-up appointments. The adult model
is generally a smaller team with sub-specialty interests requiring more outside consultation.

The care approach is patient-focused, with shorter consultation times, less availability of psychology, and longer review intervals.
There is no specific transitional care program in urology in Ireland at present. Therefore, I would be very happy to see any patients of this nature in order to try to smooth this transition.

That is a great question! We are in the process of introducing a robotic system to Ireland for paediatric urology, but it is not currently available. Be assured however that with a combination of classical minimally-invasive open and telescopic surgery, as well as endoscopic surgical procedures, you are
not at a disadvantage in the slightest. I have been involved in writing some of the publications exploring the role of robotics in paediatric urology, and will continue to work with international collaborators, and ensure that our systems and setup is as optimal as possible before doing our first case.

Generally in most paediatric urology settings in the UK and Ireland, young adults are discharged from the paediatric service anywhere between 16-18yo. In Ireland, this tends to be 16yo.

You may not need any follow-up as an adult patient. However if you do, I am fully qualified and licensed to treat adult patients as well, and therefore you would move into my adult congenital clinic.

Don’t worry, I would never discharge a patient who required my continued follow-up.

That is an important, but complicated question. In general, the days of seeing a single surgeon or physician who would be consulted for a number of different conditions is over. Most specialists spend years perfecting their craft on a specific system in the body. In my case, this is the genitourinary system. It is recommended that patients attend a specialist consultant who has done the appropriate specialist training in their area of interest. However, I work very closely with a number of different specialists, with whom I communicate often. If your other condition is outside my field of expertise, I would be very happy to work together with your general practitioner to address this.

This is a very important question. There is no upper age limit, and therefore the question really points at what is the youngest we operate on children in the institutions. Of course, I have operated one babies as young as a day old for various urological emergencies, but in those cases, the risks of not
operating were very high. In general, for elective surgery, we use a cut off of 12 months old and above. Below this, we need to take into account the physiology of the child, and the effect of anaesthesia and medications on their body.

As a surgical team with specialised paediatric anaesthesiologists, we would be happy to operate between 6-12months old if the condition warranted
it, or the operation was time-sensitive (such as orchidopexy or hypospadias).

There is generally no indication to operate below 6 months old except in an emergent or emergency situation. Therefore, the
optimal age is 12months+.

Paediatric urologists are expected to spend 80% of their time looking after paediatric and adolescent urology patients. This is what distinguishes paediatric urologists from adult urologists, or paediatric general surgeons with an interest in urology.

I spend 95% of my time seeing paediatric and adolescent patients. The other 5% is spent seeing adult patients with congenital urological issues. In addition to this I am heavily involved in paediatric urological research, training, education, and leadership.