Frequently asked questions

No — you can self-refer directly without a GP letter for all private consultations. Many patients come having already received a scan or test result from their GP and wish to discuss next steps, while others present with symptoms they want assessed directly. Both are entirely appropriate. If you do have a referral letter or existing investigation results, please bring them to your appointment as they can be very helpful in directing your assessment efficiently.

Same-week appointments are usually available, particularly for urgent concerns such as blood in the urine, a raised PSA, or a newly identified mass on imaging. Mr Sri sees patients across three London private hospital locations — Spire St Anthony's in Cheam, Nuffield Parkside in Wimbledon, and HCA Princess Grace in Marylebone — which gives considerable flexibility for appointment timing.

If your concern is urgent, please note this when booking and the team will prioritise accordingly.

It is helpful to bring:

• Any recent blood test results, including PSA or kidney function tests
• Imaging reports or scan discs (ultrasound, CT, MRI) — even if from another provider
• Any previous biopsy or histology results
• A list of your current medications
• Your GP referral letter, if you have one
• Your insurance details and authorisation number, if applicable

If you are attending for a urology assessment, producing a urine sample on arrival at the hospital may be requested — it is worth attending with a comfortably full bladder.

Your first consultation will typically last between 20 and 30 minutes. It begins with a detailed discussion of your symptoms, medical history, and any previous investigations or treatments. A physical examination may be performed where clinically appropriate.

By the end of the consultation, you will have a clear understanding of what investigations are recommended, what the likely diagnoses are, and what the treatment options look like — including timelines and recovery expectations. There is never any pressure to make an immediate treatment decision; you are encouraged to take time and ask all the questions you need.

Yes — second opinion consultations are actively welcomed. As a subspecialty surgeon who performs robotic prostate cancer surgery, who leads the kidney cancer service across the South West London referral network, and who accepts tertiary referrals from across the UK, second opinion consultations form a significant part of Mr Sri's practice.

Patients most commonly seek second opinions regarding: whether a kidney tumour is amenable to nephron-sparing (kidney-preserving) surgery; whether nerve-sparing prostatectomy is possible for their stage of disease; the choice between treatment options for prostate cancer (Mr Sri specialises in well counselled surgical treatment even in high risk disease, and partakes in clinical trials to this effect within his NHS practise); and whether robotic reconstruction is feasible for complex upper tract or pelvic pathology. All such opinions are given honestly, clearly, and without pressure.

Some outpatient procedures can be arranged at or shortly after your initial consultation. Flexible cystoscopy — a camera examination of the bladder performed under local anaesthetic — is commonly arranged as a closely following outpatient appointment. Urine tests, blood tests, and flow rate tests can usually be performed on the same day.

More complex procedures such as transperineal prostate biopsy, robotic surgery, or laser prostate treatment require separate booking and pre-operative assessment, but can usually be arranged promptly.

Robotic-assisted surgery uses the da Vinci surgical system — a platform that translates the surgeon's precise hand movements into scaled, tremor-filtered motions of small instruments inside the body, through tiny keyhole incisions. The surgeon controls everything from a console with three-dimensional, high-definition magnified vision and wristed instruments that have a greater range of motion than the human hand.

Compared with open surgery, robotic surgery offers significantly less blood loss, less post-operative pain, a lower risk of infection, and a faster return to normal activity. Compared with conventional laparoscopic (keyhole) surgery, it provides superior precision for fine suturing and dissection — particularly important in nerve-sparing prostatectomy, nephron-sparing kidney surgery, and upper tract reconstruction.

Mr Sri performs over 200 robotic procedures annually and leads the RCS-accredited robotic surgical fellowship at St George's University Hospital.

The majority of patients requiring kidney cancer surgery, prostate cancer surgery, or urological reconstruction are suitable for robotic-assisted surgery. Suitability depends on the individual clinical picture — including tumour size, location, stage, kidney function, and general health — and is determined at consultation following a review of your imaging and relevant investigations.

Mr Sri specifically accepts patients who have been told elsewhere that their tumour or condition is not amenable to robotic or minimally invasive treatment. A significant proportion of his practice involves complex cases that have been declined for nephron-sparing surgery at their original referring centre, and for whom robotic kidney-preserving surgery is found to be feasible upon specialist review.

Recovery varies by procedure, but most patients undergoing robotic surgery with Mr Sri are mobile on the day of surgery or the following morning, eating normally within hours, and discharged after one to two nights in hospital. The majority return to light daily activities within one to two weeks and to their full normal routine within two to four weeks.

• Robotic partial nephrectomy: median hospital stay 1 day. Return to normal activity 2–3 weeks
• Robotic radical prostatectomy: discharged after 1 night. Catheter for approximately 1 week. Return to normal 2–4 weeks
• Robotic pyeloplasty or ureteric reconstruction: 1–2 nights. Ureteric stent in situ for 4–6 weeks

These timelines compare favourably with open surgical equivalents, which typically require 5–7 days in hospital and 8–12 weeks of recovery.

All surgical procedures carry a risk of complications, and robotic surgery is no exception — but the complication profile is generally more favourable than open or conventional laparoscopic surgery for the same procedures. Risks specific to each procedure are discussed in detail at consultation and again at your pre-operative assessment, and informed consent is obtained on both occasions.

General risks of any robotic urological surgery include bleeding, infection, adjacent structure injury, anaesthetic complications, and deep vein thrombosis. Procedure-specific risks — such as urinary leakage after partial nephrectomy, or continence and erectile function after prostatectomy — are discussed in full on the relevant condition pages and in consultation.

Mr Sri's personal complication data: 97% trifecta achievement (major complications) in robotic partial nephrectomy, 0% conversion to open surgery in his personal series of robotic prostatectomy, partial nephrectomy, nephroureterectomy & reconstructive procedures to date as consultant.

The first step is a specialist consultation to review the imaging in detail. Most renal masses require further characterisation — typically a dedicated CT or MRI renal protocol & urogram — before a treatment decision is made. Some small kidney lesions are benign (such as cysts or angiomyolipomas), but the majority of solid renal masses are renal cell carcinoma. Even where cancer is suspected, there is rarely an urgent need to rush into surgery before the full clinical picture is clear.

At consultation you will receive a clear explanation of what has been found, what further investigations are needed, and what the likely treatment options are — including whether active surveillance, robotic surgery, or an alternative approach is most appropriate for your situation.

Possibly, yes — and this question is worth asking. Many patients who have been advised that their tumour is unsuitable for nephron-sparing surgery are found to be appropriate candidates for robotic partial nephrectomy when reviewed at a specialist centre with high-volume nephron-sparing experience.

Mr Sri's practice specifically includes patients referred from other centres for this reason. 48% of the kidney tumours he operates on are classified in the highest complexity category (RENAL Nephrometry Score above 10). His conversion to radical nephrectomy rate — meaning cases where kidney-preserving surgery was planned but had to be abandoned — is 0.3% in his personal series. A second opinion before proceeding to kidney removal is always worthwhile.

Preserving kidney function matters not just for today but for decades ahead — reducing long-term risk of chronic kidney disease, cardiovascular disease, and the need for dialysis.

Most robotic kidney surgery is performed through the abdomen — the transperitoneal approach — which requires working around the bowel. The retroperitoneal approach accesses the kidney directly through the back, without entering the abdominal cavity at all. This avoids bowel manipulation entirely, resulting in faster return of gut function, less post-operative bloating, and a smoother early recovery. For tumours situated on the posterior or upper pole of the kidney, it also provides a more direct surgical route.

Mr Sri is one of a small number of surgeons in Europe who performs retroperitoneal robotic partial nephrectomy as their default approach — using this route for the majority of his personal kidney cancer series. He introduced this technique to South West London and has published on its long-term outcomes in the Journal of Robotic Surgery.

A prostate cancer diagnosis can feel overwhelming, but it is important to know that for most men — particularly those with localised disease — there is time to understand your options before making a treatment decision. There is rarely a need to proceed immediately.

The first step is a consultation to review your biopsy result, MRI, and PSA in detail and to explain clearly what the diagnosis means in terms of grade, stage, and risk category. Treatment options — which may include active surveillance, robotic surgery, radiotherapy, or focal therapy depending on your specific situation — are discussed openly, with honest assessments of the benefits and trade-offs of each.

Temporary urinary leakage after prostatectomy is common and expected in the early weeks following catheter removal. The great majority of men achieve good to excellent continence with time and pelvic floor physiotherapy, which begins before surgery and continues in the post-operative period.

The precision of robotic technique — particularly in preserving the urethral sphincter, bladder neck, and surrounding support structures — is a major factor in continence recovery outcomes. 80-90% of men achieve excellent continence outcomes in high volume, subspecialty hands. In Mr Sri's practice, the expectation is that the majority of patients are dry at night and using a single pad for precaution at six weeks post-operatively, which typically places them ahead of the published benchmark curves for continence recovery.

Erectile function recovery after prostatectomy depends on several factors — age, baseline erectile function, and whether nerve-sparing surgery was possible. Nerve-sparing technique — preserving the neurovascular bundles alongside the prostate — is used whenever it is oncologically safe to do so, and robotic precision allows this to be performed with a level of accuracy that open & laparascopic surgery cannot reliably match.

Recovery of erectile function is gradual and can take months to a year or more. Structured penile rehabilitation — starting early after surgery — significantly improves long-term outcomes, and Mr Sri works with specialist andrology colleagues to provide this as part of post-operative care. This is always discussed honestly and in detail at consultation.

Both robotic prostatectomy and radiotherapy are effective treatments for localised prostate cancer, with comparable cancer control rates in most risk categories. The right choice depends on your cancer characteristics, general health, personal priorities regarding side effects, and your preference for the treatment journey.

Surgery and radiotherapy have different side effect profiles — surgery carries risks primarily related to continence and sexual function; radiotherapy carries risks primarily related to bowel and bladder irritation, and sexual dysfunction develops over time. Neither approach is universally superior and both are discussed openly. Where radiotherapy is the preferred path, Mr Sri refers directly to specialist clinical oncology colleagues.

NICE guidance on prostate cancer provides a helpful framework for understanding current UK recommendations.

Not necessarily. PSA (prostate-specific antigen) is elevated in prostate cancer but also in a number of benign conditions — including prostate enlargement (BPH), prostatitis (inflammation), urinary tract infection, and vigorous exercise shortly before the test. A raised PSA is an important signal that warrants specialist evaluation, but it is not in itself a diagnosis of cancer.

The recommended pathway for a raised PSA involves a multiparametric MRI (mpMRI) of the prostate first, followed by targeted transperineal biopsy of any suspicious areas if the MRI indicates this is necessary. This approach — which Mr Sri follows in his practice — minimises unnecessary biopsies while ensuring accurate diagnosis where cancer is present.

Mr Sri offers the complete range of modern BPH surgical treatments and discusses all options openly at consultation. The choice between procedures depends on prostate size, symptom severity, your priorities regarding ejaculatory function and recovery, and your fitness for general or local anaesthetic. The main options are:

• Rezum (water vapour therapy) — ejaculatory-preserving, day case, local anaesthetic. Best for prostates 30–80ml
• Aquablation — robotic waterjet, low ejaculatory risk, overnight stay. Suited to prostates 60–150ml
• Greenlight laser (PVP) — day case, preferred for men on blood thinners
• TURP — gold standard, overnight stay, longest follow-up data
• HoLEP — highest symptom improvement rate (90–95%), best for large prostates above 80ml, overnight stay

The effect on sexual function varies by procedure. Traditional BPH procedures such as TURP carry a significant risk of retrograde ejaculation — where semen passes into the bladder rather than externally during orgasm. This is not harmful but may be important for men who wish to preserve natural ejaculation or fertility.

Ejaculatory-preserving procedures — notably Rezum and Aquablation — are specifically designed to minimise this risk and are appropriate options for men for whom ejaculatory function is a priority. Erectile function is generally not significantly affected by BPH surgery. These considerations are discussed in detail at consultation so the choice of procedure is aligned with your personal priorities.

Blood in the urine — whether visible to the naked eye or detected on a dipstick test — always warrants specialist investigation. Most causes are benign, such as urinary tract infection, kidney stones, or benign bladder conditions, but haematuria can also be an early sign of bladder cancer or kidney cancer, which is why it must not be dismissed or left uninvestigated.

Mr Sri offers a structured haematuria assessment pathway that follows NICE guidelines, including urine tests, upper tract imaging, and flexible cystoscopy (camera examination of the bladder). Same-week appointments are available.

Vasectomy is a minor surgical procedure that divides the vas deferens — the tubes that carry sperm — to provide permanent male contraception. Mr Sri performs vasectomy under local / general anaesthetic as a day-case procedure, typically taking 15–30 minutes.

A pre-operative consultation is mandatory before proceeding, to ensure the decision is fully considered. A semen analysis at 12–16 weeks after the procedure confirms success — contraception must be continued until this result is received. Vasectomy must be considered permanent; reversal is possible but cannot be guaranteed to restore fertility.

Recurrent UTIs — defined as two or more confirmed infections within six months, or three or more within twelve months — warrant specialist urological assessment to exclude an underlying structural cause. Repeated antibiotic courses without investigation contribute to antibiotic resistance and do not address the root cause.

A specialist assessment includes urine culture review, post-void residual measurement, upper tract imaging, and flexible cystoscopy to exclude bladder pathology. Where no structural cause is found, evidence-based prevention strategies — including topical oestrogen for post-menopausal women, antibiotic prophylaxis, and non-antibiotic alternatives — are implemented under NICE guidance.

Mr Sri is recognised by all major UK private health insurers, including BUPA, AXA Health, Aviva, Vitality, WPA, and Cigna. Robotic-assisted surgical procedures for kidney and prostate cancer are covered by the majority of policies where treatment is clinically indicated. Complex robotic procedures typically will require a fee uplift from the insurer.

Before your consultation, it is worth contacting your insurer to confirm your cover and to obtain a pre-authorisation reference number where required. The hospital's billing team can assist with any insurance queries relating to your treatment episode.

Yes — self-pay patients are actively welcomed. A fee schedule for consultations and common procedures is available on request. For self-pay surgical patients, a fixed-price package covering the procedure, anaesthetic, and hospital stay is usually available and provides cost certainty before you commit to treatment.

Note that some elements — such as laboratory fees for semen analysis after vasectomy, or histopathology charges — are charged separately by the relevant service and not included in the surgeon's fee. These are always clearly explained in advance.

Yes — all consultations, investigations, and treatments are conducted in full accordance with UK medical confidentiality standards and the GMC guidance on confidentiality. Information is not shared with third parties — including your GP — without your explicit consent, though sharing a letter with your GP is strongly recommended for continuity of care.