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St George’s robotic reconstructive urology service treats complex, non-cancerous conditions of the kidney, ureter, bladder and pelvic floor using keyhole robotic surgery. The page explains what the service treats, who it’s for, and how patients can be referred, including for second opinions on cases that have proven difficult to manage elsewhere.

Service overview

St George’s set up its robotic reconstructive urology service in 2008. It is one of the longest-running and highest-volume services of its kind in the UK.

We use the da Vinci® robotic system to carry out keyhole surgery for complex problems affecting the kidney, ureter, bladder and pelvic floor. Many of these problems have traditionally needed open surgery, with a larger cut and a longer recovery. Robotic surgery offers patients a minimally invasive alternative, even for cases that other centres may find too complex for keyhole treatment.

We have a unique expertise in extraperitoneal (space behind the abdomen) pelvic and upper tract robotic surgery and are a national referral centre for conditions that require management through this approach. This approach results in a faster recovery for patients compared to traditional minimally invasive routes.

We treat four main groups of conditions:

Upper tract conditions (kidney and ureter) – led by Denosshan Sri

  • Pelvi-ureteric junction (PUJ) obstruction, treated with robotic pyeloplasty
  • Recurrence of PUJO, upper tract stricture or long or complex ureteric strictures, treated with buccal mucosal graft ureteroplasty
  • Scar tissue around the ureter (retroperitoneal fibrosis), treated with robotic ureterolysis
  • Non-functioning / complex benign kidney conditions (including stone disease)
  • Adrenal gland tumours and paraganglioma, treated with robotic adrenalectomy & retroperitoneal lesion excision

Pelvic conditions (bladder and ureter) – led by Rami Issa

  • Ureteric stricture disease, treated with robotic ureteric reimplantation, including Boari flap reconstruction
  • Extensive loss of the ureter, treated with robotic ileal ureter (ileal chute) reconstruction
  • Bladder diverticula, treated with robotic diverticulectomy
  • Large, non-cancerous prostate enlargement, treated with robotic Millin’s prostatectomy.
  • Abnormal connection between bowel/vagina and the urinary system (fistula) – treated with robotic fistula repair

Urinary Incontinence Surgery – led by Jai Seth

  • Stress urinary incontinence in women, managed with robotic colpo-suspension or robotic artificial urinary sphincter, including revision surgery for women who have had previous incontinence surgery that has not worked.
  • St George’s pioneered this technique in the UK and carries out more of these procedures than any other single centre in the country.

Post Radiotherapy Complications

  • We also have subspecialty experience in treating urinary complications that can follow pelvic and abdominal radiotherapy, affecting the bladder, ureter or kidney, using robotic surgery.
  • These cases can be complex because of tissue changes caused by radiotherapy, and we manage them with input from the wider multidisciplinary team, including robotic gynaecologists and colorectal surgeons.
  • We offer both reconstructive surgery in the post radiotherapy setting, and salvage completion surgery.

Who the service is for

This service is for adult patients with:

  • A non-cancerous problem affecting the kidney, ureter, bladder or pelvic floor that needs surgery
  • A urological problem following previous pelvic or abdominal radiotherapy
  • Salvage surgery following previous pelvic or abdominal radiotherapy
  • Stress urinary incontinence, including women whose previous incontinence surgery has not worked
  • A complex or previously treated (redo) reconstructive problem that another hospital has found difficult to manage, or has said is not suitable for keyhole surgery

We accept second opinion and tertiary referrals from across the UK.

How to access the service

Patients are referred to us by their GP or another hospital consultant. We cannot accept self-referrals.

GP and clinician referrals and second opinions:

Please email urology.enquiries@stgeorges.nhs.uk, marked for the attention of:

  • Pelvic reconstruction queries — FAO Mr Rami Issa
  • Upper tract reconstruction queries — FAO Mr Denosshan Sri
  • Female incontinence queries – FAO Mr Jai Seth

Please include relevant imaging, previous operation notes, and a summary of the problem so we can advise on the most appropriate next step.

Contact details

Main urology enquiries: urology.enquiries@stgeorges.nhs.uk

Trust switchboard: 020 8672 1255

Key staff or team members / Clinicians (Optional)

Pelvic reconstruction team

  • Mr Rami Issa
  • Miss Andrea Tay
  • Mr Denosshan Sri

Upper tract reconstruction team

  • Mr Denosshan Sri
  • Mr Pieter le Roux

Female Incontinence Surgery

  • Mr Jai Seth
  • Mr Roger Walker

Benign Specialist Nursing Team

  • Jundy Llamido
  • Lidia Assefaw

Patient information leaflets or documents

BAUS Patient Advice Leaflet for Ureteric Reconstruction – https://www.baus.org.uk/_userfiles/pages/files/patients/leaflets/Ureteric%20reconstruction.pdf

BAUS Patient Advice Leaflet for Pyeloplasty –

https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Pyeloplasty%20lap.pdf

BAUS Patient Advice Leaflet for Ureterolysis

https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Ureterolysis.pdf

BAUS Patient Advice Leaflet for Fistula Repair

https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Vaginal%20fistula%20abdominal.pdf

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