Where do I go?

Please report to reception on Level 2 at the Spire Hospital. A nurse will show you to a seat near Mr Keeley’s consulting room. He will call you in when he is ready to see you.

How long is my appointment?

If it’s your first appointment, it will take approximately 40 minutes. If you have to attend a follow-up appointment, this will last for 20 minutes.

What happens during the consultation?

• When you arrive for your first consultation, you will be asked to provide a urine sample by the nursing staff in outpatients.
• Mr Keeley will take a full medical history from you and ask about your current symptoms.
• He will ask you questions about whether you take any medication or suffer from any illnesses. (It may be an idea to take your medication along or write down the name if you are taking any).
• He will usually perform an examination and look at any scans you may have already had. Please inform Emma (07547475984) if you have had scans done elsewhere so she can ask for them to be imported on to the Spire radiology system.
• He will go through the next step of your treatment; whether this is an x-ray, a flexible cystoscopy, some form of medication or surgery.

What if I need to see Mr Keeley again in the future?

• If you want to come back and see Mr Keeley at the Spire Hospital Bristol, you can make an appointment through the bookings line on 0117 317 1321 or call Emma Price on 07547475984. Emma will ensure that your previous notes are available for your next appointment.

MRI Scan

MRI (Magnetic Resonance Imaging) is a technique that is used to get an internal picture of specified areas of the body.

The MRI scan uses magnetic waves, meaning that there is no exposure to damaging forms of radiation.
You will lie in a large, cylinder-shaped magnet that uses radio waves 10,000-30,000 times stronger than the earth’s magnetic field. The magnet sends differing radio waves through the tissues in the body to show up what types of tissues are present. As it does this, the particles in the cells of the tissues bounce. As they move back into their original place, they send out a radio wave of their own. A specialized computer then turns these waves of energy into a picture of the types of tissues present in the area of the body being scanned.

Different types of tissues emit differing signal strengths, bones usually look dark on the scans and fatty tissues look much brighter. The MRI scan provides such a detailed picture of your body, that it is possible for your Consultant to see if there are any little growths or abnormalities in the area being scanned. As the MRI scan is like a very defined photograph of the internal workings of your body, if you need an operation your Consultant will then use your MRI scan to guide him to the correct area of the problem.

CT Scan

A CT or Computerized Tomography (also known as CAT) Scan is a special type of x-ray. A normal x-ray sends out a single x-ray through your body, whereas the CT scanner will send several beams from lots of different angles. This allows the Consultant to get a clearer idea of the density of the tissues in your problem area.

A CT/KUB (Kidneys/Ureters/Bladder) is a quick scan commonly done for kidney stones and does not involve any contrast agents. A CT Urogram does involve an injection of intravenous contrast and takes around 30 minutes.

KUB Scan

A KUB (kidney, ureter and bladder) is an abdominal x-ray. The KUB is used diagnostically to detect kidney stones. This x-ray can also be performed post-operatively to see if the surgery for kidney stones was successful.

Ultrasound Scan

Ultrasound is a high-frequency sound that you cannot hear, but it can be emitted and deflected by different tissues in the body. As the ultrasound probe is rolled over the affected part of your body, thicker tissues bounce more of the waves back. For example; ultrasound echoes pass straight through fluids such as blood and urine, but will bounce back when they hit something like your kidney or a kidney stone.

The ultrasound doesn’t hurt at all. You may feel a little bit of pressure from the ultrasound probe being run over your skin, but this won’t be uncomfortable.

It normally takes about 30 minutes. Your Consultant will receive the results in a form of a letter from the person who performed the scan. Some pictures, taken from the screen of the monitor during the ultrasound, will be taken for other clinicians to view.

Flow Study

A Flow Study is an investigation into the function of the lower urinary tract and evaluates whether there is any bladder outlet obstruction or problems emptying the bladder.

Patients are normally asked to attend the hospital with a full bladder. They are asked to pass water in the usual way into a toilet that measures the flow rate and prints off a graph. This procedure is normally carried out twice and the results are then passed on to Mr Keeley. The lower the flow rate the more likely it is that there is some form of bladder outlet obstruction.

Flexible Cystoscopy

Flexible Cystoscopy is a procedure where Mr Keeley will look into your bladder using a thin telescope called a Cystoscope. This is a diagnostic procedure and is usually done in the endoscopy room as an out-patients procedure. You are awake during this procedure, although some anaesthetic gel may be used locally.
To arrange this procedure you will be asked to contact Emma (07547475984), who can discuss this procedure with you in more detail and arrange a convenient time and date.

Who do I contact if I’m having issues following an operation?

You can contact the nurses at the hospital for advice. Bristol Spire Hospital nurses are available 24 hours a day, 7 days a week on (0117) 9732562.

Alternatively, you can call Emma (07547475984), during working hours, who will either offer you a follow-up appointment, or if it’s an urgent issue contact Mr Keeley on your behalf to ask his advice. Finally, you may find it helpful to see your General Practitioner.

When can I return to work?

Your return to work depends on a few factors, some of which you will be aware of ahead of the operation or procedure. For instance, if you are self-employed or run your own business, you will no doubt feel a greater need to return to work as quickly as possible. Others, such as employed professionals, need to be at or near their best before feeling confident enough to return. If you have a physically demanding job, you may need to wait 4 to 6 weeks after laparoscopic (keyhole) surgery, for example. Patients with a ureteric stent after ureteroscopy, for example, can return to work quickly but typically find that they have more blood in their urine when they are more active — while this is not usually a major problem, it can be distressing.

Mr Keeley will discuss your individual needs and expectations with you before and after your treatment. If you have not been feeling well beforehand, your recovery may take longer. Typically, the longest-lasting effect of the operation is profound fatigue while your body heals. No matter what procedure you have, you will be encouraged to be active afterwards, despite how tired you may feel.

Typical return to work timings:

• Flexible cystoscopy: the following day
• Shock wave lithotripsy: the following day
• Ureteroscopy: 1 to 2 weeks
• Percutaneous nephrolithotomy: 4 weeks
• Laparoscopic (partial) nephrectomy: 4 to 8 weeks
• Laparoscopic pyeloplasty: 4 to 6 weeks

I am insured

• You should inform your insurance company (before you attend a consultation) that you are planning to see Mr Keeley. They will issue you with a claim form that you will need to fill out.
• Some parts of the claim form may need to be completed by Mr Keeley. If this is the case, take it with you to your initial consultation or post it to Emma afterwards.
• If you do need to have an operation, Emma will provide you with a code for the operation that your insurer will need in order to pay the bill.
• They may also need other details such as the time and date of the operation, who the anaesthetist will be, and the length of stay at the hospital. We can provide you with all this information.

I am paying myself

• Your Consultant will bill you directly to your home address. This invoice will be for his fee only. This invoice is payable by cheque to the Consultant. Send it to Emma at the Bristol Spire Hospital who will then deal with your account.
• If you have an operation, the hospital will collect the fees. This is called an ‘inclusive care package’. They will collect the full amount and pay the surgeon and anaesthetist on your behalf. One follow-up consultation is included in this price. Any subsequent consultations will be billed for.