I qualified from St. Thomas' Hospital, London in 1975. Having served with the Royal Army Medical Corps until 1981, I joined University College London as a lecturer in geriatric medicine, then senior lecturer in 1984. I was promoted to a personal chair in 1994 moving to the Barlow Chair of Geriatric Medicine in 1996.
In 1999 I moved to the Whittington hospital campus of the school as Professor of Medicine, Head of the Department of Medicine for that campus. My personal research work has always been on urinary incontinence but at the Whittington Hospital he has supervised a much broader brief in clinical science.
My research work has focused on the pharmacology, biomechanics and physiology of urinary incontinence. In recent years my discoveries in relation to chronic bladder inflammation in the aetiology of overactive bladder have resulted wider collaborations with microbiologists, physiologists, immunologists and pharmacologists. I am a keen supporter of basic science as the foundation of modern medicine but nevertheless I remain an avowed clinical researcher.
I can summarise my discoveries as follows:
Urodynamic investigations appear to provide little information useful to the clinical management of patients with lower urinary tract symptoms
Quantitative microbiology applied to the routine MSU, based on the Kass criteria of 1957 to 1960 is extremely insensitive, missing many genuine infections.
The dipstick tests for leucocyte esterase and nitrite are substantially worse than the culture methods. Such tests should not now be used to exclude urine infection.
Microscopy of a fresh unspun, unstained specimen of urine, to count the urinary leucocytes is the best test for urine infection that we have but it will miss about 40% of infections.
Many persons with lower urinary tract symptoms are living with chronic infections that go untreated because of contemporary guidelines.
The symptoms that patients describe are extremely important, accurate and the best guide to the pathology afoot. They should never be ignored and pain is not necessarily essential.
Many urine infections are caused by mixed colonies and mixed growths are associated with important independent markers of urinary tract inflammation and infection.
Many urine infections involve intracellular bacterial colonisation of the urothelium by mixed pathogens that are fastidious and extremely difficult to treat by conventional methods.