Leading urologists – Associate Professor Troy Gianduzzo from The Wesley Hospital and Melbourne’s Dr Philip Dundee – have recently published the country’s first study analysing the outcomes of a new surgical technique delivering earlier continence recovery following prostate cancer surgery.

The study, published in the BJU International Compass journal in February, presents the results of a multi-centred cohort of patients who underwent Retzius-sparing Radical Prostatectomy – a surgical technique that’s been gaining momentum globally since it was pioneered in Milan, Italy, a decade ago.

The outcomes published affirm the technique’s significant early continence benefits for patients, and marks a milestone in the advancement of prostate cancer care in Australia. 

“The major difference with the Retzius-sparing technique is that we are seeing patients get drier, faster,” Dr Troy Gianduzzo said. 

“In the long term, outcomes are largely the same as the standard Robotic-assisted Radical Prostatectomy technique, but this approach helps men reach that continent stage much earlier,” he said.

The impacts of incontinence after prostate surgery are well documented, with previous studies finding up to a third of men were still using continence pads 12 months post-surgery. 

For many, it can be source of ongoing distress affecting quality of life. That’s where the Retzius-sparing technique shows promise.

“Compared to the standard robotic technique, Retzius-sparing aims to preserve more of the structures around the prostate and bladder,” Dr Gianduzzo explained. 

“Rather than going through the space above the bladder and between the pubic bone, which is called the space of Retzius and used in the standard approach, we go underneath the bladder, leaving that space intact.”

It’s the space above the bladder that is spared, that gives the technique its name. 

The study by Gianduzzo and Dundee found immediate pad-free rates of 53.5 per cent, increasing to 79.5 percent at 3 months. By 12 months, 91.3 per cent of men reported being pad-free. 

While the early continence outcomes are compelling, the story behind the research is just as rich.

Dr Gianduzzo and Dr Dundee not only share a surgical specialty, but a deeper connection through the mission-based hospitals they are a part of.  

Both operate at hospitals founded as outreach ministries of the Uniting Church – The Wesley Hospital and the Epworth in Melbourne. In fact, the very names of the hospitals are linked to the Methodist founder John Wesley, whose hometown of Epworth gives the name of one, while the other bears his namesake.  

For Dr Gianduzzo, there is also a personal connection to the journey he has taken to learn and ultimately offer the technique to his patients in Brisbane.  

“The Retzius-sparing technique was pioneered at Ospedale Niguarda in Milan, the same hospital where my Aunt worked as a nurse,” Dr Gianduzzo said. 

“My Aunt and cousin still live just up the road from that hospital,” he said. 

Visiting family along the way, Dr Gianduzzo travelled to both Milan and London to study the procedure, training with international mentors who later visited The Wesley to support him in his first Retzius-sparing cases.

The technique which is more challenging technically is made possible in some ways by robotics. 

The Wesley Hospital is home to three da Vinci surgical robots, allowing more than 40 surgeons to perform hundreds of robotics cases every year across nine specialty areas. 

It’s this combination of surgeon experience together with centre experience that Dr Gianduzzo says makes a difference. 

“We value the supportive and collaborative culture that we have at The Wesley because that is what drives knowledge and innovation,” Dr Gianduzzo said. 

“We all help each other out and look after each other as well. I was able to start doing Retzius-sparing cases with the support of my peers, because as a group of urologists we all grow together.”

Despite the paper marking an Australian-first, Dr Gianduzzo is quick to temper any hype.

“This isn’t a revolution, it’s an evolution,” he said. 

“While we have found significant benefits for early continence recovery, that is not to say that patients don’t get good results with the standard technique as well, because we know that they do. 

“If you’re a patient seeing an experienced surgeon doing the standard technique, you will still get good results.

“I continue to use the standard approach for many surgeries because in my hands not every patient is a suitable candidate for Retzius-sparing, including those with a very large prostate and a range of other factors,” Dr Gianduzzo added.  

For now, uptake of the technique in Australia remains steady, and many younger urologists are training in the new technique as part of their international fellowships. 

“It is another tool in our toolkit. I’ve also been able to borrow elements from the Retzius-sparing technique to refine my standard approach,” he said.

“That continuous refining of techniques and gaining experience is the real progress to celebrate.” 

In a case of watch this space, from here the focus remains on collecting more data.

“We will be keeping a close eye on the results and will continue to support each other to do the best we can for each and every patient.”