Toby's Take: Surgery, Upside Down and Backward

Would-be doctors, even into their first year of medical school, aim to know the human body inside and out. How about upside down and backward?

Dr. William Parker’s description of a very popular prostate surgery he’s known for makes it sound like he operates that way. It’s not really true, but it’s one of the details that makes this procedure so fascinating. And for guys, sure, a little scary.

Dr. Parker has become known as the “Retzius-sparing guy” around The University of Kansas Health System and throughout the Midwest, frankly. The procedure’s full name is Retzius-sparing radical prostatectomy. I’ll get into the details later. And I’ll try to write them as though I were explaining them to me. We’ve posted renderings of the male anatomy, but I hope to explain it so simply you can see it in your mind’s eye.

This approach Dr. Parker has perfected drastically cuts down a nasty side effect when removing the prostate. And it’s not for everyone.

A prostate is a gland the size of a walnut integral to a male’s reproductive system. It sits just below the bladder and often gets bigger as men age. That makes going to the bathroom a challenge.

See if any of this sounds familiar:

• Standing at the urinal longer than most of the other guys at halftime. 
• Feeling like you have to go all the time, even when you just went. 
• Realizing the tiniest bit of leakage is more than enough to feel self-conscious.

These are minor, of course, next to the seriousness of prostate cancer, the second-leading cause of cancer deaths among U.S. males. A growing prostate is irritating enough. But since cancer of the prostate will hit many men if they live long enough, urology is a big deal at the health system.

When cancer is detected, the gland often has to come out. First done as open surgery, making an incision in the belly and going in after the prostate, many surgeons started using robots requiring much smaller incisions. This surgery still goes through the front, but on the inside Dr. Parker starts under the prostate and bladder as opposed to starting from the top. “Upside down and backward,” as he describes (in his own mind’s eye) in a recent blog post.

The traditional way renders men incontinent for up to 6 months. The underneath route means guys can start urinating regularly after a week. That’s a lifestyle changer.

“I have men who are very resistant to the idea of surgery because of the risk of incontinence, and some of it isn't just the psychological impact of leakage,” Dr. Parker said. “I have guys who have physical jobs. The type of incontinence that happens is what's called stress incontinence, meaning that when you do something that increases the pressure in your belly, like lifting, you leak.

“It forces urine out of their body, lifting and straining. I've got folks who have very physical jobs where, for them, continence is a huge concern because they're going to constantly test the system, if you will.”

Dr. Parker did a 5-year residency here at the health system, followed by 2 years at a Mayo fellowship. He’s been back at The University of Kansas Health System for 5 years.

He explains there’s a difference between passive continence (your body knows to control your bladder for you) and actively trying to do so. If I were talking to a friend, I might say, “I’m constantly trying not to pee.”

If that lasts 6 months, that’s a real hindrance. Sure, it’s better than having a cancerous prostate still in your body. But fear of embarrassment or not being able to work can sure help a guy put off the surgery.

Here’s the cool part. For some reason, some of which Dr. Parker can’t explain, the Retzius-sparing procedure can cut the time a guy’s incontinent to a week or 2. That’s an attractive option.

Here’s the other cool part. Parker has done hundreds of these and is really the only surgeon in the area doing it. He started working on this in his first year back at the health system and perfected it in short order.

“If it had not been quick success, I probably wouldn't have continued doing it,” he said. “I mean, now I've been doing it long enough that it's not a big issue, but the learning curve and the kind of frustration factor of doing it initially was very high because it is a different surgery. And it requires kind of letting go of some of the traditional landmarks that we use to guide the surgery.

“But the successes were so dramatic early on. It was a no-brainer to keep going.”

Do you have questions about prostate cancer and this treatment? You can email Dr. William Parker here.