Colin Cochrane is meticulously logging figures in a notebook. Under columns headed 'time', 'quantity', 'colour' and 'flow', he records each day's activity. He will convert the data to an Excel spreadsheet soon, for better analysis.

"I've been using a digital timer and measuring system to calculate flow in millilitres per second. At the weekend it was one millilitre per second but it has improved to 10 now.

But as you see from these figures, it is still not the quantity it should be, so I will be working on that."

This analytical approach is what you would expect for a process control instruments technician - Cochrane has been working at the paper mill in Tokoroa for 35 years.

Advertisement

But the 69-year-old is not at the plant in Tokoroa now - he is in his Papamoa lounge.

And he is not monitoring chemicals at the plant, but his own urine flow using a stopwatch and a measuring jug which he keeps in the bathroom.

Four days ago Cochrane had surgery to correct his enlarged prostate, which over a period of 10 years had grown to three times what it should have been, causing him pain and discomfort and affecting his everyday life and work.

"It would stop me doing things. I would think twice about going for a walk and avoid long drives. The one hour 20 minute drive each way to work became difficult. If I went out anywhere, I would always make sure I would know where the toilets were. 'Never pass a toilet without using it,' that was my motto."

Cochrane now is very open, to the point of joviality, about his condition. He says his colleagues at work joke with him, asking him if he knows where the toilet is. If in a meeting, he tells people from the outset that he might have to pop out for a toilet break.

He hasn't always been that open about his symptoms. A grandfather and father to three daughters, his wife had passed away and Cochrane thinks if he had sought treatment earlier it might have not have got to the point it did three months ago when his prostate was so enlarged he couldn't pass urine at all.

"In retrospect I should have come forward sooner and pushed for solutions. I think men often hide symptoms because they are embarrassed."

There was no embarrassment last Saturday morning in Tauranga Hospital. In fact, Cochrane had never had so much attention focused on his prostate.

"The theatre was the size of my house - with cameras, video cameras, and heaps of people. It was like a movie set."

In the spotlight

It was not just the entourage of people in theatre in Tauranga focusing on Cochrane, though; he had the eyes of the world on him.

That day, Cochrane, along with five other Bay of Plenty men, became the first to take part in a $64 million worldwide trial to pioneer a groundbreaking treatment for enlarged prostate problems - called benign prostatic hyperplasia (BPH), a common condition affecting more than half of all men older than 50.

The 18-month trial, called WATER, will involve 225 patients in 19 centres around the world - and will test a surgical procedure that uses high-speed jets of water to make incisions in the prostate, developed by Silicon Valley-based company PROCEPT BioRobotics, which raised the funds for the trial by venture capital and private investors.

Spearheading the trial is Tauranga doctor Peter Gilling, who will be one of two principal investigators overseeing the trial - the other is in the US. Tauranga and Melbourne are the only Australasian sites in the trial, with the other 17 centres in Europe. The company elected to trial the surgery in Tauranga because of Gilling's reputation as a world-class surgeon.

"We trialled a version of this machine in Tauranga in 2013 which was the first time it had been tried on humans - before then it had only been used on dogs, but this is a brand new international trial. If successful, it means this machine will become commercially available in 2017, making the treatment of the enlarged prostate more accessible, safer, quicker and easier for many men," says Gilling.

In his surgical rooms, on the first floor opposite Tauranga Hospital, Gilling's enthusiasm for the subject is infectious.

He always wanted to enter the field of urology, he says, because of "fascinating pathologies, dynamic research opportunities - and lots of gadgetry".

His multi-disciplinary clinic in Tauranga, Virtuouso, specialises in minimally-invasive techniques and state-of-the-art procedures.

Alistair Possin is recovering from a prostate operation. Photo/George Novak
Alistair Possin is recovering from a prostate operation. Photo/George Novak

Fighting the good fight

Over the years, Gilling's research into BPH has been driven by a belief that with proper diagnosis and early treatment more serious complications could be avoided, such as urinary tract infections, bladder stones, as well as kidney and bladder damage.

Tauranga is a very relevant setting for such research, he says, given the city's ageing population.

"The poor old prostate - it does good work as a sex gland - when you ejaculate 70-plus per cent of fluid is prosthetic fluid, without whose enrichment the sperm wouldn't be fertile. But then after men's fertile years it kind of becomes a less useful accessory. The prostate issues that men have today wouldn't have existed 100 years ago because we didn't live long enough. But nowadays the prostate can get infected, get cancer, but most commonly with age it just gets enlarged, meaning it's difficult to pee, you pee more often and it hurts."

Surgery for enlarged prostate, to remove all or part of the tissue, is one of the most common surgeries, says Gilling.

Several thousand Kiwi men a year have prostatectomies with up to 10 a week performed in Tauranga Hospital.

Leading the way

Tauranga Hospital was the first in the world to pioneer usage of a Holmium laser, developed by Gilling and colleagues, which is now used in many hospitals around the world. Yet despite this laser technology, another prostatectomy procedure, called TURP, has been the commonly used around the world since the 1930s. This surgery, which involves more invasive cutting of tissue, can be improved upon, says Gilling, and the new trial aims to make the operation less invasive than ever.

"Despite advances that we made here in Tauranga using laser, the old procedure is still the most common around the world but that old system does come with certain risks - such as affecting sexual function, ejaculation and incontinence problems."

The WATER trial will involve blind, randomised testing of the old TURP system against the new technology called Aquablation - high-velocity water ablation.

In the procedure, Gilling, after examinations, tells the machine how much tissue to remove, and inserts the robotic arm into the patient's prostate.

The machine then takes over and a jet of water as thin as a strand of hair and accelerated almost to the speed of sound tears off the affected tissue with precise, automated incisions.

Similar gadgetry has been used in industry to cut metal, wood and glass, but Gilling says this system is more uniquely refined.

"An industrial machine would use pressure of up to 90,000 PSI, whereas this is 8000 PSI so it's less pressure but still enough to deal with the tissue. In industrial uses it is the pressure of the water doing the cutting, but this system uses water through a tiny outlet, smaller than the diameter of a human hair. To create cavitation in the cavity so the tissue is effectively vaporised - you are effectively blasting a hole in the thing."

Gilling says that water jets avoid the usual complications of heat-based surgeries - instead of damaging neighbouring tissue, they affect only the problematic areas.

The speed of the operation and minimal downtime and recovery time makes it efficient for both hospital and patient. says Gilling.

"Once the machine is lined up, it uses software imagery to map where we are going to aim, and you press go. The water jet is going for just a few minutes. The whole procedure is less than half an hour."

Under the knife, or water jet

Along with Cochrane getting the star treatment in theatre on Saturday was 70-year-old Greerton semi-retiree Alistair Possin who can boast that he was the first man in the trial. Possin had only just started experiencing symptoms of an enlarged prostate - blood in the urine and frequent urination - since May. Like Cochrane, he is happy to talk about his symptoms. Wife Gladys is a medical administrator.

"We have always been an open family," she says, "but I know many particularly in our generation who are so private that they may be suffering terribly and not seek help."

Due to the blind nature of the trial, Cochrane, Possin and the other men involved in the worldwide trial will not know for now whether they have been treated with the new Aquablation procedure or the old standard TURP system.

Colin Cochrane has just had a new water treatment for enlarged prostate. Photo/George Novak
Colin Cochrane has just had a new water treatment for enlarged prostate. Photo/George Novak

But, already, both men are feeling better. By the third day Possin is already thinking of going fishing. Cochrane is due to return to work at the mill on Tuesday and has been going on a 1 kilometre walk a day, which would have been daunting in his prior state.

Turning 70 in April, he is looking forward to a retirement free of the symptoms that have plagued him over the last 10 years, and will be turning his attention to the garden, planting some natives and attracting birdsong.

Both men said they were excited, if a little bemused, at the global attention the trial would receive.

"It's great for Tauranga, and we are lucky to have someone of Gilling's talent here," said Possin.

Cochrane agreed it was exciting that Tauranga was at the forefront of such pioneering treatment.

"I feel so much better already, I just would urge men to get to know the symptoms and not be worried about talking about it."

Waiting game

Gilling says if the trial is successful, he is certain Tauranga Hospital will acquire one - there is no commercial cost to the machine yet, but it is likely to be in the hundreds of thousands.

He says a trial is already being mooted to treat female fibroids.

"If this goes ahead we are likely to be approached for this too."

An associate professor at Auckland University, Gilling is just back from an international urology conference in Melbourne where he was presented with the Distinguished Career Award from Societe Internationale d'Urologie. In May he received the Surgical Research Award from The Royal College of Surgeons, which recognises the contribution of a pre-eminent surgical scientist who has made significant contribution to surgical research.

He is on the executive management team at Bay of Plenty District Health Board and, as head of the Bay of Plenty District Health Board Clinical school, he reports directly to departing chief executive Phil Cammish.

But Gilling has not got his eyes on that big job.

Instead, he is focused on that little gland which has been the focus of decades of research and put himself, and Tauranga, at the forefront of surgical research.

It may be the "poor prostate" but Tauranga's population can be thankful that Gilling's contribution to the field has made lives easier not just for many Bay of Plenty men, but potentially millions throughout the world.

"The technology has demonstrated much promise... With the initiation of the WATER study we are one step closer to providing a minimally-invasive solution for BPH that offers both a sustainable and significant improvement to quality of life and a reduced risk of sexual side effects," says Dr Nikolai Aljuri, co-founder and chief executive of PROCEPT BioRobotics.

Gilling sees the future benefits, too.

"The potential for this type of machine to be used in other surgeries is huge - automating routine surgeries where we can. It is just the beginning. Water really could revolutionise surgery. And Tauranga is very much on this map."