I completed my Urology specialisation at the University of Malta. In 2014, I moved to the UK, working across various hospitals to further specialise in pelvic uro-oncology. I have spent several years as an NHS consultant in General Urology and Pelvic Robotic Surgery at Eastbourne Hospital, a key referral centre for major robotic urological procedures in Sussex. My focus has been developing comprehensive services for our urological patients, particularly those with prostate and bladder cancer, aiming to enhance the quality of care and establish our department as a leading NHS Urology centre in the South of the UK.
Achieving excellence in urology requires a dynamic and highly motivated team. Over the years, I have committed myself to building and leading such a team, guided by the philosophy of 'Ubuntu' – 'I am because we are'. This belief in collective success and mutual support is at the heart of my healthcare and patient treatment approach.
REDEFINING EXCELLENCE
My dedicated team and I achieved a significant milestone by performing the first-day case Robotic Prostatectomy in the South of England in 2023, showcasing our commitment to excellence in a state-of-the-art facility. This fusion of cutting-edge technology and outstanding patient care sets a new standard in the field.
I use the latest robotic-assisted technology to conduct precise, minimally invasive surgeries that lead to faster recovery times, diminished pain, and minimal scarring for our patients. However, these technical advancements alone are not the sole contributors to our success. The collaboration with an enthusiastic and skilled team has enabled us to deliver such groundbreaking care and results.
I am at the forefront of surgical innovation in Sussex, having successfully performed the region's first robotic prostatectomy and radical cystectomy at an Ultra-Low abdominal operating pressure of 6mmHg. This advanced technique, adopted by only a select group of surgeons worldwide, offers my patients unparalleled benefits.
In my practice, I apply this low-pressure technique to all surgeries, leading to a smoother and quicker recovery process. Patients benefit from reduced anaesthetic and surgical risks, faster return to daily activities, and significantly lower discomfort levels post-surgery. This approach sets a new standard in surgical care. It underscores my commitment to providing the safest, most effective treatments available.
After examining MRI prostate scans and patient results from 2016 to 2019, I discovered that a PIRADS 5 score often indicates a higher risk of cancer extending beyond the prostate. This discovery prompted the development of a customised nerve-sparing technique, markedly reducing the incidence of positive surgical margins. Consequently, this means a significant decrease in the likelihood that cancer cells remain post-operation and a reduced necessity for additional treatments.
This advancement in surgical strategy highlights my commitment to pioneering patient-centred care, ensuring that each treatment is as effective and minimally invasive as possible, fostering quicker recoveries and better overall patient outcomes.
Introducing a revolutionary development in Robotic Prostate Surgery: the Extended Maximum Urethral Length Preservation technique. This advanced surgical method, honed through extensive research and experience, significantly enhances post-operative recovery, mainly promoting enhanced dryness following catheter removal for men undergoing prostate cancer surgery.
Early data indicates superior continence outcomes compared to the traditional Retzius-sparing approach. This technique sets new benchmarks in patient care, with results that promise redefining standards in post-surgical continence recovery.
Together with our enhanced recovery nurses, I've established preoperative services to support urology patients awaiting surgery for prostate or bladder cancer. This initiative provides a crucial opportunity for patients to learn more about their upcoming procedures and how to prepare effectively to maximise benefits. The programme aims to improve their health, nutritional status, and fitness levels before surgery.
This significant effort is not just about individual cases; the lessons learned can transform care across different types of surgeries, aiming to reduce complication rates, speed up recovery times in the hospital, and enable a quicker return to everyday life.
Experience a surgical approach designed with your well-being at the forefront, offering shorter operation times for a safer, fruit of more efficient experience. Our commitment to efficiency reduces your exposure to anaesthesia, minimises potential complications, and places your safety as our top priority.
You'll spend less time in the operating theatre and more on your recovery journey, allowing you to return to the moments that matter most swiftly. This approach shortens your hospital stay and accelerates your path to reclaiming your everyday life.
Since 2017, I have been devoted to mastering the art of robotic surgery. In choosing a robotic surgeon, the depth of experience is paramount. Select a proven expert who not only performs three robotic prostate surgeries daily but also upholds an unwavering dedication to excellence. My established track record and meticulous attention to detail in surgery provide you with absolute confidence in your care.
My goal is to enhance my practice to manage four surgeries daily, always focusing on delivering superior outcomes and ensuring a smoother, faster recovery for every patient. Opt for a surgeon whose expertise and commitment reflect your best health interests.
Make the choice that guarantees your well-being in the hands of a practiced and dedicated robotic surgical leader.
In my work on survivorship programmes for cancer patients, I've uncovered many unmet needs. Drawing on valuable insights from Movember projects, I've adapted and applied these learnings to the context of East Sussex. We are on the cusp of launching an innovative survivorship programme designed explicitly for our prostate cancer patients. This initiative is just the beginning, as we have plans to broaden our support to include individuals battling bladder and kidney cancer.
This upcoming programme is a testament to our commitment to treating cancer and enhancing survivors' quality of life, addressing the comprehensive spectrum of their needs. Stay tuned for the launch of this transformative support system, marking a significant step forward in our journey towards holistic cancer care.
My commitment is centred on securing the most favourable recovery outcomes for patients undergoing significant surgical procedures. In line with this, I have spearheaded the development of a pioneering programme within our department that integrates fitness trackers into your post-operative recovery plan.
This patient-focused strategy underscores fitness trackers' significant role in monitoring and advancing recovery. By utilising these innovative devices, patients can play an active role in their recuperation. The valuable data from fitness trackers provide insights into vital health metrics such as physical activity, heart rate, sleep quality, and stress levels. This information is instrumental in crafting a tailored recovery plan, establishing realistic goals, and fostering a sense of empowerment among our patients.
I am based at the Sussex Cancer Regional Centre, a leading facility catering to a population of 1.5 million, renowned for its specialised care and advanced treatments.
Selecting a robotic surgeon for your prostate surgery at a high-volume centre such as ours brings significant benefits. With a wealth of experience from conducting numerous robotic prostate surgeries, I offer unparalleled expertise and precision. You can expect efficient, streamlined processes, quicker recovery periods, and shorter hospital stays, all underpinned by the latest technology and a committed team.
Place your trust in our dedication to patient comfort and safety, guaranteeing outstanding results for a brighter and healthier future.
Edward Calleja
Dry (on removal catheter) 70%, (with new technique)
Dry (at 1 month) 85%, (with new technique)
Dry (at 6 months) 99% (with new technique)
Positive margin (localised disease) 8% (advanced) 18%
Urinary incontinence (requiring corrective surgery) <1% Wound hernia <1%
Narrowing of bladder neck<1%
Urine leak requiring prolonged catheterisation 1%
Blood transfusion <1%
Rectal or bowel injury 0%
Lymphoedema / lymphocoele<1%
Conversion to open surgery <1%
20% of patients have received radiotherapy as an adjunct to surgery for recurrent disease. The radiotherapy rates are 3% for low-risk cancer, 15% for intermediate-risk cancer, and 33% for high-risk cancer cases.
In October 2020, I assumed leadership for the non-muscle invasive bladder cancer program. I established the inaugural guidelines for bladder cancer management in East Sussex. Our goal was to streamline the patient journey, reducing waiting times while adhering to the latest international standards of care. This achievement was made possible through the dedication and collaboration of our dynamic team.
We have established a dedicated multidisciplinary pathway for bladder cancer, where each case is meticulously discussed in depth, ensuring comprehensive and tailored care.
Since taking charge, I have significantly reduced the time from diagnosis to treatment, surpassing the national guidelines. This improvement has had a profound long-term impact: early detection and treatment of bladder cancer through methods like bladder instillations of chemotherapy (mitomycin or epirubicin) or immunotherapy (BCG) significantly lower the risk of recurrence and progression.
Identifying the most aggressive forms of bladder cancer earlier leads to prompt, radical interventions such as radiotherapy or surgery, thereby improving overall survival rates. Our approach is not just about treating cancer but enhancing our patient's quality of life and outcomes.
My thesis concentrated on antibiotic stewardship, a crucial aspect of contemporary healthcare. I analysed over 400,000 urine cultures and antibiotic sensitivities, contributing valuable insights to antibiotic stewardship principles.
While urinary tract infections (UTIs) are commonly linked to females, it's important to note that males are also susceptible. A significant concern in treating UTIs is the escalating threat of antibiotic resistance. Non-antibiotic treatments should be given priority wherever possible.
Historically, cranberry juice and supplements have been touted for their natural preventive properties against UTIs. However, recent studies debunk these claims, showing they are ineffective in treating or preventing infections.
Lifestyle changes are vital to managing recurrent UTIs. A prevalent factor is inadequate fluid intake; simply increasing water consumption throughout the day can significantly reduce the recurrence of infections. I recommend maintaining an infection diary to help identify potential triggers and patterns associated with your UTIs.
Furthermore, it is essential to submit urine samples for laboratory culture with each infection episode. It identifies the causative bacteria and rules out other conditions, such as interstitial cystitis, which can present with symptoms similar to a UTI.
Proper diagnosis is crucial for effective treatment and to avoid unnecessary antibiotic use.
I have significantly expanded the enhanced recovery programme for our major urological surgical procedures. This success was made possible by the collective effort of various healthcare professionals working in unison.
This collaborative approach has led to improved patient outcomes, fewer complications, a reduced need for pain medication, shorter hospital stays, and quicker recovery times. The strategies and insights gained from the successes of robotic prostatectomy and cystectomy have now been applied broadly across all other urological surgeries.
When I initially joined the team in Eastbourne, the average hospital stay for a patient undergoing radical bladder removal was between two to three weeks. Through three years of dedicated effort and teamwork, I proudly announce that we have reduced this duration to 5 to 7 days for most patients.
We have established a successful day-case robotic prostatectomy service. It has been well received; men feel that going home on the day has great benefits.
Now, I am planning to expand the enhanced recovery team so that we can open additional services to our patients. The aim is to deliver better quality of care.
We do have a enhnaced recovery teaching day that was halted due to COVID restrictions but from 2023 this will kick back in order to share the lessons learnt with all those who want to see an improvement in their delivery of care.
Patients with localised low-risk prostate cancer, typically classified as Gleason 6 and some Gleason 7, are often enrolled in a structured programme known as Active Surveillance. Research indicates that such prostate cancers are frequently overtreated, yielding minimal long-term benefits.
Under Active Surveillance, patients undergo regular PSA blood tests, interval MRI scans, and, if necessary, prostate biopsies. Treatment is initiated if signs of cancer progression are observed or if a patient opts for therapy due to the discomfort of living with closely monitored cancer.
Different hospitals worldwide implement varying surveillance protocols. In East Sussex, there was a lack of a standardised protocol, which prompted me to spend eight months developing a protocol that caters to patient needs while aligning with national and international guidelines.
We now have dedicated prostate cancer nurse-led clinics, supported by me, to oversee the management of patients with prostate cancer on Active Surveillance, ensuring they receive the most attentive and personalised care possible.
I am honoured to have been chosen by Prostate Cancer UK as a prostate clinical champion, a role dedicated to spearheading projects that enhance prostate cancer patients' care and quality of life.
Prostate cancer is one of the most common cancers among men in the UK, with approximately 48,000 new cases diagnosed annually. It predominantly affects older men, but the risk increases at a younger age, particularly in Black men or those with a strong family history of prostate cancer or maternal history of breast or ovarian cancer.
This role as a clinical champion has significantly shaped my leadership abilities and deepened my understanding of the challenges faced by healthcare professionals across the board – from diagnosis and surveillance to treatment options like radiotherapy, hormones, surgery, and innovative therapies.
I have honed my leadership skills through self-reflection, effective communication, and building networks across the UK. This personal and professional growth directly contributes to advancing prostate cancer care, ensuring patients receive the highest standard of treatment and support.
I have dedicated significant effort to training our surgical care practitioner, who now proficiently performs bedside assistance during major robotic surgeries for kidney, bladder, and prostate cancer. I provided comprehensive instruction and support in basic surgery techniques, and he achieved autonomy in conducting a range of minor urological procedures, thus reducing NHS waiting times. Furthermore, I supervised his two-year master's degree, guiding him through this advanced education and practical experience. The next step is expanding the team of our surgical care practitioners.
In addition to surgical training, I actively support and educate our urology diagnostic nurses, particularly in handling two-week wait referrals for prostate and bladder cancer. These referrals often come from patients with elevated PSA levels, suspicious prostate examinations, or haematuria, necessitating rapid diagnosis to facilitate early cancer detection and treatment.
I also assist our urology cancer nurse specialists, focusing on prostate and bladder cancer care, ensuring they have the knowledge and skills to provide top-tier patient support.
Moreover, I am committed to the training and development of both junior and senior doctors, covering academic and surgical aspects to foster the next generation of urologists and medical professionals. This comprehensive training programme is designed to bolster the future of urological care and ensure a legacy of quality healthcare provision.
Together with my colleagues, we have conducted an in-depth review of catheter care delivery at Eastbourne Hospital.
This initiative has resulted in the development of enhanced teaching and care practices focused on catheter management, aimed explicitly at elevating the standard of care for our patients experiencing difficulties in bladder emptying due to prostate or bladder issues.
These advancements will culminate in superior catheter care, establishing a robust educational foundation for our current staff and future students. This progress marks a significant step forward in our commitment to improving patient outcomes and healthcare education in urology.
In collaboration with another hospital and my dedicated team, we have pioneered a self-removal catheter approach for patients recuperating from Robotic Prostate Removal surgery. This innovative method allows patients who come to our Trust from across the South East for their radical prostatectomy to eliminate the need for a follow-up hospital visit solely for catheter removal.
This initiative conserves precious time, minimizes clinic appointments, and significantly reduces travel expenses and parking fees for our patients. Moreover, by decreasing the footfall in the Urology Clinic, we can better safeguard patient dignity and privacy during the sensitive post-operative recovery phase.
Additionally, it's important to note that patient travel accounts for approximately five per cent of the NHS's total carbon footprint. By reducing the need for post-operative visits, we also contribute to the NHS's broader environmental objectives by lowering the carbon emissions associated with travel. This approach aligns with our commitment to sustainable healthcare practices while enhancing patient care and convenience.
I have established protocols at our hospital and set up comprehensive support for patients eligible for day-case TURBT (Transurethral Resection of Bladder Tumour). The change aligns with practices observed across the UK, which report that the feedback from patients treated under this model has been overwhelmingly positive, highlighting outstanding experiences.
This innovative approach has enabled selected patients to undergo the procedure and return home on the same day, eliminating the need for an overnight hospital stay.
Introducing day-case TURBT offers substantial benefits, including reduced hospitalisation costs, a diminished risk of acquiring infections in the hospital, and enhanced convenience for patients, allowing them to recover in the comfort of their homes. This initiative reflects our ongoing commitment to improving patient care and outcomes.