Saturday, January 14, 2006

New training session in Valencia

Today, a saturday, I took an early plane to Valencia in order to participate in a training session on KTP laser for the treatment of Benign Prostatic Hyperplasia. I operated a high risk patient with a 100 gram prostate. The operation was uneventful and I hope the patient will go home later today.

This patient had a very big median lobe, that can easily be seen in this ultrasound image. The way I treat median lobes is to reduce them uniformly until I reach the bladder neck, and then I perform an incission in the midline until I see the bladder neck fibres. Later on, the bladder neck is widened laterally. This strategy avoids damaging the ureteral orifices. It is a simple and quick way of treating the median lobe and achieving a fantastic result without risk of complications. This christmas I could not sleep one night and I started drawing these in order to explain this technique to other doctors interested in KTP laser prostate surgery (PVP- Photoselective Vaporization of the Prostate).

Interestingly, one of the surgeons attending the surgical session in theatre has asked me to fly to Valencia again in March in order to operate him, he is very bothered by his symptoms and he has decided to undergo PVP. It will be my pleasure to treat a colleague.


James Bollini said...

In mid 2002 in the USA my Urologist performed Greenlight PVP on my 105 gram main gland only to discover another 200 gram central lobe. He removed most of the central lobe and made a "nice channel" around my urethra.
After the procedure my main gland measured in at 100 g. On 1/10/6 my gland is 124 g.
I get up twice a night due to a feeling of pressure more than urgency to void. He will perform a retention test on me next month.
My one regret from having PVP vs. a simple (cut) surgery is that I now experience retrograde ejaculation. I have little semen during sex. I am now 64 and my wife is 56.
I do expect to receive another PVP within the next 1-2 years.
jimstir /

Dr. Fernando Gómez Sancha said...

Dear James,

That was a huge prostate. In 200 gram prostates, PVP can only do a partial vaporization of hiperplastic tissue. You had a 100 gram prostate that most probably will continue growing slowly, but deobstruction had to be good if you experience retro. Simple cut surgery is not indicated when a median lobe is present, so I guess your only chance to improve your voiding and quality of life was to exchange a better flow for a worse ejaculation. If you opt for a second PVP, this would finish the job. You can also consider taking proscar or avodart, this will slow prostatic growth and improve simptoms. Thanks for your comment in my blog.