Monday, April 26, 2010

More surgeries in Sofia

This weekend I travelled to Sofia, we operated again during the weekend patients in the Hill Clinic, with Dr. Kalchev. This is the first time I have seen the sun in Bulgaria.... it seems the spring is finally here...

Tuesday, April 20, 2010

After two intense days of surgery with Dr. Richard Gastón, I flew to Barcelona, where the Annual European Association of Urology Congress was going to take place. It has been sadly affected by the ash cloud that has kept Europe with most airports closed throughout the week. A disaster as thousands of urologists registered at the congress could not come.

In this congress I presented the video "GreenLEP: GreenLight Enucleation of the Prostate", a very innovative technique that I have developed over the last year, that was very well taken by the attendees. As the moderators for the session had not reached Barcelona, I had to moderate the session as well.

This all begun when Dr. Peter Gilling, from New Zealand, described in 1998 the technique of Endoscopic Enucleation of the prostate with a Holmium Laser and an end firing fiber. This technique, te best studied surgical technique in urology, has demonstrated to have outstanding results in the treatment of BPH in multiple studies, with long follow up. The only problem this operation had was its technical difficulty, the long learning curve that made many centers desist in their intention to use it.

GreenLight Laser, when used for vaporization, is fairly easy to use and this justifies its success and broad diffusion worldwide, and it has demonstrated to be safe, efficacious and well tolerated by patients. My contribution has been to describe a technique that allows to perform the complete enucleation of the adenoma with a green laser, with a side-firing fiber. A new approach and also maybe more simple, that opens new perspectives in this field of urology. We will soon publish our results obtained during this last year, that look exceptionally good.

The company manufacturing the surgical instruments that I use for this operation, Richard Wolf, has helped me produce a training video that was also presented during the congress and that will soon be available for all of those interested in learning this technique.

Then I returned to Madrid by plane, with permission of the ash cloud that has caused so many problems in Europe...

New surgical session with Dr. Richard Gastón

For the last three years, Dr. Richard Gastón, from Bordeaux, France, has come to Madrid to operate with us once a month.

Dr. Gastón is the inventor of the technique of laparoscopic radical prostatectomy and he has an experience of more than 10 years and more than 4000 patients in this technique, considered nowadays as the ideal technique for the treatment of localized prostate cancer. His oncological and functional results (preservation of potency and urinary continence) are espectacular. He told us he is performing more than 500 cases per year in his center in Bordeaux, Clinique Saint Agustin in Bordeaux. There he performs laparoscopic surgery of prostate, kidney, bladder cancer and complex reconstructive prolapse surgery in women.

This past weekend, right before departing to the European Association of Urology meeting we did two days of surgery at the Clínica CEMTRO in Madrid. In the photo with Dr. Estefanía Romero, urologist from our ICUA team, specialized in laparoscopy and trained by Dr. Gastón in Bordeaux.

We are strengthening our collaboration with Dr. Gaston due to the fact that many spanish patients want to access the best expert and they prefer to be operated in Madrid than to travel to Bordeaux.

It is a great stimulus for us to have Dr. Gastón in our team at the Institute of Advanced Urological Surgery in Madrid.

Editor of the Spanish version of

Recently I received an invitation to edit the spanish version of the website

The Prostate Cancer Gene 3 assay is performed in a urine sample obtained after a digital prostatic examination performed by the urologist. It allows to make better decisions on when to do or repeat a prostatic biopsy when prostate cancer is suspected and it is becoming a useful tool for the early diagnosis of significant prostate cancer.

It will soon be available in madrid.

Tuesday, April 13, 2010

Trip to Uruguay

Again I travelled to Montevideo, invited by Dr. Daniel Porto and Dr. Javier Zeballos to participate in a meeting on Greenlight Laser Prostatectomy. This meeting was celebrated due to the interest generated by Greenlight laser enucleation of the prostate, and we had colleagues coming from Uruguay, Ecuador, Argentina, Paraguay, Bolivia and Venezuela.

The first day we went to Hospital Maciel, a public Hospital in Montevideo. First I did a prostatic vaporization that was transmitted to the Hospital's meeting room.

Then I gave a talk on the different aspects of laser prostatectomy. It was a great pleasure to meet old friends like Dr. Dario Soto, or Dr. Gustavo Pico.

Then we were interviewed by several radio stations and the TV channel Canal 4. This was the first time that a Greenlight procedure was performed in a public hospital in Uruguay.

Later on that day I performed an endoscopic lithotripsy followed by a GreenLEP (Greenlight Laser Enucleation of the Prostate) procedure on a patient who had bladder stones and a 190 g prostate. Despite the complexity of the case I managed to complete the procedure successfully, I enucleated the adenoma in two pieces and carried out the morcellation of the tissue under a fantastic view. Everyone was impressed by the surgical result and the elegance of the technique.

Then we all went out for dinner and we tried the delicious uruguayan meat, although I was under the effect of the jet lag...

The following day we continued in the Hospital Británico, where Dr. Porto and Dr. Zeballos, who are wonderful organisers had prepared a room for the attendees to see the transmission of the operations and where they could ask questions.

I did 4 operations throughout the day, in patients with 40, 100, 120 and 140 grams. The three enucleations were successful and all patients had clear urine at the end of the procedure, and all the catheters were pulled out the next morning, and all the patients were sent home.

We took the opportunity and the fact that there were Greenlight users from several iberoamerican countries to create the "Grupo Iberoamericano de Láser en Urología, GRILUR" where all urologists are invited to join. We decided to meet next year in Buenos Aires, and Dr. Edgardo Becher offered himself to organise next year's meeting. In the photo, signing the foundational documents, with Dr. Zeballos.

We all went home happy with the experience. I am convinced that GreenLEP (Greenlight Laser Enucleation of the prostate) is a step forward in the treatment of high volume BPH. The GreenLight wavelength is optimal for this procedure due to the fantastic haemostasis and versatility. We manage to remove the whole adenoma in 60-90 minutes, we get tissue for histology and patients can go home without a catheter the next morning. The patient we operated last had a catheter only for 12 hours, an unseen tolerance for an enucleative procedure.

Finally I went back to Madrid, very happy after this trip. Dr. Porto and Dr. Zeballos are awesome urologists and very remarkable people, I had a great time with them.