Sunday, February 27, 2011

Visit of Dr. Joao Pippi Salle

This weekend we received the visit of Dr. Pippi Salle, who came to Madrid to operate with us a one year old boy with a severe congenital malformation of the penis. He and Dr. Enrique de la Peña, the pediatric urologist of our team at the Institute of Advanced Urological Surgery, operated the boy with success at Hospital NISA Pardo de Aravaca, in Madrid.

Dr. Enrique de la Peña with Dr. Pippi Salle after the operation
Dr. Pippi Salle is one of the geniouses of current urology, he has described several surgical procedures and is one of the most respected pediatric urologists worldwide. He is originally from Brasil, but works in Toronto, Canadá.

Then, as we always do when we receive visitors, we took Dr. Pippi Salle to have dinner at Restaurante Botín, and then to the flamenco show at Casa Patas, that was magnificent!

Friday, February 25, 2011

Invitation to speak at the European Congress

I have received an invitation to speak on GreenLight Laser surgery for BPH at the European Association of Urology Annual Congress that will take place in Viena next month. I will be there to tell our experience with the new GreenLight XPS 180 watt laser!

Thursday, February 24, 2011

Visitors from Morocco

This week we received visitors to Clínica CEMTRO, Dr. Saadallah khalid, Dr. Benjellorin Saad and Dr.  Fekkak Hamid, from Casablanca. I showed them the current technique for Greenlight vaporization of the prostate and they could clearly see the difference between the 120 watt GreenLight HPS system and the new 180 watt GreenLight XPS. We saw very interesting cases.

Then I took them to Casa Patas to see some flamenco, we had a great time!

Thursday, February 17, 2011

More visitors... this time from Spain

This week we were honored by the visit of colleagues from Hospital Fundación Jimenez Díaz, Madrid, and Hospital Rio Hortega, Valladolid.

I showed them how the new GreenLight XPS allows to perform a good prostatectomy even in very large prostates.

The last case was quite impressive. The patient had a very big prostate and was a high risk surgical candidate. He had a giant intravesical median lobe. We applied a mixed technique, vaporizing first the anterior and lateral part of the adenoma with a Moxy fiber, that allows to work at 120 watts, vaporizing very fast. I took a lot of care in  preparing very well the area near the urinary sphincter, and then we proceeded to enucleate all the median lobe with a 2090 fiber, more resilient to mechanical force and ideal for enucleation. We worked at 80w-vap/40w-coag to enucleate the median lobe. After it floated freely in the bladder we extracted it with the Piranha morcellator from Wolf. I think we extracted about 60 grams of tissue... and at the end of the procedure we had used 500.000 joules. This mixed technique, using vaporization first and enucleation next is very interesting, because enucleating the median lobe after the vaporization of the lateral and anterior tissue is a piece of cake.

On the ohter hand, this type of technique would allow many surgeons who use GreenLight to face bigger prostates with better results, and it is not as difficult as the complete enucleation of the adenoma. Maybe also this initial preparation of the sphincter allows for a very low rate of sphincteric continence.

The following photos illustrate the completeness of the procedure.

Pre and postoperative transrectal ultrasound, longitudinal view

Pre and postoperative transrectal ultrasound, transverse view

Friday, February 04, 2011

New surgical session in Bilbao

Again I took a plane to go to Bilbao. We had programmed a session with two operations. Two patients with symptoms of benign prostatic hyperplasia (BPH) with two 80 cc prostates. We used the new GreenLight XPS 180 watt system. Both surgeries were uneventful.

Then I returned to Madrid rather early, to rest for the weekend.

Tuesday, February 01, 2011

Trip to Valladolid to learn to use the UROLIFT System

This afternoon I took the high speed train to Valladolid, to learn to use the new Urolift System to treat mild symptoms of benign prostate hyperplasia (BPH). I had known about this system before from my friend Dr. Henry Woo, from Australia, who was involved in the first trials in humans with this new system. It is also being evaluated at the Hospital del Rio Hortega, in Valladolid, and I was invited to see how Dr. Marcos Cepeda implanted this system in two patients.

It is a new concept for the treatment of lower urinary tract symptoms suggestive of BPH. It consists in applying two, four or six sutures with a special applicator, under local anesthesia + sedation into the prostate, and these compress the prostatic tissue opening the prostatic urethral lumen to facilitate micturition. The application was rather straightforward.

The main advantages of this system are: it is a minimally invasive system, with very low risk. It benefits younger patients, with smaller prostates, with moderate symptoms and it has the advantage of not altering ejaculation, a specially important issue in younger patients.

The disadvantages are for me that it is quite expensive and that there is a limited clinical experience published yet. My friend Dr. Woo tells me that it does not benefit all patients treated, but in those who benefit it is an elegant solution and long lasting, which prevents from having to receive medical treatment for years. He calls it "the surgical pill", precisely because it  is a minimally invasive intervention that can substitute medical treatment.

We sill see how it goes. It is available right now at the Institute of Advanced Urological Surgery in Madrid.