Friday, July 03, 2015

Surgeries in Coimbra, Portugal, with Dr. Antonio Oliveira

Again I went to Cimbra to operate with Dr. Antonio Oliveira at Hospital Idelamed. Dr. Oliveira is now performing GreenLEP regularly and he is happy with his results.

We had a patient who had been submitted to prostatic arterial embolization despite having a stone in the bladder, and a prostate 170 cc in volume. After a total failure of embolization and not experiencing any improvement, he decided to undergo endoscopic enucleation with the GreenLight laser.

To me it was a new clinical situation and it was interesting to see how the dissection of the capsular plane could be performed without any trouble. In the postoperative TRUS control the prostatic fossa was very huge.

I am very skeptical about prostatic arteries embolization. It seems to me a relatively illogical concept, to produce a prostatic infarction and then wait for the tissue to evolve, to atrophy. Very unpredictable. Some interventional radiologists are promoting it without having much scientific evidence to do it, and they apply it without any urological criteria (¿in a patient with a stone in the bladder?).

I think endoscopic enucleation in the hands of a properly trained urologist is today the best option for the surgical treatment of BPH. Endoscopic enucleation is without doubt the best option in patients with large prostates.

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