Holidays are over

My holidays are over. What a pleasure to rest, sleep, relax, read, oxygenate my brain and evaluate my life from a different perspective... My American brother in law, Wade Hatler (have a look at his website, it is really worth it) recommended a very interesting book, Ray Kurzweil's, "The Singularity is Near", that has made me understand that the advances in medicine will be exponential in the next years and that technology will evolve very fast to provide better treatments. I am even more convinced than I was that we as doctors have to look forward now and try to learn new techniques and keep updated to the minute. He also recommended "The Shangri-La Diet", written by Seth Roberts, a whole new theory on why we get fat and lose weight, that has made me decide (at last) to start losing weight.

But now it is time to go back to work. I am looking forward to it. I foresee a very intense and interesting year.

When I arrived to Madrid I found I have received several invitations to perform live surgeries and conferences in several international congresses before the end of the year, India, Mexico, Belgium...

I have also found out that our paper with recommendations on the PVP technique has been selected as a key article by www.urosource.com, one of the most relevant urological websites in Europe.

This year will also be interesting because we will try to incorporate new very exciting technologies that are being evaluated by the ICUA... 

Training session in El Cairo, Egypt

The 31st of July I took off to El Cairo, to help starting a Greenlight HPS laser unit in the most prestigious urological hospital in this city. It is devoted to Urology and Nephrology and the panel of urologists working here is impressive.

The distributor of this laser in Egypt, Heart Mission Egypt, prepared this fantastic cake to celebrate the occasion, a great idea indeed.

The organization of the session was really good, I managed to do 5 operations during the day to demonstrate the technique and all were highly impressed by the absence of bleeding and the excellent endoscopic result at the end of the operations.

Then we went to have some Kebab for dinner, and to smoke the "shisha". We finished late and I slept like a baby in the plane back to Madrid.

This is the last training activity before my holidays. I will spend the month of August on holiday with my family.

It has been an exciting and intense year. I will try to get a good rest, I suspect the coming year will also be very intense.

Surgical demonstration in Manresa

This Monday I woke up early to travel to Barcelona, and from there to Manresa, to the Hospital San Joan de Deu, to make a demonstration of the high power Greenlight HPS at work.

The hospital is considering to offer this technique to its patients, but they needed to see it with their own eyes...

So I was asked to operate four patients with prostates weighing 40, 100, 75 and 70 grams, and all of the operations were uneventful and satisfactory. They were positively impressed. As always, on my return to Madrid, Iberia provided another delay, and I got home relatively late. Tomorrow I will do the last clinic before my holidays and I will depart to EL CAIRO, my last trip before I leave on holiday.

New surgical session in Gran Canaria

This thursday I took an early flight to Gran Canaria. Again I operated with Dr. Juarez four patients. All the operations went fine and we had fun spending the day together in theatre. This is the good thing of laser surgery, it is very relaxed, not only for the patient, but also for the surgeon.

It is relatively sad to get to Gran Canaria and have to leave right away. In this time of the year one feels like staying there... so I had no choice but to wake up early again on Friday to return to Madrid. I had scheduled a full day operating list, with some minor operations, a PVP of a large prostate and a Cryosurgery of a recurrent prostate cancer after radiotherapy.

Dr. Juarez gave me a print of a newspaper published recently in the Canary Islands covering the first installation of an HPS laser in the region.

Invitation to operate in Cancún, Mexico.

Today I received an invitation to participate in the World Congress of Endourology in Cancún, Mexico, in October. I will perform a Greenlight HPS prostatectomy live, that will be transmitted to the congress venue, for all the urologists attending the congress to see...

It is an immense honour. Operating live in the World Congress of Endourology is for a urologist as competing in a final of the Olympiad for a sportsman. I am delighted with the invitation. From all of the urologists in the world they could have chosen to invite, they chose me.

Triple surgical session in La Coruña

This Monday I travelled to La Coruña, in the North-West of Spain to participate in three surgical sessions with the new High Power Greenlight HPS laser. We conducted two surgical sessions, Monday afternoon and Tuesday morning at the Abente y Lago Hospital, training two prestigious colleagues from La Coruña. We did six operations in total. All cases were very satisfactory. This hospital belongs to the Juan Canalejo Healthcare complex, and they mainly do short stay surgery here.

On Tuesday afternoon we went to the Modelo Hospital in La Coruña, where we performed another operation, that was also uneventful. The truth is that it is a great pleasure and honor to help my colleagues to perform their first steps with the greenlight, specially when they are such outstanding pupils, and learn so fast.

Anyone reading this blog might ask what moves me to travel so much and to train so many urologists, today here, tomorrow there, always on the move.... it is really a big effort, and something must justify this huge effort.

Well, what really moves me to do this is that I learn a great deal in these training sessions. First, because I am training seasoned urologists, who know a lot and have seen a lot. They share their views with me. I learn much from them and ultimately they become good friends. Secondly, each prostate is different (I have not seen two prostates that are exactly the same), and the fact that we review once and again the basic concepts of endoscopic laser surgery, and that I explain thousands of times why hold the scope this way, or how fast to rotate the fiber, or what is the ideal working distance, how to approach a median lobe, how to avoid and handle complications, etc... helps me reflect and understand more deeply and grasp the immense amount of details that one should know to perfom this operation with excellence.

This technique is evolving constantly, getting better and better. We learn day by day how to make it better and safer. It will change the current worldwide panorama of the surgical treatment of BPH (Benign Prostatic Hyperplasia). In my opinion, classic surgical techniques, open prostatectomy and TURP (Transurethral resection of the prostate) are obsolete, but they are being performed and offered to patients in hospitals worldwide, and many patients still suffer the secondary effects and complications, sometimes very severe, of these classic operations.

It is a true adventure to be able to play a part in this movie... operating so much, in so many theatres, having the opportunity to interact with urologists, nurses, patients all over Spain and the rest of the World is really a privilege and an enriching activity. More importantly, this enables me to learn more and to be able to offer my patients a better operation, safer and more close to perfection.

Masterclass with Dr. Gastón

Today we have operated two patients with prostate cancer with Dr. Gastón and Dr. Piechaud, from Bordeaux, France, in the new Hospital Pardo de Aravaca, in Madrid.



Dr. Gastón visits us regularly, he invented the technique of laparoscopic radical prostatectomy. Dr. Piechaud is another international expert in laparoscopic surgery, with a special interest in robotic surgery.

Greenlight HPS world experts meeting in Madrid

This weekend we celebrated the second meeting of world experts in Greenlight laser surgery of the prostate, again in Madrid. The organization was carried out by the ICUA, with the unrestricted support of AMS (Americal Medical Systems). The idea was simple and innovative, put together the surgeons with more experience in Greenlight HPS laser surgery to allow them to share experiences and reach consensus on how this operation should be done and then be able to share what we learnt with the rest of the world.


Doctors attending were Mr. Gordon H. Muir (London), Alex Bachmann (Basel, Switzerland), Oliver Reich (Munich, Germany), Jean de la Rossette (Holland), Benjamin Choi (New York, EE.UU.), Shahin Tabatabei (Boston, USA), Edward Collins (San Francisco, USA), Henry Woo (Sidney, Australia) and I was chairing the meeting. We named this group the IGLU group (International Greenlight Users Group).


We jointly performed 9 operations with prostates from 15 to 92 g in the Sanatorio del Rosario, in Madrid. We had a chance to observe different techniques and to share surgical tips and tricks, strategies and opinions during the whole day. On Saturday, we went to Toledo, where we had a wonderfu round table discussion and then on Sunday we discussed how to spread the conclusions of this meeting, so the can reach the rest of the urologists in the world.


It has been an excellent meeting. I have learn a lot from my colleagues. We all share the same passion for the Greenlight HPS Surgery. We, also, enjoy a very nice atmosphere and camaraderie...

Soon we will start publishing our results and the recommendations on how to perform this technique, so everybody can benefit from the experience we have gathered over the last four or five years. The group will continue working together and aiming to improve this technique and the way it is applied worldwide. We are all quite certain that this treatment option will dethrone the classic surgical options...

Surgeries in Santiago de Compostela

Today I was invited to operate at the University Hospital in Santiago de Compostela. They wanted to see firsthand the new Greenlight HPS and the small Holmium laser Stonelight at work. They prepared two cases, one of them with bladder stones, so I first operated the prostate and then the stones. Everyone enjoyed the session and both cases were spectacular. Then I returned to Madrid. The world experts meeting in Madrid will start the day after toworrow, everything is ready....

Weekend in Gran Canaria

I have spent this weekend in Gran Canaria. Again we had a surgical session with Dr. Juarez. His case was perfect, he was able to complete it even when the prostate was relatively big (80 grams). He is really good and has learned fast. The patient left the hospital the following morning, very happy. This time I took my family with me and we enjoyed the rest of the weekend in Costa Meloneras, enjoying a fantastic weather and the hospitality of Dr. Juarez and his wife. We are interested in furthering our collaboration and establishing a closer work relationship in Gran Canaria. We thought of offering a package for patients including prostate surgery and a week recovering in the canary islands, enjoying the sun and the good life.... attractive, isn't it? Then we went back to Madrid to start the week on Monday.

Surgical session in La Coruña

Yesterday I went to La Coruña, to help two urologists from the Juan Canalejo Hospital Complex with their first operations with the new HPS laser.

Specifically we went to the Hospital Abente y Lago, one of the hospitals in the complex. It is an old refurbished hospital, really beautiful, by the seaside.

We did three surgeries during the morning that were uneventful. They have learned the technique with ease... Soon I will come back to help them with six more cases to finish their mentoring before they can fly on their own.

This Hospital Complex is evaluating the technique in order to incorporate it to their services. They want to see how these patients fare after surgery. I think that there will be no residual doubt in their mind that this treatment is here to stay and to displace classic surgery.

Invitation to the Spanish TV

Today I went to the National TV - Televisión Española TVE - to participate in the most important health related TV program in Spain " Saber Vivir". We spoke about the disorders of the bladder, including cystitis, stones and bladder cancer. Although it was not specifically on prostate, I mentioned that bladder stones are often a result of prostate problems, and that both the causing problem - the prostate- and the effect - the stone - were treatable with modern laser techniques. It was a nice experience, Manuel Torreiglesias, the director of the program is a great communicator. He has succeeded with this program for ten years, it is already a classic of Spanish TV.




Then I spent some minutes answering questions online in the program's internet forum.... I had a very good time this morning!

"Joaquin Albarrán" Prize

Today I heard I got the third prize to the best video presented at the Spanish Urological Association Annual Meeting. My video presented the new Greenlight HPS laser. The prize consists in some money and a nice medal (below). I have uploaded the video to be able to post it here, sorry, it is in Spanish.

Jedda, Saudi Arabia, part II

This morning I went to the hospital. There were three patients programmed, the first one was operated by Dr. Al Tayyib, who looked like an expert surgeon after only three cases. The second patient had a big gland, with 115 grams, and I did it.

Right from the start of surgery, he started bleeding a little bit, nothing serious or risky for the patient, but enough to impair visibility and I inserted a suprapubic laparoscopic trocar and connected it to a draining tube, to improve the irrigation and be able to finish the operation satisfactorily.div>

I was happy that the urologists watching the operation had a chance to see how a difficult case is solved and finished with success. Then I was presented a much more complex case, an 85 year old old man, who was suffering from dementia, and had a high surgical risk, being diabetic, having cardiac problems... He was catheterised as he could not void spontaneously and the family asked if we could do something for him. After discussing his case with the anaesthetists, we decided to operate him under spinal.
I positioned him in the sitting position to allow him to tolerate the operation better. He tolerated the operation really well. All surgeons present in theatre were impressed to see that these patients can be operated. Due to their high surgical risk They were before condemned to life time catheterisation!!.

We finished at 9:30 and after greeting the patient's family, I joined the scientific session organised after my visit. There were many urologists from Jedda. I did my best to transmit them my experience and what how has this treatment influenced my patient's lifes. Then there was a debate and then we went out for dinner. There was a lot of interest in learning all aspects of this technique, and we all had a goog time.

I am leaving Jedda, fascinated by its architecture, full of palaces and wonderful mosques. I am also fascinated by their people, the wonderful team of the hospital where we have been operating.

That same night, I took the plane to return at 3:00 am. I went to bed and slept like a log. I was exhausted.

Jedda, Saudi Arabia

This friday I flew to Casablanca, where I stopped to connect to Jedda, Saudi Arabia. Again I have been invited to help a Saudi Hospital to start operating with the new Greenlight HPS laser. I reached late at night and we went to the hospital, a very impressive private center with a wonderful architecture and state of the art medical technology.

There were two surgeries scheduled, and both were performed by Dr. Abdulmalik Al Tayyib with my supervision. He did not need any help, as he is a great surgeon. He visited us in Madrid for a whole week and he could see lots of operations. He is a wonderful person and a very respected urologist in Saudi Arabia.

These fast trips do not allow for much tourism, but as we left the hospital we went to see Jedda by car. It is a very beautiful city, much more relaxed than Riyadh, very nice. Then we went to have some fish for dinner sitting by the sea...

Tomorrow we have more surgeries scheduled, I will give a talk in the evening and then I will depart back to Madrid late at night.

Visitor from Portugal

This thursday we received a visitor from Portugal who is going to start using the Greenlight PV unit in a hospital near Lisbon. As always, it is a pleasure to receive visitors and to have a chance to talk about the surgical technique and tips and tricks, and to share how this treatment has profoundly change the way we handle our BPH patients...

Surgical Session in the Island of Gran Canaria

This saturday I took an early flight to the Island of Gran Canaria, where my colleague Dr. Juarez, had prepared four patients to operate in the Hospital Santa Catalina, with the new HPS laser. It has been one of these days where everyting is smooth and easy, all patients went really well and we had a great time together. Normally after a Greenlight operation the urine is clear, but in these patients it was cristal clear...


Then we went out for dinner, and we had a chance to talk and it seems we will keep on collaborating from now on. Dr. Juarez has learned how to do it and he is very skillful and performs a very good Greenlight prostatectomy, but he wants to offer the best possible care to his patients, so he wants me there with him, specially for the most complex cases. I am happy to go there, although I will try to get some additional day and take my family with me, so we can all enjoy our beautiful canary Islands...

Live surgery at the Escandinavian Urology Congress in Aahrus, Denmark

This thursday I traveled to Denmark to participate in the Congress of the Scandinavian Urological Association (NUF 2007). I was invited to perform a Greenlight HPS laser prostatectomy in a patient with Benign Prostatic Hyperplasia (BPH). The operation was broadcasted live from the prestigious Skejby Hospital to a conference room with 130 urologists from Norway, Finland, Sweden and Denmark. The congress welcomed 400 urologists and 400 scandinavian nurses, all of them blond and with beautiful blue eyes... (no comments...;-)

The hospital is impressive, it only has two floors, but it is massive. Nurses travel in small motorbikes around the hospital. It is really something different.

When I arrived to Billund Airport, I was picked up and driven to the hotel where the congress was taking place. Another impressive place, with beautiful architecture. I felt as if I was inside the Death Star from Star Wars.... (see photo).

Then we went out to a dinner organised by the congress at the "Old city" in Aahrus. A wonderful place with old fashioned Danish houses populated by actors... really beautiful.

There I had the chance to see two old friends, Ola Bratt, an expert in prostate cancer from Sweden and Henning Olsen, a pediatric urologist working at Skejby Hospital. I was really happy to see them. We shared many experiences while we all worked at the European Society of Residents in Urology 10 years ago...

The 80 watt Greenlight PV - KTP laser is very popular, but apparently they use very little amounts of energy (80-90.000 joules) in each prostate, and thus, they do a minimal channel prostatectomy. I am convinced this can only work in the short term. Patients improve after sugery, but I am afraid they have a higher risk of needing a reoperation in the future.

The live surgery went really well. The case was ideal for a surgical demonstration, a 45 gram prostate. The audience saw how I used 275.000 joules to perform the operation and how the operation resembled a complete TURP. I showed them my tips and tricks and they all saw the fantastic end result. During the operation, I answered questions from the audience... I think we all had a good time. The feedback after the session was very positive, I think many urologists changed a few concepts in their minds, and saw a different operation to what they were used to...

Then we did a second case, without the cameras, because they had prepared two cases just in case one of the patients got ill and could not be operated that day. Both cases were unevenful. It has been a great experience, and a great honour to operate in one of the best hospitals in Europe.

After the session, I rushed to the airport as I had to reach Madrid on Friday. I had to travel to Gran Canaria on Saturday, I had an appointment with my friends there...

Symposium on HIFU for prostate Cancer

Yesterday we celebrated a symposium on HIFU (High Intensity Focused Ultrasound) in hotel Hesperia Finisterre, in La Coruña, during the Annual meeting of the Spanish Urological Association. The panelists were Dr. Sebastian Rogenhofer, from Regensburg, Germany (in the center of the image), Dr. Ander Astobieta, from Bilbado and me.


I presented the scientific basis of the treatment of prostate cancer with HIFU (High Intensity Focused Ultrasound) and I also explained the training system for new users. Dr. Astobieta, from Bilbao, summarized the spanish experience and Dr. Rogenhofer commented on the results in his Hospital in Regensburg, Germany after 11 years using this technology.