Visitors in Theatre

This thursday we had programmed a surgical session and we received the visit of some new employees of the company American Medical Systems, who wanted some training on GreenLight Laser Prostatectomy.

I performed two operations, a prostate vaporization and a GreenLEP procedure, and then we had some time to talk on the technique, laser basic science and its application to the procedure and the recommendations on how to train other doctors to perform these operations.

Visit from Dr. Bautrant

These days we have received the visit of Dr. Bautrant. Dr. Bautrant is one of the leading experts in pelvic pain in Europe.

The chronic pelvic pain syndrome is a group of diseases caused in the pelvis, from different etiologies and different clinical presentations (perineal pain, chronic prostatitis, urethral or vaginal pain...) generally very difficult to treat successfully.

During the last five years I have teamed with Dr. Fernando Itza (a pelvic pain expert), Lydia Serra (a specialised physiotherapist) and Dr. Zarza (a brilliant neurophysiologist) and we have succeeded in reaching a specific diagnosis of the problem in the majority of patients, and also in improving or even curing some of these patients.

Dr. Bautrant came to Madrid to help us with some difficult patients and he showed us the technique for pudendal nerve release, that can be very helpful in selected patients with pudendal nerve entrapment syndrome.

Visitors from Ireland

This friday I had the pleasure to receive the visit in Madrid of Mr. Keane, Mr. Thompson and Mr. McCarthy, from Ireland. They are about to launch a laser prostatectomy unit and they wanted to see procedures. It was very interesting to comment the surgical technique and all the tips and tricks I know to perform a good prostatectomy with them.

More surgeries in Caracas

The following day I went to the Instituto Metropolitano Docente de Urología (IMDU), a surgical day-care center participated by 26 local urologists. I first gave a talk on GreenLight prostatectomy and then I went to the surgical theatre, where I performed two operations.

Both went very well and we could comment many of the new principles of an anatomic prostate vaporization (localization of the capsule followed by vaporization down to the capsule).

Then we ate a wonderful "Pabellón Criollo" in the hospital before we departed to the Centro Médico de Caracas, where I met Dr. Jose Manuel Pardo, current President of the Sociedad Venezolana de Urología and Dr. Leonardo Borregales. They had prepared another case for the afternoon and I performed a GreenLight Enucleation of the prostate, and we discussed the steps to follow to perform it safely.

The next day I packed and took my case to the Instituto de Clínicas y Urología tamanaco, with Dr. Juan Carlos Vargas and other well known urologists, like Dr. Dario Soto, who had flown from Maracaibo. Dr. Vargas had prepared three patients with prostates weighing 60, 100 and 120 grams. I did three enucleations in the same theatre where we presented the GreenLight Photoselective Vaporization of the Prostate two years ago for the first time in Venezuela.

Then I went to the airport, back to Madrid. It has been another intense trip, with a lot of work, but very stimulating. All the urologists I met were excited by this technique and they thought that the GreenLEP technique is a very attractive operation for patients with big prostates. I love Venezuela, everybody here is nice and warm and I always have a great time!

Trip to Caracas

Last sunday I took a direct flight to Caracas. When I arrived I went to the hotel to spend the night, to start with a four day programme of surgeries in different centers.

The first day I had to visit the Centro Integral de Urologia UNO, with Dr. Gastone Valongo. Dr. Valongo has been performing greenlight operations for more than a year and he wanted to see advanced techniques, so we operated four patients and did four GreenLight prostatic enucleations (GreenLEP) throughout the day.

As this is an ambulatory center, all patients were discharged home carrying a catheter, that would be pulled out the following day in the outpatient clinic. It is very interesting to see the effect in my colleagues to realize how it is perfectly possible to enucleate prostates with this laser and with a side-firing fiber.

Then I was invited to have dinner in a wonderful Italian restaurant... we had a lot of fun and finally I went to bed very tired due to the time difference.

The following day, this morning, I went to the Policlínica La Arboleda, with Dr. Ivanhoe Acero and his team.

There I started with a lecture on GreenLight laser technique and then we did a procedure, that I started and was finished by Dr. Acero, who followed my indications to perform a perfect job.

Now I am at the Hotel, waiting Dr. Acero to pick me up for dinner. Caracas is not very safe to wander around, so I have slept for a while and I took the opportunity to write the blog. More tomorrow.

Visit from Prof. Tubaro, from Rome

Yesterday we received the visit in Madrid of Prof. Tubaro, from Rome. He is a very prestigious urologist, very well known in Europe, extremely active and an international expert in BPH. He was very interested to see the GreenLight Enucleation of the Prostate. I operated two patients and we had a chance to talk about the details of the technique. He also thought this technique has a bright future and many advantages over vaporization in big sized prostates.

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...

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 PCA3.org

Recently I received an invitation to edit the spanish version of the website www.PCA3.org. 

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.

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.

Conferences in Malaga

Last thursday, after finishing my clinics in Madrid, I took the car and drove to Malaga. I went to the wonderful Don Carlos Hotel, that hosted a meeting on Laser in Urology organised by the technical secretariat of the Spanish Urological Association, with more than 95 Spanish urologists registered.

The meeting took place on Friday. I had to talk about three topics, the physics of laser and its application to prostatic surgery, the advantages of enucleation over vaporization with the GreenLight HPS laser and on the different types of lasers used for the treatment of BPH, advantages and disadvantages.

It was a very intense meeting, very interactive and very interesting. I was impressed to see the enormous interest of Spanish urologists in the GreenLight. I think the GreenLEP enucleation technique caused a great impact as well, because it opens a new way to offer a definitive treatment for patients with BPH of any size, with minimal surgical risk.

It was also a fantastic opportunity to visit the School where I studied when I was 16 years old in Malaga. This school hosted the high performance center of the Spanish Swimming Federation. I spent a wonderful year swimming and studying there, surrounded by wonderful friends. That year I won the Spanish National Championship of the Complete Swimmer in my age group. It was a truly happy year! Being able to see the swimming pool where we trained twice a day (in the photo) really moved me and brougth back fantastic memories. I then went to the Restaurant "El Tintero", a fantastic experience that I recommend to anyone visiting Malaga.

Then I returned to Madrid, I still have to work Monday and Tuesday. After the Easter Holidays I still have to go to Montevideo, then to the European Association of Urology Congress that will take place in Barcelona, and then to Venezuela, Bulgaria... I hope to be able to rest a little before all that.

Important visitor from Paris

Today I did two operations in Madrid. I received the visit of Dr. Bertrand Lukacks, from Paris. He is very well known for his publications on Benign Prostatic Hyperplasia.

I did two GreenLEP (GreenLight Enucleation of the Prostate) operations. Dr. Lukacks was very impressed by the technique. He has a broad experience in GreenLight vaporization and has used other lasers. He promised he would try to use this technique on his return to Paris.

He commented on various aspects that he considered very interesting of this technique:

- One, that the haemostasis of the GreenLight is better than that of the Holmium laser.
- Two, he was very impressed for the easiness of finding the enucleation plane and the good differentiation of the capsular plane (of a rose color) and the adenoma, which is whitish.
- Three and last, he was also impressed by the usefulness of the side firing fiber for this technique. It allows to vaporize residual tissue, to coagulate small vessels with ease, and that was surprising for him.

I had a great time with him, and it was a big honor to receive his visit and his very interesting comments.

More surgeries in Sofia

This weekend I flew to Sofia in Bulgaria again. Dr. Kalchev had prepared 10 patients who needed an operation for Benign Prostatic Hyperplasia, we operated them over the weekend.

We used the new enucleation technique in the bigger glands and vaporization for the smaller glands. It is wonderful to be able to remove the whole prostatic adenoma with minimum risk and complications.

A tough weekend, but a great opportunity to continue learning with difficult and challenging cases, in good company!

3rd World Congress on Controversies in Urology (CURY) - Athens Greece

This weekend I went to Athens with my daughters. We took the opportunity that I had to come to Athens to participate in the 3rd World Congress on Controversies in Urology (CURY), to spend some time together and enjoy some sightseeing. I had to participate in a symposium on GreenLight treatment of BPH (benign prostatic hyperplasia), with other international experts in this field.

The meeting was very successful, with high quality presentations from all the faculty members. I had a new chance to present the new GreenLEP (GreenLight Laser Enucleation of the Prostate) in the talk on how to treat big prostates.

Then I spoke on the differences of this laser with other lasers, and I gave my opinion on which is the reference treatment, the Gold Standard treatment for BPH. For me there is no doubt that laser treatment of BPH is nowadays the Gold Standard, and that TURP (transurethral resection of the prostate) and open prostatectomy have a much higher risk of complications.

This time I did have time for some tourism and we enjoyed a fantastic weather in Athens, that we were missing in Spain! 

More surgeries in Sofia, Bulgaria

This weekend I flew to Bulgaria, where we had scheduled 10 operations at the Hill Clinic in Sofia, with Dr. Kalchev. The weather was very nice. This is the view of the mountains from the hotel. I felt like going to ski, but we had to start the operations at 7 am...

This was the first time we did endoscopic GreenLEP (GreenLight laser enucleation of the prostate) followed by morcellation of the fragments, and they all went smoothly. The bulgarian press announced it because it is the first time this technique is ever performed in this country.

Some cases were extremely complex, high risk patients with huge prostates and big stones in the bladder that we had to fragment with a Holmium laser. I love anyway to perform these surgical sessions and operate these very difficult cases. I am happy to see that the GreenLEP technique I developed provides very good results and allows to treat huge prostates.

This was an extreme case, the prostate was bigger than 200 grams, as the patient had several big stones in the bladder, we decided to enucleate it with the laser and extract it through a minimal incision of the skin, with the stones. The patient went home the next morning!

Fast trip to Paris

This saturday I flew to Paris to participate in a filming session for an educational programme that will be published in Univadis, a famous international medical website. I had to explain the management of patients who consult for hematuria (blood in the urine) to general practitioners.

Then I flew back to Madrid, to get some rest..

Visitor from Germany

In this occasion I received the visit from Dr. Brunken. He was very interested to see how we do the Greenlight Laser Enucleation of the prostate. He came to the operating room where I performed two operations in two patients with 100 gram prostates.

This new technique that I have developed allows to extract the whole prostatic adenoma endoscopically. First it is detached from the prostatic capsule and it is thrown inside the bladder in two or three pieces, that are later extracted using a morcellator (I use the wonderful Piranha system, from Wolf). This allows to perform a complete adenomectomy (the risk of reoperation is extremely low, because there is no residual tissue that can regrow), to perform a histological analysis of the tissue (it is not vaporized), with minimal risk and without size limitation. I will present this technique at the European Urology Congress this year.