From London to the AUA congress in Anaheim, California

This May 17th I travelled to London, where I stayed with Gordon Muir, one of the best HPS laser experts in the world. I was invited to participate with an interview in a new DVD that is being produced on laser prostatectomy with the HPS laser... this DVD apparently will be distributed to GPs and urologists around Europe.

The we travelled to Los Angeles, where we went to the American Urological Association Annual congress. We used the oportunity of flying together to work in a couple of editorial projects we are co-editing during the journey.

This year I was not presenting any scientific paper nor giving any talk, but I had important meetings with experts in HPS laser prostatectomy from all over the world. After the success of the KTP laser experts meeting held last year in Madrid (soon the conclusions of this meeting will be published in the Journal Prostate Cancer and Prostatic Diseases), I will soon organize a second meeting, this time to discuss the new HPS laser. We will try to reach a consensus on how this laser should be used and how the operation should be performed and more importantly, how urologists and residents should be trained. We also will try to publish the conclusions of this meeting.

During the congress I also had the opportunity of attending the scientific sessions and participating in some courses. The AUA is a good meeting to learn and to keep updated. The congress center was just in front of Disneyland. My hotel was inside the park and every morning I had breakfast with Minnie, Lilo and Stich. I really missed my daughters...

Surgery in Sevilla

This morning I had to wake up early to reach the airport in time to catch the Iberia plane to Seville. As always, the plane had a problem and we had to step out of the plane and wait for a replacement. So I had to wait and wait until I finally got to Seville.

There I went to the Infanta Luisa hospital, where I have operated a patient with Dr. Felipe Ros. When we finished, we went to have lunch and enjoyed the "Salmorejo", a tipical plate from Seville. And finally we went to "Popular TV", where Dr. Ros is the director of a TV program on health and well being and he has interviewed me. It was very interesting as we managed to show some video footage from the operation.

I came back home in the AVE (High Speed Train), in only two hours and a half. The landscape was extremely beautiful, you could feel the magic of the Spring season. I think I will rather not to fly to Sevilla again.

Surgeries in TEKNON, Barcelona

This Tuesday we had the festivity of San Isidro in Madrid. This is the time of the year when all the bullfighting starts. I used the oportunity to fly to Barcelona to operate with Dr. Gil Vernet at the TEKNON medical center. We did two cases and then I got back to Madrid in the air shuttle, that was deserted... This medical center still uses the Greenlight KTP 80 watt laser, and it feels strange to go back to it, now being used to the new 120 watt HPS unit... it is so easy to get used to the good stuff...

Visitors from La Coruña

This thursday we received two visitors from La Coruña. We had three HPS laser prostatectomies in our list, and we all enjoyed a very interesting training session. One of the prostates was relatively big, with 130 grams, and a big median lobe. They were impressed by the ability of this laser to reproduce the same job one could get with the TURP, but with much less risk. They also enjoyed the anterior start technique (it can be seen in the screen, the photo was taken when I was creating the anterior initial channel).

Full length Greenlight HPS prostatectomy video

This video shows a Greenlight HPS endoscopic prostatectomy. It is a fast movie, compressing a 50 minute full lenght procedure into 10 minutes of video. It shows the "anterior start" strategy and discusses its benefits. I guess it will be more interesting for urologists, but some patients might also want to see how the procedure is performed.

Holmium laser for stone treatment

This friday we asked Dr. Ibarluzea, from Bilbao, to help us with a very complex case. A patient with a single kidney full of stones. He had progressive renal insuficiency and kidney infections. Dr Ibarluzea is a stone expert and he said this was the most difficult case he had ever seen.

Dr. Llanes is the director of our stone unit, and he is also an expert in minimally invasive stone surgery (PCNL, percutaneous nephrolithotomy and ureteroscopy). We all had a hard time sorting out this case...



I bring this video up here to show how lasers have other applications in urology apart from prostate surgery. This laser allows to treat patients with stones in the urinary tract. We used a "stonelight" 15 watt holmium laser, from AMS.

Sorry, the video is in Spanish...

Visitors from AMS in theatre

This thursday I operated in Madrid, and I had some visitors, this time from AMS (Americal Medical Systems), the manufacturer of the HPS laser. They wanted to see a PVP (photoselective vaporization of the prostate) for the treatment of benign prostatic hyperplasia. The case I had scheduled was very difficult, it was a masssive prostate with an immense median lobe, so I had to be very systematic and slowly I managed to get a fantastic postoperative result. Then I gave them two lectures on basic science and clinical aspects of this technique. My voice was still not perfect, but I managed...

From Barcelona to the Canary Islands

This tuesday I took a flight to Barcelona, to help Dr. Guillermo Batlle to perform his first case with the 80 watt KTP laser at the Delfos Medical Center in Barcelona. It was a 60 gram prostate that seemed to be a little bigger endoscopically... The surgery was uneventful and I was satisfied with the result. Then I rushed to the airport back to Madrid. I had to connect with a flight to Gran Canaria. I landed only 20 minutes before departure time and it was a miracle but I got into the plane in time. Dr. Juarez and his wife, Loli, picked me up and took me out for dinner and the next morning we started operating with his brand new HPS laser. We had three patients scheduled, two big prostates and one smaller, all of them were successful.


Dr. Juarez and Loli are not only married but also work together and have a very wide experience in endoscopic surgery and andrology, so they learned the technique very fast and they are such nice people that I really enjoyed this trip. I returned to Madrid and went to bed very late, and totally croaky.... too many planes are bad for your health.

Visitors from the Canary Islands

This Friday I received in Madrid the visit of Dr. Juarez and his wife, who came from the Canary Islands to see the new Greenlight HPS in action. The surgical session was specially interesting because we operated two patients, one of them was a 50 gram prostate, very straight forward. The second case was a 220 gram prostate that needed 1.100.000 joules and a suprapubic trocar to enhance irrigation. We managed to do a good job in 2 hours and 45 minutes... the patient went home the next day, happy. Dr. Juarez is going to start using this HPS laser in the Canary Islands next week. I plan to jump there to give him a hand with the first cases. I did not take photographs, but I will in the Canary Islands...

Interview on Spanish TV on HIFU + Greenlight

This is a recent interview in the Spanish National TV most popular health program "Saber Vivir". They asked me about the characteristics of the HIFU (High Intensity Focused Ultrasound) + Greenlight HPS laser combination to treat prostate cancer. This interview took place during a press round we made with the company of Dr. Andreas Blana, from the University of Regensburg in Germany, who came to Madrid to help us with some of our cases.



This minimally invasive prostate cancer treatment is gaining popularity in Europe due to its efficacy and low risk. Patients can go home in less than 24 hours and they go back to their normal life very fast. It has a low risk of incontinence and the rate of potency postoperatively is 50%. Very good for a prostate cancer treatment.

Visitors from Denmark

Yesterday we received four visitors from Denmark interested in the PVP technique with the new HPS laser system. First I did a small talk introducing the basic concepts and theoretical concepts of the Greenlight laser. Then we went to the surgical theatre where I did two PVPs. I did not join them to the Flamenco Show this time...



Both patients were fine and today came to see me to my clinic. They were both happy, feeling well and could not believe how well they are feeling only some hours after surgery...

Masterclass with Dr. Gaston

This Saturday we received Dr. Gastón, from Bordeaux, in the company of Monique, his mithycal nurse, to perform three radical prostatectomies in patients with prostate cancer. He regularly visits us to operate with Dr. Castillón (the director of the laparoscopy unit at the ICUA) once a month.

It was a very interesting session because we operated relatively difficult cases that Dr. Gaston was able to solve elegantly. Dr. Gaston liked very much the new hospital where we have started to operate (Sanatorio del Rosario) in Madrid. Then we took them to the airport as they had to return to Bordeaux. We used our new high definition laparoscopy tower from OLYMPUS, that we have just adquired, with 5 mm videolaparoscopes. State of the art technology that allows operating with the best possible image quality.

We move!!!

Today we moved to a new hospital, the "Sanatorio de Nuestra Señora del Rosario". We leave the "Hospital San José" where we have been carrying out most of our surgical activity to start operating at the new hospital this week.

It has been a pleasure to work in San José for the last few years, where we have shared our activity with fantastic professionals. We will miss all the medical, nursing and administrative staff at San José, we have shared many moments of hard work and many intense and happy moments.

The "Rosario" hospital is one of the classic private hospitals in the "Barrio de Salamanca" in the Center of Madrid. Although an old hospital, it has kept the pace with medical innovation and it offers fantastic technology and state of the art services. Some of the best surgeons in Madrid work here, some of them are good old friends of mine. I worked there for many years as the surgical assistant of Dr. Hidalgo Pascual (Head of the Department of General Surgery of the famous "Hospital 12 de Octubre" from Madrid) and of Dr. Pereira Sanz (Head of the department of Urology of the "Hospital de La Princesa"), during the years of my specialisation. I learned a great deal from them.

In the "Rosario" Hospital we can continue our surgical activities in the best possible environment. For us it is very important that it is also very well equipped for training activities, and it is very close to the ICUA....

Interesting images

Recently, reviewing a patient in my clinic, I could compare the ultrasound appeareance of a prostate before and after PVP with the Greenlight HPS. I thought it was interesting enough to offer it here. This first image shows the preoperative image obtained with a 7 mHz transrectal ultrasound probe. This was approximately a 50 gram prostate.

And this is the postoperative image on transrectal ultrasound a month after the operation. This is a transversal image, where a wide prostatic cavity can be seen, similar to what we obtained with the classic trasurethral resection of the prostate.

And this is the longitudinal view. The prostate with a central cavity in the right hand side and the bladder in the left hand side.

I am extremely satisfied with the results we get with this laser. It is a quantum leap in the treatment of BPH, not only because it is safe and comfortable for patients (nobody doubts nowadays that it is safe, and that the side effect profile is better than classic surgical options), but because of it's efficacy. Many urologists still think that TURP is the best treatment in terms of efficacy, but I think that once you learn to master PVP properly, and that takes some time, to gather the appropriate experience, you can have exactly the same efficacy, with much lower morbidity. I hope to be able to prove this when I publish my results, but in the meantime, every urologist wanting to see this with his own eyes is invited to come to my theatre to watch it!!

Surgery in Toledo

Yesterday I drove to Toledo, a city just one hour away from Madrid, to show the new 120 watt Greenlight HPS laser to two colleagues from Toledo. They already had performed 30 cases with the 80 watt laser and were interested in upgrading to the new system.

They scheduled a patient with a big prostate, they estimated to be bigger than 100 cc. I needed 90 minutes and I delivered 550.000 joules. It was a tricky case because the camera system was not very good and the image ketp on saturating with the high intensity of the light. We lowered the light source intensity and managed to see a little bit better. The operation was uneventful and my colleagues were happy to see such a big prostate treated in a reasonable surgical time and with a fantastic result.

After my weekend in San Sebastian with my family, my camera was full of photos and I could only take this shot of the color of the urine postoperatively.

I am now starting every procedure with the 120 watt setting, before I would start with 80 watts until a tunnel was made and I was certain that the fibre would not contact with the tissue. Fibres do not like direct contact with tissue, and if you do contact and pressure against the tissue, the reflection of the energy on to the fibre will crack it. Interestingly, the fibre tolerates very nicely to work in near contact. Although this fibre can be used 3 mm apart from the tissue, I have the impression that performance is even better when you work in near contact and with a very slow sweeping speed. I got these tips from Dr. Carson Wong, and I must say it seems to work OK!!!

Then I went back to Madrid, I will spend the Easter days at home with my family. Being at home is a real pleasure!!!

Training in San Sebastian

This friday I travelled to San Sebastian. I took a plane with my wife and daughters, accompanied by Dr. Al Tayyib, from Saudi Arabia, to participate in a training session on HPS laser prostatectomy at the Clinica del Pilar, that has decided to invest in top technology for the treatment of benign prostatic hyperplasia. I had to train two local prestigious urologists.

We had some problems just after arriving to San Sebastian. Iberia lost my luggage, and my cystoscope was inside my suitcase, and I needed it to operate that same afternoon. Thanks to the rapid reaction of the Olympus representative in the Vasc Country we could borrow a new continuous flow Olympus cystoscope. This new instrument has an 8 F channel that allows a better irrigation and it performs much better than the previous Olympus cystoscope. It provided us with a fantastic visibility during surgery, so I would recommend it to other users.

I did two cases, the first one was a huge prostate, bigger than 120 grams, that was completely uneventful. Then we did a second case that was also interesting. Dr. Al Tayyib, who was extremely satisfied to have had a chance to see the HPS in action with small, medium and large prostates during his week in Spain with us, rushed to the airport as he had to return to Saudi Arabia. I stayed in San Sebastian to spend the weekend with my wife and daughters.

Although it is one of the most beautiful cities in Spain, we were not very comfortable in San Sebastian, as the rain did not stop pouring over us and also because we could not change our clothes as much as we would have liked. If you lose your luggage with Iberia, you are in trouble. You call the lost luggage information number and they do away with you with a simple recording. I was lucky because Ana María, my PA, went to Madrid Airport on Sunday, and asked a friend working at the airport to help her review case by case until she found it. If I did not have the best PA in the world, I think I would have never recovered our lugagge and cystoscope!

Visitor from Saudi Arabia in Madrid

Today I did three PVPs with the new high power 120 watt HPS laser in the company of Dr. Al Tayyib, from Jedda, Saudi Arabia. We enjoyed very much because the cases were very interesting, prostatic sizes were bigger than those we did on tuesday. We had a wonderful session together where we could share a lot of information on the technique. I prefer to have this one-to-one sessions because it is much easier for me to share my experience and for the visitor to ask every possible question. One of the cases was extremely interesting, because the patient had very limited mobility of his right hip, and I had to perform the operation with very limited movements of the cystoscope, but the result was fantastic... we both thought it would have been impossible to operate him with the traditional TURP.

Dr. Al Tayyib, as all Saudi doctors I have met, has a fantastic urological knowledge and it was a great pleasure to share this session with him. Soon his Urology department at Jedda will start using this technology and I will travel again to Saudi Arabia to give them a hand.

Multinational visitors to theatre in Madrid

Today I had a theatre training session in Madrid with a lot of visitors. We received 6 visitors from Sweden, four from Switzerland and one from Saudi Arabia. I first did a talk in a nearby hotel on the basic principles of Greenlight HPS 120 laser treatment of BPH, and then we went to the hospital, where I did two operations with this laser.


Then I had lunch with the Swedish visitors who left Madrid very impressed by the technique and then I went to have dinner with the Swedish visitors to a famous flamenco restaurant in Madrid, El Corral de la Morería, so we had time enough to enjoy the operations in theatre and then a fantastic dinner and a great dance show. Our visitor from Saudi Arabia stayed in Madrid to participate in further surgical sessions this week.
I did not take photos in theatre this time, but one of our visitors did and promised to send them to me, so I hope she does and I can update this post sometime...

European Association of Urology Congress in Berlin

I have just arrived from Berlin, where I have participated in the 22nd Annual Congress of teh European Association of Urology. This is the impressive building where it took place.

I try to go every year to the EAU congress because it is an excellent congress. Not only it allows to update your knowledge, but also to get to know new drugs in the market, new medical or surgical devices, but also it is a great opportunity to meet friends from other countries. In this respect, I have had a very intense activity meeting with other world experts in Photoselective Vaporization of the Prostate, we have very interesting projects in common that I will cover in future posts in this blog. There were many abstracts related to PVP coming from many different countries, and all of them were extremely positive.

This year I chaired the European School of Urology course on Multimedia applied to urology, with Dr. Aurel Messas, from France. The EAU offers webcasts of all ESU Courses online, and my presentations are available online. I guess the quality of the webcast will not be perfect, because I was using a lot of flash videos that will not play on the webcast. A pity.

Another very interesting aspect of this congress has been the launch of www.urosource.com, a website sponsored by the EAU that offers news, key papers and other content, but the most amazing is the possibility to access the surgical video bank of the EAU. There I found, for example, a video on a new urethroplasty technique that I submitted to the congress two years ago.

From Bilbao to Venice

On Friday morning I did a short talk on the new Greenlight HPS at the congress in Bilbao. Thanks to the impressive technological organization of the meeting we could transmit to the audience the status of the patient I had operated the previous day. He was doing well, and we showed a live transmission of his ultrasound compared to the previous day. His prostatic volume went down from 70 cc to 25 cc, the median lobe had been vaporized completely. The flow rate had gone up from 5 mL/s to 18 mL/s in just one day. He was after discharged and I went to the airport.


I took a flight to Venice, Italy, invited by the pharmaceutical company Astellas to a training session on how to improve medical presentation skills. It was beautiful to take the boat-taxi from the airport to the hotel...


This was a very interesting initiative from Astellas, I had a very nice working day in the company of some friends, Dr. Castillón, Dr. Sanz from Marbella and Dr. García Montes, from Mallorca. The lady in the photo is Chira Ariño, from Astellas, a fantastic woman and professional.


Dr. García Montes is the chap with the looks of a flamenco dancer in the middle of the photo, and he is one of my most loved friends. We shared a lot of time together when we both worked at the Institute of Urology in London. He is now an expert on artificial sphincters.

Then I travelled back to Madrid on Sunday, I needed to rest a little in the company of my family.