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.

Trip To Teherán

From Istanbul I flew to Teheran with Dr. Shahin Tabatabaei. He was born in Irán, but lives and works in Boston, at the Massachussets General Hospital, University of Harvard.

Shahin, Gordon Muir and myself share the same concern. The treatment of benign prostatic hyperplasia worldwide is very heterogeneous, and today patients are treated with modern techniques in some places, but with very old techniques in other places, that entail much more risk for the patient. For quite a long time we have shared the same protocols for the diagnosis and management of prostatic patients in our centers, and we have enjoyed a very low rate of complications. We think that this level of excellence should be reached everywhere worldwide, and we have decided to promote an initiative to offer help to those hospitals of the world interested in developing state of the art prostate centers.

In this photo with two Iranian Urologists. Dr. Marzbani was a pioneer in Iran with laser surgery. I met him when he came to visit me in Madrid some time ago.

I had a great time and I enjoyed the overwhelming hospitality of Shahin and his family. Teherán is a beautiful and modern city with 15 million inhabitants and is packed with nice people. The hospitals are wonderful and it seems there is a lot of interest in establishing a collaboration to promote state of the art prostate centers.

Creation of the International Prostate Research Group

In this occasion I travelled to Istanbul in Turkey to participate in a surgical session with various colleagues and friends. All of them recognized experts in the surgical treatment of BPH. The reason for this meeting was double, we founded the International Prostate Research Group and also we kicked off the first prospective study of this group. We enjoyed a wonderful dinner by the Bosphorus and then we had a joint surgical session that was very interesting.

An important trip, but very short. I have acquired the compromise to develop the group's website and an online utility so we can all input the data obtained from the results of our patients, so we can finally publish our global experience.

In the photo, with some of the members of the group (not all members could make it to the meeting): Dr. Shahin Tabatabei from Massachussets General Hospital, Harvard, Boston, Dr. Benjamin Choi, Cornell University Nueva York, Mr. Gordon Muir, King's College London and Dr. Edward "Chip" Collins, from San Francisco, USA).

A very interesting initiative, because after some years of friendship and international collaboration, now we compose a very dynamic group, able to perform international studies on surgical techniques and drugs used for the treatment of Benign Prostatic Hyperplasia, with a modern and sophisticated organization. For me it is also a great opportunity to relate to international opinion leaders and to share knowledge and experiences...

Publication of my video in TTMED UROLOGY

One of my videos has been published in the prestigious urological website Ttmed Urology. They have more than 14.000 registered urologists worldwide!! I hope it will serve to promote the greenlight HPS enucleation technique that I have developed recently.

The link to this website is www.ttmed.com/urology

National Meeting for Stones, Endourology and Laparoscopy

On January 28th I flew to Santiago de Compostela in the north of Spain to participate in the National Meeting for Stones, Endourology and Laparoscopy, where I had to participate in a round table on applications of different types of lasers in urological diseases. We spoke of the different kinds of lasers used in urology and we had a lively debate on their advantages and disadvantages... I also took the opportunity to present the new technique of prostate enucleation with the greenlight HPS laser that I have recently developed. (I recently learned that my submission to present it at the European Urology Congress has been accepted). I returned to Madrid the same day, as I had to leave to a meeting in Istanbul.

More surgeries in Sofia, Bulgaria

Again I went to Sofia, to perform more operations with Dr. Kalchev. Sofia was beautiful, dressed in white. I am falling in love with this city and my friends in Bulgaria!

This was the view from the terrace of the Hill Clinic in Sofia. It was snowing and we had very low temperatures.

In this surgical session we operated two days, and two of the patients had huge prostates. We used the new GreenLEP technique, enucleating the adenoma with the Greenlight HPS laser. The size of the prostate fragments was so big that we decided not to morcelate and to extract them through a small incision over the pubis. This is one of the specimens we sent to the pathologist for histological study.

The weight of the adenoma was 245 grams in one of the cases and 260 in the second case (in the photo). This was really impressive. I am now convinced that Greenlight enucleation allows to treat prostates any size with minimal risk, removing the whole prostatic adenoma.

Then I returned to Madrid to celebrate Christmas, happy and hopeful that the year 2010 will be very interesting!

Surgical Marathon in Sofia

Again I travelled to Sofía to help Dr. Kalchev with his learning curve with the Greenlight HPS laser for the treatment of BPH. In a weekend we did 13 operations and operated patients with prostates of all sizes... Everyone of them left the clinic the morning after the operation. 

It was a surgical marathon, but we also had some time to enjoy. Dr. Kalchev showed me the video of an interview that was broadcasted by the Bulgarian National TV, they have published it in their webiste. The introduction of the Greenlight HPS laser in Bulgaria has generated an immense interest. My daughters came with me to Bulgaria this time, and they had a great time getting to know Sofia.

Flash trip to Boston

This was a flash trip to Boston. I had to meet there with Mr. Gordon Muir, from London, and Shahin Tabatabei, from Boston, to discuss some common projects related with prostatic surgery. I took the photos with my mobile, for some reason they looked pink!

With my friend Gordon Muir, visiting the Mass General Hospital.

With Dr. Shahin Tabatabei, during our visit.

I only spent a night there and I returned in a direct flight to Madrid. I landed in Madrid and went straight to my clinic, to work, a little tired.

Surgery in Gran Canaria

Again I travelled to Gran Canaria to operate with Dr. Juarez del Dago. In this ocassion he invited me to give him a hand with a patient with a huge sized prostate. The operation was very succesful, and we had a chance to talk after a "long time no see".

The following day I went back to Madrid, I had to connect with a flight to Boston.

Resident session at the University Hospital Gregorio Marañón, Madrid

This friday I had the great pleasure to be invited to the residents session at the University Hospital Gregorio Marañón, in Madrid, to talk about greenlight laser surgery for BPH. I loved to share my experience with the residents in this hospital and meet some old friends and colleagues as Dr. Lledó, Dr. Escribano and Dr. Durán Merino, among others.

Then I rushed to the hospital, I had patients waiting to be operated!

III Urology meeting for primary care physicians and urology residents

Shortly after my arrival from Taiwan I participated in this scientific meeting invited by Dr. Juan Carlos Ruiz de la Roja.

Dr. Ruiz de la Roja is an old friend and colleague and maybe the most relevant communicator of urology in Spain, after publishing his two books: Hablemos de tu próstata y Potencia tu vida sexual, consejos de un médico.

In this meeting urologists and primary care physicians interact and we communicate recent advances and advice for the management of urological patients in the primary care setting. My role was to discuss the use of the greenlight HPS laser in Urology.

Trip to Asia III: Taiwan

From Shanghai I flew to Taipei, and when I arrived I went to walk around it's famous night markets. Taipei must be the city with most motorbikes in the world, and it is a modern and nice city with heavy traffic.

The following day I visited the Tri-Service General Hospital, a military hospital serving Taiwan's army, the navy and the air force. First I gave a talk on Greenlight HPS treatment of benign prostatic hyperplasia.

Then we went to the surgical theatre, where I helped the hospital's urologists to perform a case, there were also urologists from other hospitals. It was a really interesting case.

 


That day Dr. Richard Santucci, a famous reconstructive urological surgeon, was also visiting the hospital, and we had a very nice chat over a Taiwanese banquet consisting on 11 or 12 courses.

That same night I took the speed train to Kwashioung, the second main city in Taiwan, where I had to make a presentation on greenlight laser and BPH in the 2009 Asia-Pacific Uro-oncology Summit.

The dinner after the congress was very nice and fun, with a lot of karaoke going on. I shared the table with Dr. Paibul Boonyapanichskul, from Bangkok; Dr. Hwancheol Son, from Seoul; our host, Prof. Po Hui Chiang, and Prof. Lawrence Klotz, from Canada. I had a lot of fun!

That same night I went back to Taipei to prepare my return to Madrid. I had time enough to visit the tallest building in Taipei, where I could see the city from above. It was a great farewell after a long trip.

Trip to Asia II: Shanghai

From Hong Kong I travelled to Shanghai, I arrived at night and it was incredible to see the amount of skyscrapers in this wonderful city. It reminded me very much of the movie "Blade Runner".

This is the view of Shanghai I had from my hotel room.

The following morning I was picked up by Dr. Henry Chen, the Chinese urologist with the largest experience in the treatment of BPH with the Greenlight laser. We went to Shanghai's Number 1 People's Hospital to perform a surgical operation that would be transmitted live to the venue of the 30th Congress of the Société Internationale d'Urologie.

The operation was succesful, although we had to calibrate the camera because we had relatively bad camera image, but we managed to solve it. It was a pity that the transmission only lasted 30 minutes, because we could not show the final result of the operation to the audience. We had a good discussion though during the part that was transmitted.

The following day I presented the new technique of Greenlight laser enucleation in a congress session. It was very welcome by the audience. The combination of initial vaporization to facilitate subsequent enucleation could prove to be an optimal strategy to operate bigger prostates with safety and efficacy. Many urologists have problems treating big glands and also they were afraid of morcellation. The new Piranha Morcellator from Richard Wolf has improved this process significantly, and it is much safer than it was before.

 

Then my contribution to the congress finished, and I took the opportunity to get to know Shanghai, a surprising and wonderful city.

I had never seen Malls so huge. 10 floors and thousands of shops and restaurants. Amazing city, Shanghai.

Trip to Asia I: Hong Kong

I love to travel, but when I travel to Asia, I do even more. I think that globalization has limited the differences among countries and cities. We all live a similar kind of life, we drive to work, we buy in the same shopping centers. Many times when I travel I do not find much difference between places. But in Asia the differences are much deeper, you really have the feeling of being somewhere exotic and far away.

In this occasion I travelled to Hong Kong to participate in a full day of talks and surgeries, invited by the North District Hospital and the Chinese University of Hong Kong. From the airport I went to the Hospital to see the patients we would operate on the following day, and check that everything was in order for the meeting. Hong Kong is a wonderful city.

The following day I woke up early to go to the hospital. It has wonderful installations and an amazingly well trained personnel. I was positively surprised by the quality of the hospital and its people.

In the photo, with Edison Chung, the distributor of AMS in Hong Kong. A true gentleman and an amazing host. He took me to the hospital and accompanied me during my trip.

The meeting room was packed with urologists and hospital personnel. I did two talks on surgical technique and tips and tricks to obtain a better outcome with greenlight and I did two operations that were retransmitted live to the audience.

We were able to comment the operations live. I first operated a small prostate, about 50 grams, and then a bigger one, approximately 100 grams.

It turned out to be a fantastic session, we had plenty of time to discuss and comment all aspects of the surgical treatment of BPH with the Greenlight laser. The attendees were really interested and stayed there paying attention until the end. Chinese people are usually smaller than me, I had to pack myself into the biggest surgical jacket in the hospital.

That night we had dinner at the Hotel Sheraton, but before the dinner I gave a short talk on the comparison of Greenlight with other laser types. The traditional chinese banquets include 11 diferent courses, so the dinner was amazing. The Hong Kong chinese food is very different to the chinese food we are used to have in Spain.

The next day I had some time to enjoy Hong Kong. I visited a fantastic zoo where I could see the panda bears and other wonders of nature. I had a great time.

And went up to the peak, to see Hong Kong from above. Impressive.

That night I was invited to dine at Dr. Richard Lo's house. He fascinated me with his amazing hospitality and kindness. We enjoyed his cooking talents in the company of other urologists. I left Hong Kong wishing to come back, as always. It is a marvelous city, a pity it is so far from us.

A new technique: Greenlight Enucleation of the Prostate

This is a new technique to treat patients with big benign prostates with optimal results. Instead of vaporizing all the hyperplastic tissue, after a brief preparation, the middle lobe and then lateral lobes are enucleated, thrown into the bladder and later morcelated or fragmented in the bladder to be extracted.

It allows to remove the BPH(Benign Prostatic Hyperplasia) tissue completely, retrieve it for histological analysis and to obtain excellent results, similar to open prostatectomy, but with mininal risk and a hospital stay of 24 hours.

I hope to present this technique at the Spanish National Congress, the European Association of Urology Congress and the American Urological Association Annual Congress.