This time I moderated this session online on the use of micro ultrasound in the diagnosis of prostate cancer. The presenters were Dr. Pereira, from Bilbao and Dr. López Alcina, from Valencia. Both presented their data and impressions on where this new technology fits in the diagnosis of prostate cancer and the potential role in active surveillance, monitorization of focal treatment and some new other applications that will possible gain force as this technology becomes more widespread.
Dr. Pereira's team was the first in the world to acquire this technology. We at ICUA-Clínica CEMTRO were the second team to use it in Spain and Dr. López Alcina right after us, so it was a very interesting webinar full of first-hand experiences. We have all published our data and we keep studying the data and the results we are getting to better understand how to make a better use of this potentially game changing technology.
This time I participated in the Masterclass in Endourology organized by the Endourology Society with a talk on the new Holmium lasers with pulse modulation. You can see it following this link.
Recently this editorial letter was published in the World Journal of Urology, where I reflect on the need to evolve from the traditional techniques for the treatment of BPH, open simple prostatectomy and transurethral resection of the prostate, to endoscopic enucleation.
The paper can be accessed for some time in this link rdcu.be/cfM9a
In these trying times we have modernized to be able to broadcast surgeries online, so that other colleagues can learn the techniques we perform at ICUA-Clínica CEMTRO.
Before the pandemic, it was quite usual to have visitors in our operating room. Today that is no longer possible but we can use the internet to do the same.
Today we broadcasted two live surgeries for Australian colleagues, one patient with a normal sized prostate, and a second one with a very large gland. We obtained 180 grams of tissue at the end of surgery, that took approximately 1 hour.
A new way of communication, very useful to share experiences and knowledge. I am sure we will do many of these broadcasts from now on.
This time I participated in the online congress UROVIVO. I presented a semilive surgery, an En bloc Holmium laser enucleation using the Lumenis 120 W laser with MOSES 2.0.
Everything went very well and I received positive feedback from the session. I have uploaded the video of the surgery to my YouTube channel, with my comments, as the urovivo session with moderator comments can only be accessed from the Urovivo website.
This time I did a webcast for urologists from Australia & New Zealand who are interested in HoLEP-
I explained how HoLEP has been simplified and how it is now a relatively easy to learn technique.
The meeting was lively and there was some interaction, it was nice for my colleagues down under that this is an affordable technique to learn if one follows the right path. I also spoke about the changes in technology that facilitate this technique, and ease the learning process, as advances in fast morcellation and Holmium pulse modulation, as the MOSES system from Lumenis.
One of the slides reflected how sometimes experts have overemphasized how this technique was only ment for extremely talented surgeons, which I do not share at all.
Soon we will perform a live surgical transmission of two cases, to demonstrate that all I said is real.
This time I participated in this important European congress in Endourology, organized by Dr. Cesare Scoffone in Milano, Italy. It had to be online due to the pandemic.
I participated with a talk on endoscopic enucleation with early apical dissection and sphincter's mucosal preservation. And with a live surgical case that I posted in YouTube.
It was a pleasure to see my endourologist friends from all over the world in this online meeting, in this trying times. The video shows a HoLEP with the 150 W Holmium laser from Quanta System, with the virtual basket pulse modulation from this console.
We have recently published this paper on the recent advances in Anatomic Enucleation of the Prostate with Holmium laser.
The paper discusses our evolution in surgical technique from the use of the GreenLight laser to the Holmium laser and describes in detail the surgical technique we published last year in the World Journal of Urology. The development of this technique has allowed us to improve the results of HoLEP as it helps preserve the external sphincter optimally, which results in an extremely low risk of postoperative temporary stress incontinence.
This is a recent paper on the iTIND device. It reflects our participation in the multicenter international study on the use of this device for the treatment of BPH.
It is a minimally invasive new option for the treatment of lower urinary tract symptoms that respects sexual and ejaculatory function.
This year, due to the COVID-19 pandemic, the European Urological Association congress was celebrated online. This article was published, also electronically, in the congress newspaper. It was based in my participation in a session on urological problems of trasplanted patients, where I was going to speak on the treatment with Holmium laser of benign prostate hyperplasia in these patients.
This year the EAU congress was celebrated online, due to the COVID-19 Pandemic.
These are the papers presented to the congress with my participation and the original papers we published at ICUA. All this work has been possible due to the team effort at ICUA.
We are all struggling with the COVID-19 Pandemic. Scientific work is certainly going to suffer. We will keep trying to contribute!
This year the Annual congress of the American Urological Association, that was going to take place in Washington DC has been cancelled.
Instead, all scientific works that were going to be presented there, will be published online.
This year we boosted our scientific activities, and the results are starting to be visible. We present 4 abstracts.
One comparing the En bloc endoscopic enucleation of the prostate with early apical liberation with GreenLight and Holmium lasers.
Another video-abstract on Aquablation
Another one on the results of the iTIND device for the treatment of LUTS sugestive of benign prostatic obstruction.
And finally, the work that makes me proudest, that has also been accepted for publication in the Journal of Urology, and the result of the hard work of the group, but specifically due to the stubbornness of my colleagues Dr. Moisés Rodriguez Socarrás and Dr. Juan Gómez Rivas. It is our protocol for the diagnosis of prostate cancer combining microultrasound (ExactVU system) and transperineal fusion biopsies (Biopsee system).
The coronavirus has brought us many bad things. But it has pushed us to step forward in the digital world. I think future medical congresses will no longer be as in the past. More and more, medical training and scientific exchange will take place online.
The coronavirus infection has taken us all by surprise, we could not imagine the dimension this was going to take in such a short time.
We have been forced to stop our consultations and elective surgeries to only operate on urological and oncological emergencies, to protect our patients and the staff from ICUA and Clinica CEMTRO of the danger of contagion. We have cancelled our programmed attendance to courses and congresses as well as all the training courses, internships and visitorships we had programmed.
Clínica CEMTRO has devoted all its efforts and resources to help to cope with this terrible infection and all the urology staff supports the clinic in this endeavour. Sadly, some of the members of our team are isolated at home affected by the infection.
We will still offer telephone and video-conference consultations and we remain available to our patients at www.icua.es & www.clinicacemtro.com. You can contact us at:
Telephone +34914352844
E-mail: icua@icua.es
This time we welcomed the visit of Dr. Baghaloo, from South Africa, who spent two days with us in the operating room. There is a growing interest in HoLEP in South Africa.
Again we received the visit of urologists from Epsom Hospitals near London. We shared two days of surgery and I explained the en bloc technique with early apical release and the MOSES Holmium laser.
It was a very nice session and I enjoyed the company of these colleagues. I stayed in London for one year doing a reconstructive urology fellowship, right after my specialization and I keep excellent memories from that time. Many of my colleagues from that time are now eminent urologists in the UK
This time I participated in the user meeting organized by Abex, the distributor for the Da Vinci system in Spain and Portugal, that took place at the "Casa de América" in Madrid.
My role was to speak about strategies to improve urinary continence after radical robotic prostatectomy.
I discussed the posterior reconstruction described by Rocco, the anterior and posterior reconstruction preconized by Tewari, the periurethral suspension of Patel, the ARVUS technique, the anterior reconstruction, MULP technique and bladder neck preservation.
Then I spoke about the preservation of the Retzius space, but then I centred myself in discussing the advantages of the right lateral approach of Dr Gaston, that in a certain way encompasses all these techniques by preserving the anterior support, allowing for the preservation of the bladder neck, preservation of urethral length, and has the advantage of allowing to perform an intra, inter or extrafascial dissection in each side and to decide if the neurovascular pubovesical complex of Santorini is preserved or not, depending on the location and aggressiveness of the tumour.
I also presented our results at ICUA-Clinica CEMTRO, with excellent continence preservation with this technique. Dr Reinoso Elbers and Dr Rodriguez Socarrás from our team reviewed all our robotic experience of these last years and they carried out the statistical analysis of our data.
Continence preservation is optimal when the whole periprostatic tissue can be preserved, and a little worse when we have to be more aggressive to cure the tumour. The definition of continence or incontinence we used was the need to carry a pad or not.
I also showed that this technique, although technically difficult and demanding, is perfectly reproducible, as there are no statistical differences in the results obtained by Dr Gaston and myself in terms of urinary incontinence.
We published some videos in youtube of this technique performed by Dr. Gaston and myself. I include them here.
It is a great satisfaction to see how robotic surgery is becoming solid in spain for urologic surgery. The Da Vinci robot allows us to perform surgeries in a minimally invasive way and achieve results that are not possible with conventional laparoscopy or open surgery. An excellent initiative of Abex, to get us all in one room to discuss and share our experiences.
This week we received the visit of two urologists from the Royal Free Hospital in London, who are already expert HoLEP surgeons, who were interested in learning the technique of En-bloc MoLEP (HoLEP with Moses technology) with an early apical release.
Mr Cohen and Ellis spent two days with us watching operations and we had a great time sharing tips and tricks on HoLEP, as well as discussing the subtleties of this technique that we published recently.
This time I went to Barcelona to participate in the international course UROFORUM, organized by the Clinic Hospital in Barcelona.
My role was to participate in an expert panel with Dr Javier Sánchez and Dr Cesare Scoffone on endoscopic enucleation of the prostate with Holmium laser.
I presented my technique of en bloc enucleation with an early apical release. I recently published a video on the technique in youtube, that I include here.
Sadly I could not stay for the remainder of the course as I had a lot of work in Madrid. UROFORUM is an important international meeting in Europe. From now on it will deal with oncological urology one year and alternatively non-oncological urology the following year.
This time I went to Barcelona to participate in this course organized by the European School of Urology and the European School of Uro-Technology (ESUT).
My role was to participate in a round table discussing clinical cases and then I went to the operating room at Fundació Puigvert to perform a live surgical case that was broadcasted to the main auditorium of the course.
I performed an En-bloc enucleation with early apical liberation with the Holmium laser with MOSES technology. I was a bit uncomfortable during the operation as I do not usually use the Kuntz applicator for my operations, but the case went very well. I could demonstrate an excellent preservation of the external sphincter and later I was informed that the postoperative course of the patient was excellent. We published this technique recently and I think it is going to improve the results of HoLEP procedures. There are many urologists now in Europe adopting this approach.
As always, the organization at Hospital Sant Pau and Fundació Puigvert was impeccable.
Urologist. HoLEP and robotic surgery specialist. Head of Urology at Clínica CEMTRO, Madrid. I have operated in over 50 countries and performed more than 10,000 laser procedures.
