ExactVu system, micro-ultrasound of the prostate for prostate cancer diagnosis

Last December 2017 we tried for the first time the ExactVu system of high resolution microultrasound of the prostate for the diagnosis of prostate cancer.

It is a sophisticated high resolution ultrasound (conventional transducers for transrectal ultrasound imaging have 7 MHz, but this has a 29 MHz probe), that improves radically our ability to detect subtle anatomical details in the prostate.

After studying carefully what this technology can add to the diagnosis of prostate cancer, we have decided to adopt it at ICUA-Clinica CEMTRO, to make it available for our patients.

We believe it can be a very nice companion to 3 Tesla Multiparametric MRI and that it can be of great help in paitents who do not tolerate MRI or in which MRI is non conclusive. In some of the cases we performed we could see lesions that the MRI had not even seen and on biopsy there was a tumor lesion.

It is a costly technology, but we believe it will help us detect prostate cancer even earlier in men and thanks to that, improve the chances of cure in our patients.

Many other high level centers are also adopting this technology, and the data published to date is extremely positive.

A very interesting tech that can be better known at the website of exact imaging.

First cases of Prostate Aquablation in Spain

This december we had the opportunity to try for the first time in Spain the Aquablation system, from
Procept Biorobotics for the treatment of BPH.

It is a robotic system that uses a very powerful water jet to deobstruct the prostatic urethra, and it does that in just 5 minutes. The patient is awake, tipically under spinal anaesthesia.

It needs some preparation, but it is surprising to see how fast one can treat prostates of all sizes in such a reduced time.

The main advantage of this system is that 90% of men treated preserve the ability to ejaculate normally.

This is why this technology is very interesting, as many men that need to face an operation for BPH would like to preserve ejaculation, that is tipically affected by other surgical techniques.

More info in spanish here, or watch our video below.

Focal treatment for localized prostate cancer

I Spent this weekend in Paris participating in the ESU-ESUT-ESUI course on Focal therapy for localised prostate cancer.

It is interesting to see how this concept is gaining ground around the world, and evidence to support its use is acumulating. It was interesting to explore this option of management for very selected patients. The information obtained from MRI-Ultrasound fusion biopsies is allowing us to better select the patients who will benefit from this approach.

A very interesting course in Paris!

Visitors to our operating room

As it is common every month, we had visitors in our surgical room. This time, various colleagues from spain came to witness a surgical session, where I could show them the advanced techniques for the treatment of benign prostate hyperplasia with the GreenLight laser. I showed them anatomic vaporization and GreenLEP and how to transtion from vaporization towards enucleation.

The reactions of visitors coming to our surgical room are always the same, they leave convinced of the versatility of this laser and the robustness of theste techniques, as they are very safe and efficacious. It is always a pleasure to receive visitors and make new friends.

ESU-ESUT Masterclass on Lasers in Urology

This weekend I travelled to Barcelona to participate in the ESU-ESUT masterclass on lasers in urology.

I was invited to give a couple of lectures, participate in a round table and to perform a live surgical procedure that was broadcasted to the main auditorium of Fundació Puigvert.

Everything went very well and I could present my techniques of anatomic vaporization and GreenLEP (Green Laser Enucleation of the Prostate), and a very interesting discussion followed. Despite I am trying to travel less offten to be able to devote myself to my patients at Clinica CEMTRO in Madrid, it is always a pleasure to see my friends and to participate in the training of other urologists in the minimally invasive treatment of prostatic diseases.

Visitors to our operating room

As usual, today we received the visit of Urologists from the United Arab Emirates and Saudi Arabia, who were interested to watch advanced techniques on the treatment of BPH with the GreenLight Laser.

I could show both an anatomic vaporization and two enucleations (GreenLEP). I think they were surprised as there are still many urologists that are unaware of the extreme versatility of this laser ot treat prostates of all sizes.

New video of a radical nephrectomy in a patient with renal cell carcinoma and caval tumor thrombus

We have edited this video of a recent surgery we performed at ICUA - Clinica CEMTRO in Madrid.

The Da Vinci Xi robot has improved the contitions to perform this kind of complex surgery that used to entail big open operations with a high risk of surgical complications.

It is in Spanish, I will see if I can produce an English version of this soon.

Experts meeting in London

This time I went to London to join a meeting with other international experts in surgery for BPH to discuss advanced techniques for the treatment of BPH, that at last are going to be promoted internationally in collaboration with Boston Scientific, the manufacturer of the GreenLight laser.

I had to present on my techniques of anatomic vaporization and GreenLEP (Green Laser enucleation of the prostate).

I am also working in the preparation of a manual describing step by step how to perform these techniques, that will be distributed to all GreenLight Users worldwide.

Despite the fact that these techniques that I described have gained wide support by urologists in various countries, as Italy, France and USA, up to now Boston Scientific had not supported them officially, but the good results obtained in studies published in Italy and France and the enthusiasm they generate in their users and patients finally have made it happen!

Surgical course on GreenLight in our operating room

As it is becoming a tradition now, we received visitors to our operating room for a new course on GreenLight Laser surgery for BPH.

In these courses we show the different techniques that can be performed with the GreenLight laser, as EP-PVP (ejaculation protective PVP), anatomic vaporization and GreenLEP (Green Laser enucleation of the prostate).

As always, it is very nice to receive visitors and to be able to exchange knowledge with other colleagues.

EAU prostate Cancer course in Vienna

This weekend I was in Vienna to participate in a monographic course on Prostate Cancer organized by the European Association of Urology.

It was quite interesting to be able to listen from international experts all the new aspects of the management of this disease. It is a very dynamic field where a lot of research is conducted worldwide every year. These courses are helpful to keep track of all that is changing and that is to come.

I was also happy to see the high standard of care we offer at ICUA Clínica CEMTRO, in line with the best centers of the world in prostate cancer.

Challenges in Laparoscopy and Robotics en Burdeos

This time I travelled to Bordeaux to participate in the Challenges in Laparoscopy and Robotics course organized by the urology team at Saint Agustin in Bordeaux, where Dr. Richard Gaston, our colleague at the ICUA in Madrid, works.

Three days of many live surgical transmissions and update talks by international experts. I enjoyed so much! The quality of the course was amazing, and we enjoyed with the participation of first line experts like Indebir Gill, James Porter and others.

Dr. Gastón had as always a stellar role, performing a radical cystectomy that left everybody impressed and a lateral approach for radical prostatectomy.

During the congress a faculty dinner took place and I could not assist as I was having a terrible cold, that hit me very hard that night. Dr. Gaston made balance of his professional life in a talk he gave to the dinner guests. A resident working for Dr. Gaston sent me this photo where Dr. Gaston included me in the short list of "journey friends". I really felt very honored for his friendship and consideration and I was very sorry that I could not be there with him in such an important moment in his career. We have worked together for the last 10 years and it has been an honor to share so many moments and surgeries with one of the best robotic surgeons in the world.

Instructional Course on GreenLight for BPH at the American Urological Association Annual Congress in Boston

This time I went to Boston to participate in one of the Instructional courses the Congress organizes on specific topics. I spoke about the techniques I described for the treatment of BPH with the GreenLight laser, anatomic vaporization and En Bloc GreenLight Enucleation of the prostate.

I was very satisfied to see that other authors are publishing on these techniques with excellent results. 

One of the presentations in the congress was the first american experience with GreenLight enucleation, a paper coming from Massachussets General Hospital, Harvard University, by Dr. Shahin Tatatabaei and his team.

Two years ago I was in Harvard helping Dr. Tabatabaei with his first steps with this technique and before that he came to visit us in Bulgaria, and now we see the fruits of that collaboration.

Other authors from Europe also published on this technique.

I am very happy to see that my little contribution to urology is coming alive and starting to influence positively the life of many patients.

Trip to China

This time I received an  invitation from the European Association of Urology and the European School of Urology to travel to Beijing and participate there in two congresses, as a representative of both European Associations.

After the opening ceremony where we all rang the bells as it is traditional over there, two days of courses started with chinese urologists.

First we did three training sessions where my role was to discuss medical and surgical treatment of BPH with two other very good Chinese professors.

My European colleagues representing EAU and ESU where Dr. Peter Alken, a true mythical urologist from Europe, inventor of percutaneous surgery, and Dr. Henk Van der Poel, a very well known urooncologist from Amsterdam.

The following day, a memorial congress celebrating the centenary of dr. Wu Jieping, the father of urology in China. There we had to report on the best papers presented at the EAU congress in London.

And, again we had to give our talks.

It has been a very interesting trip. China is an impressive country, and technologically very advance. I think in Spain we do not realize the dimension of this country and its power in the world.
Then I returned to spain, there is work to do!

EAU congress in London, UK

This year's EAU congress is taking place in London.

My role this year is to moderate a session of live surgery with minimally invasive operations with other international experts.

It is quite clear that this year endoscopic enucleation of the prostate is one of the hot topics of the congress. I think open prostatectomy and TURP are finally dying.

New video of a radical prostatectomy with Dr. Richard Gaston

I have recently posted this video on youtube. It shows a radical robotic prostatectomy performed by Dr. Richard Gaston with my help using his lateral approach technique that preserves all the nerves around the prostate. This helps in an early recovery of continence (most often immediate postoperative continence) and erectile function.

Dr. Gaston is an internationally renowned expert and he has been working with us for the last 8 years in Madrid, where he operates with us every month at Clinica CEMTRO. For more information on robotic surgery we have this website in Spanish www.icirugiarobotica.com

Publication of a new paper

This morning I went to study for a while and I was happy to see that our review paper on Endoscopic Enucleation of the Prostate has been published!

It has been a collaborative effort with other european experts in endoscopic enucleation. There is still much to do. We all know that endoscopic enucleation of the prostate is a fantastic operation, now we have to strive to demonstrate scientifically what we already know.