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.

Live surgery in Bilbao

Yesterday started the I Symposium Internacional de Cirugía Robótica y Nuevas Tecnologías en Urología, organised by the prestigious urologists group Urología Clínica, from Bilbao. This congress, mainly devoted to robotic surgery, also has a session on lasers for benign prostatic hyperplasia. The panel of experts invited is espectacular, with urologists as Cathelineau, Gastón, Lugnani, Murat, Piechaud, Wilson. I was invited to participate performing a live surgery in a patient with BPH with the new Greenlight HPS (High Performance System) laser in the Virgen Blanca Hospital in Bilbao, while the attendees were in the conference hall at the Museo Marítimo de Bilbao, in a beautiful part of the city. The hospital was equipped with a system to retransmit video and audio to the congress hall.

The patient I operated had a 70 gram prostate with a humungus median lobe, a slightly difficult case, with the intention to show the audience a real life case, rather than a selected and easy BPH case, so they could evaluate the real ability of this laser to deal with real life prostates...
During surgery, Dr. Carlos Hernández, the moderator of the session, asked me questions about the technique, the surgical strategy and the features of the new HPS system.

Surgery was smooth and beautiful, there was no problem at all. I delivered 525.000 joules in 80 minutes. Some colleagues commented they were impressed not to see a single drop of blood. Today I will do a presentation in the congress hall and then I have to split because I have to fly to Venice, where I will attend another medical meeting this weekend.

More visitors from Portugal

Today we received the visit of four urologists from Porto, Portugal, that will soon start operating patients suffering from Benign Prostatic Hyperplasia with the new Greenlight HPS. We only had one case scheduled, but it was a relatively difficult one. A patient with a huge prostate with a very big median lobe. I must say it has been the most challenging case I have had in some time.

Finally, the result was very satisfactory. The median lobe was completely gone and there was a huge cavity. The patient will leave tomorrow morning. I have used 800.000 Joules in approximaetely two hours of surgery... The normal plan for those who come to visit us is to see operations on smaller glands, but I think it was a good experience. Even when a case is difficult, the patient is totally safe and it is possible to negotiate any challenging situation presenting during surgery without much trouble.

Visitors from Portugal

Today we welcomed visitors in the OR. Two urologists from Portugal that wanted to learn to perform PVP (Photoselective vaporization of the prostate) with the new HPS laser system.

When we receive visitors we always comment the theoretical aspects of this technique, we watch videos, animations and discuss some data. Then we go to the OR, where I operate one or various patients, and we have a chance to comment the technique step by step and clarify any doubt on the procedure.

In this ocassion we operated a very big prostate, that was uneventful... At the end, the session was intense but very interesting, we shared many opinions and ideas.

Return to India

Again I have come to India, to participate in a workshop on greenlight HPS laser treatment of BPH. I was invited to attend this workshop at the Jaslok Hospital, in Mumbai. It is the best surigal hospital in town and it will adopt the treatment of benign prostate hyperplasia with the new Greenlight HPS. I am happy to come to India, I love this country and I have also made some friends that I like to visit.

My role in this meeting was to present my experience with the technique, and its advantages over other treatment options. I had 30 minutes to explain my experience, what advantages this laser has over the 80 watt Greenlight PV (KTP laser) and above all, why I think this is the best option on earth to treat BPH. After the presentation, there was a discussion and it was a lively one.

Then we went to theater, where I performed three consecutive operations that were completely uneventful. This time we did not see a drop of blod. They were easy cases, 50, 40 and 20 grams, very easy.

Tomorrow we will operate four patients and this time I will help urologists in this hospital with their first cases. After the operations tomorrow, I will get the plane back to Madrid, that departs at 02.30 a.m. !!!

Visitors from Vitoria

Today we received visitors from Vitoria, two urologists and a group of nurses interested in witnessing the technique and the details of how a PVP with the new Greenlight HPS laser is performed. We had a patient with a relatively big prostate with a median lobe that needed three laser fibres. He had a huge median lobe and it took a little more than usual to complete the operation. After finishing, we sat down for a while to discuss the technical aspects of the operation. I showed them presentations and videos to ensure that they get all the tips and tricks!!!

Riyadh, part II

I am now at the airport waiting to embark back to Madrid after four intense days in Saudi Arabia.


The third day of my stay we did two PVPs that were uneventful. This was the most relaxed day. After sleeping and working at the hotel room for a while I had the chance to visit the Kingdom Tower, the emblematic building in Riyadh, and it is really impressive. From the bridge one can see the city, immense, built on the desert. Unfortunately my camera was retained on my way up, so I can only offer this one (see the brigde of the tower in the upper left corner of the photo?).


The fourth day we were planning to operate four patients, but two of them did not show up. The first case was a 70 gram prostate and the second was again a very big prostate maybe as big as 150 grams (the patient did not have a preoperative ultrasound, so we estimated the size endoscopically). Everything was uneventful and I had a chance to show some tips and tricks on how to tackle these relatively big glands. This time, the head of the department of Urology at the King Faisal Hospital came to theatre, and he showed a lot of interest. During the operations we had a chance to comment the subtleties of PVP with the new Greenlight HPS.


It has been an intense week, with nine surgeries in four days, but it has been really interesting to visit this hospital and get to know his urologists, great surgeons and better persons. After the success of this sessions I have receive new invitations to help train urologists in Jedda and other Saudi cities.

Operations in Riyadh, Saudi Arabia

I have already been in Riyadh for two days. I travelled the whole day on Friday and I had a welcoming dinner in a fantastic morrocan restaurant.... a good start for a very intense trip with a lot of work ahead.

I have been invited to the King Faisal Specialist Hospital & Research Centre to perform a number of surgical operations (PVPs - Photoselective Vaporization of the Prostate) in patients suffering from Benign Prostatic Hyperplasia with the new Greenlight HPS. The hospital wants to evaluate the technique and it has organised four days of surgery. This is a top-level tertiary hospital that is devoted to treating very complex cases coming from the whole kingdom of Saudi Arabia. Here is where the members of the Saudi Royal Family come for medical care. It is equipped with the latest technology and it is truly a healthcare city.... it is an impressive hospital.


A good part of the sanitary personnel is non-saudi, and comes from more than 80 different countries, which makes this hospital a really exceptional place. I must admit I am very impressed to see the quality of healthcare here, the outstanding level of doctors and the technology available.

Each day I have been asigned to treat the patients of one of the consultants of the department. The objective is to show them the technical tips and tricks and to allow them to witness the surgery and evaluate the results in their own patients.


The first day I operated two cases, a 40-50 gram prostate and an 85 gram prostate with a big median lobe. Both cases were uneventful. Today I saw the patients in the morning and both were feeling fine and have been already discharged.


This morning we operated a small prostate and a bladder tumour in a high risk patient and then they offered me to operate a patient with a huge 200 gram prostate, that also was satisfactory, although it was probably the most difficult case they can offer to a visiting surgeon... I suppose they found it interesting to see the performance of the HPS laser in huge prostates. After the surgical session we had some lunch at the urology department and then I did a talk on the Greenlight Laser, that was followed by a discussion.


Tomorrow and the day after tomorrow there are more patients programmed, so there is still a lot to do... Tonight we will go to a typical Saudi Restaurant, and believe me, the food is very good here ,-)

HIFU in Bilbao

Yesterday I travelled to Bilbao, where I visited Dr. Astobieta and Dr. Ibarluzea, that had scheduled a session of HIFU (High Intensity Focused Ultrasound) treatments for two patients diagnosed of prostate cancer. We are good friends and we share the passion for minimally invasive technologies and we had a chance to discuss the latests news in Urology and our recent experiences.

I have been invited to participate in an international meeting they organise the 1st of March, in principle to lecture on the new Greenlight HPS, and if possible, to perform a live surgical operation.

I then came back to Madrid, and attended the inauguration of the new headquarters of IML (Instituto Médico Láser), by my friends, the Surgeon Dr. Moreno Moraga and his wife, also a plastic surgeon, Dr. Josefina Royo. They have the biggest laser and technological unit in Europe and they devote their efforts to applying state of the art technology in the treatment of cutaneous diseases, varicoise veins, obesity and so on. They are growing fast and they are offering technological treatments in other areas, as plastic surgery, ophtalmology and dentistry. We will soon collaborate offering laser treatments of urological conditions.

Visitors from Belgium

Today I had scheduled a surgical session in Madrid and we received the visit of Dr. Philip Ameye and Ben Van Kleinebrugel, from the University Hospital from Leuven, Belgium. I performed three laser prostatectomies with the new 120 watt Greenlight HPS, and they came to theatre to witness these operations first hand. They already have experience with the 80 watt Greenlight PV system, but they wanted to see the new HPS in action, as they are evaluating the possibility of purchasing one.
I explained them my ideas on this operation and how should one handle this new laser.

I performed three operations from 9.30 am to 2.30 pm, all uneventful, and we went out for lunch to celebrate their visit. We had fun and we also learned a lot. I always learn from the opinions and comments from other coleagues - these are top class urologists performing state of the art surgery in Leuven, Belgium.

I got an invitation to operate in Belgium in March. It seems there is a Urology Professor that is interested in this technique but that would like to see with his own eyes not only some operations, but also the postoperative recovery of his own patients. So I will do some surgeries there to allow them to ascertain if Photoselective Vaporization of the Prostate keeps up with its wonderful reputation.