Today I travelled to the northwest of Spain, to La Coruña, to participate in a very difficult case. A patient with a prostate larger than 150 grams. I could not see any ultrasound of the patient before surgery, but his digital rectal examination revealed the pressence of a massive prostate. Endoscopically it was also huge, and very long (7 cm). Maybe the biggest case I have done (I operated a 200 gram prostate once, but it was easier to operate).We finally managed to complete the operation without much trouble, I think the patient will do very well. We spent more than 3 hours in theatre, it gets long and one gets tired, but the result is very satisfactory. In cases like this the usual spinal anaesthetic is not enough, so the anaesthetist must perform a combined anaesthetic spinal + epidural, that allows for new bolus of local anaesthetic to be administered if the surgery is prolongued. This way patients are confortable during the procedure.
Then I returned to Madrid, I will operate three cases in Hospital USP San José. Two of them are high risk patients, one is very bothered with his bladder and the second one has been catheterised for months, he was not considered fit enough for surgery and his doctors told him he had to live with a catheter forever. Maybe the KTP laser prostatectomy will be their only chance to recover a normal life. (update November 16th.... all three cases went fine, all patients are happy and back home already).
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