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@RomanCarvajal • 4,790 subscribers

Endo & Onco Urologist -UNAM-, Robotic & Laser Surgeon. Dogs, Music, Books & Motors LOVER.

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I routinely use a 22Fr resectoscope and rarely exceed 24Fr. In my experience, a 26Fr instrument is often unnecessarily large for a standard urethra. This side-by-side comparison in the same urethra highlights the difference between 26Fr and 24Fr. The 24Fr offers easier passage while preserving excellent visualization and irrigation flow. Bigger isn’t always better. Sometimes, the optimal balance is achieved with a smaller caliber. What is your preferred sheath size and why? #HoLEP #BPH #Prostate

I routinely use a 22Fr resectoscope and rarely exceed 24Fr. In my experience, a 26Fr instrument is often unnecessarily large for a standard urethra. This side-by-side comparison in the same urethra highlights the difference between 26Fr and 24Fr. The 24Fr offers easier passage while preserving excellent visualization and irrigation flow. Bigger isn’t always better. Sometimes, the optimal balance is achieved with a smaller caliber. What is your preferred sheath size and why? #HoLEP #BPH #Prostate

11,345 просмотров

Small prostate. Big problem. mpMRI: 17cc. Years on alpha-blockers. PVR >150cc. This isn’t BPH—it’s a rigid, high bladder neck that meds won’t fix. Time to stop guessing. More cystoscopy. Definitive intervention. #Urology #BladderOutletObstruction #ThinkBeyondBPH #BPH #MUGA

Small prostate. Big problem. mpMRI: 17cc. Years on alpha-blockers. PVR >150cc. This isn’t BPH—it’s a rigid, high bladder neck that meds won’t fix. Time to stop guessing. More cystoscopy. Definitive intervention. #Urology #BladderOutletObstruction #ThinkBeyondBPH #BPH #MUGA

16,895 просмотров

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An 80-year-old man with high-risk, locally advanced prostate cancer (PSA 89, GG4, MRI PI-RADS 5, PSMA PET/CT with bilateral seminal vesicle invasion and pelvic nodal disease) presented with urinary retention. After initiating androgen deprivation therapy, we performed HoLEP before definitive radiotherapy. Despite the advanced disease, the procedure was remarkably straightforward: minimal bleeding, excellent surgical planes, no technical challenges beyond standard HoLEP, and successful spontaneous voiding just 36 hours after catheter removal. This case highlights that HoLEP before radiotherapy is feasible, safe, and should not be avoided solely because of locally advanced prostate cancer. #HoLEP #ProstateCancer #Urology #Endourology #RadOnc

An 80-year-old man with high-risk, locally advanced prostate cancer (PSA 89, GG4, MRI PI-RADS 5, PSMA PET/CT with bilateral seminal vesicle invasion and pelvic nodal disease) presented with urinary retention. After initiating androgen deprivation therapy, we performed HoLEP before definitive radiotherapy. Despite the advanced disease, the procedure was remarkably straightforward: minimal bleeding, excellent surgical planes, no technical challenges beyond standard HoLEP, and successful spontaneous voiding just 36 hours after catheter removal. This case highlights that HoLEP before radiotherapy is feasible, safe, and should not be avoided solely because of locally advanced prostate cancer. #HoLEP #ProstateCancer #Urology #Endourology #RadOnc

131,439 просмотров • 1 месяц назад

Small prostates can cause significant bladder damage too—and when an unsuspected urethral stricture is added to the equation, #HoLEP with miniature instruments (#MiLEP) becomes an excellent solution. 💡 The technique is exactly the same: despite the increased fibrosis and limited glandular tissue, the dissection plane is usually easy to identify—you just have to trust it and follow it step by step without skipping any part of the procedure. The best part? In experienced hands, you can be done in about 20 minutes. 😎 #Urology #HoLEP #MiLEP #Endourology #ProstateEnucleation

Small prostates can cause significant bladder damage too—and when an unsuspected urethral stricture is added to the equation, #HoLEP with miniature instruments (#MiLEP) becomes an excellent solution. 💡 The technique is exactly the same: despite the increased fibrosis and limited glandular tissue, the dissection plane is usually easy to identify—you just have to trust it and follow it step by step without skipping any part of the procedure. The best part? In experienced hands, you can be done in about 20 minutes. 😎 #Urology #HoLEP #MiLEP #Endourology #ProstateEnucleation

28,930 просмотров • 2 месяцев назад

Should very low-risk prostate cancer on active surveillance be considered a contraindication to anatomical enucleation? This patient had a >100 cc prostate with severe LUTS and bladder outlet obstruction, and a clear desire to be free from his urinary symptoms and improve his quality of life. We proceeded with anatomical enucleation to prioritize symptom relief while preserving future oncologic options. Technical pearl: prior biopsies may create mild apical adhesions, but respecting the anatomical planes allows a standard enucleation. Don’t divide the bladder neck fibers until complete release and meticulous hemostasis are achieved. Would you operate, or continue surveillance alone? #HoLEP #BPH #ProstateCancer #ActiveSurveillance #Urology

Should very low-risk prostate cancer on active surveillance be considered a contraindication to anatomical enucleation? This patient had a >100 cc prostate with severe LUTS and bladder outlet obstruction, and a clear desire to be free from his urinary symptoms and improve his quality of life. We proceeded with anatomical enucleation to prioritize symptom relief while preserving future oncologic options. Technical pearl: prior biopsies may create mild apical adhesions, but respecting the anatomical planes allows a standard enucleation. Don’t divide the bladder neck fibers until complete release and meticulous hemostasis are achieved. Would you operate, or continue surveillance alone? #HoLEP #BPH #ProstateCancer #ActiveSurveillance #Urology

10,447 просмотров • 19 дней назад

Real case: very low-risk prostate cancer (PSA 3.4 ng, Gleason 3+3, 2-12, ISUP 1) appropriate for active surveillance. A family seeks a second opinion; a surgical oncologist orders a PSMA PET-CT? and refers to medical oncology. The scan, performed at a low-experience center, is read as metastatic (bone and nodal), leading to unnecessary chemotherapy + ADT + ARPI. When the patient returned to me, the findings did not match the clinical picture, so I recommended a second nuclear medicine review. Conclusion: rib and cervical “lesions” were inflammatory/benign uptake, not metastases. Likely technical issue: residual sodium fluoride in an aged PSMA radiotracer causing nonspecific bone uptake. No CT structural correlate. Key takeaway: Integrate clinical context, pathology, and technical quality. #prostatecancer

Real case: very low-risk prostate cancer (PSA 3.4 ng, Gleason 3+3, 2-12, ISUP 1) appropriate for active surveillance. A family seeks a second opinion; a surgical oncologist orders a PSMA PET-CT? and refers to medical oncology. The scan, performed at a low-experience center, is read as metastatic (bone and nodal), leading to unnecessary chemotherapy + ADT + ARPI. When the patient returned to me, the findings did not match the clinical picture, so I recommended a second nuclear medicine review. Conclusion: rib and cervical “lesions” were inflammatory/benign uptake, not metastases. Likely technical issue: residual sodium fluoride in an aged PSMA radiotracer causing nonspecific bone uptake. No CT structural correlate. Key takeaway: Integrate clinical context, pathology, and technical quality. #prostatecancer

35,302 просмотров • 3 месяцев назад

Ya listos? Estamos trabajando todos los días para tener el congreso más exitoso y grande del año, los esperamos próximamente en Guadalajara 2025, el congreso de urología más grande y más antiguo de México, y uno de los más grandes de LATAM SMU México Será un gusto tenerlos de nuevo 😎

Ya listos? Estamos trabajando todos los días para tener el congreso más exitoso y grande del año, los esperamos próximamente en Guadalajara 2025, el congreso de urología más grande y más antiguo de México, y uno de los más grandes de LATAM SMU México Será un gusto tenerlos de nuevo 😎

93,749 просмотров • 1 год назад

I routinely use a 22Fr resectoscope and rarely exceed 24Fr. In my experience, a 26Fr instrument is often unnecessarily large for a standard urethra. This side-by-side comparison in the same urethra highlights the difference between 26Fr and 24Fr. The 24Fr offers easier passage while preserving excellent visualization and irrigation flow. Bigger isn’t always better. Sometimes, the optimal balance is achieved with a smaller caliber. What is your preferred sheath size and why? #HoLEP #BPH #Prostate

I routinely use a 22Fr resectoscope and rarely exceed 24Fr. In my experience, a 26Fr instrument is often unnecessarily large for a standard urethra. This side-by-side comparison in the same urethra highlights the difference between 26Fr and 24Fr. The 24Fr offers easier passage while preserving excellent visualization and irrigation flow. Bigger isn’t always better. Sometimes, the optimal balance is achieved with a smaller caliber. What is your preferred sheath size and why? #HoLEP #BPH #Prostate

11,345 просмотров • 1 месяц назад

🔹Liberación progresiva de la mucosa "ápex": técnica anatómica, sencilla y segura, con excelente continencia. Encuentra el plano, síguelo hacia arriba y la próstata, al caer, te dirá: “córtame aquí” por favor 🙏 Te encontrarás con el otro lado casi sin darte cuenta. 🔄 Resultado: enucleación limpia, rápida y segura. #adenomafree #HoLEP #Urología #CirugíaPrecisa Felipe Figueiredo HoLEP 🇧🇷 Alfredo Sanchez Urólogo Austen Slade, MD, MBA Dr. Rodrigo Donalisio Rodrigo Ledezma Joel Funk MD FACS Javier Romero Otero Elio Sánchez-Ali drglezb Thiago Hota Pablo Contreras Carlos Marneau Roberto Ríos Palacios

🔹Liberación progresiva de la mucosa "ápex": técnica anatómica, sencilla y segura, con excelente continencia. Encuentra el plano, síguelo hacia arriba y la próstata, al caer, te dirá: “córtame aquí” por favor 🙏 Te encontrarás con el otro lado casi sin darte cuenta. 🔄 Resultado: enucleación limpia, rápida y segura. #adenomafree #HoLEP #Urología #CirugíaPrecisa Felipe Figueiredo HoLEP 🇧🇷 Alfredo Sanchez Urólogo Austen Slade, MD, MBA Dr. Rodrigo Donalisio Rodrigo Ledezma Joel Funk MD FACS Javier Romero Otero Elio Sánchez-Ali drglezb Thiago Hota Pablo Contreras Carlos Marneau Roberto Ríos Palacios

17,310 просмотров • 1 год назад

las próstatas pequeñas tmb dañan vejigas, la medicina no es opción. #MiLEP es un excelente tratamiento, rápido (22'), seguro y eficaz, y a pesar del tamaño e inflamación, como dice mi amigo y mentor Felipe Figueiredo HoLEP 🇧🇷 siempre tienen plano 😀 Alfredo Sanchez Urólogo drglezb @roberto_rpal

las próstatas pequeñas tmb dañan vejigas, la medicina no es opción. #MiLEP es un excelente tratamiento, rápido (22'), seguro y eficaz, y a pesar del tamaño e inflamación, como dice mi amigo y mentor Felipe Figueiredo HoLEP 🇧🇷 siempre tienen plano 😀 Alfredo Sanchez Urólogo drglezb @roberto_rpal

12,708 просмотров • 1 год назад

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