Patient Selection for GreenLight & Other BPH Treatments
with Dr. Francisco Gelpi and Dr. Jose Silva
BackTable, LLC (Producer). (2021, August 25). Ep. 14 – Patient Selection for GreenLight & Other BPH Treatments [Audio podcast]. Retrieved from https://www.backtable.com/urology
Urologist Dr. Francisco Gelpi discusses surgical treatments for BPH with a special focus on the minimally-invasive GreenLight Laser prostatectomy. Listen to hear more about Dr. Gelpi’s transition from an oncology-focused practice to a BPH-focused practice, initial BPH patient workup , using prostate anatomy to choose a BPH surgical treatment, GreenLight Laser postoperative care, and the importance of BPH patient involvement and expectations.
In this episode of BackTable Urology, Dr. Jose Silva interviews urologist Dr. Francisco Gelpi about GreenLight laser therapy and other BPH surgical treatments.
Although he was originally trained in urologic oncology, Dr. Gelpi decided to expand his expertise and incorporate BPH treatment into his medical practice as well. He also explains his decision to enter private practice and his role as a Boston Scientific proctor for Rezum and GreenLight.
When initially evaluating a male patient with voiding issues, Dr. Gelpi emphasizes the importance of lower urinary tract imaging. Although he goes through the basic questionnaire to assign the patient an AUA symptom score, he usually performs a pelvic ultrasound on the first visit. In subsequent visits, he will perform an in-office cystoscopy and teach the patient about his urinary tract anatomy simultaneously. His main goal in evaluating patients is to find ways to preserve bladder health and function.
Dr. Gelpi uses individual prostate anatomy to guide his decision on BPH treatment for each patient. If there is a substantial median lobe, he prefers to use GreenLight laser therapy. He notes that overtreating patients with GreenLight laser therapy may cause irritative symptoms post-operatively. He also acknowledges UroLift and Rezum as two very good options for patients without substantial median lobes and presents different surgical complications for each treatment. His post-operative medication regimen (pyridium, meloxicam, and colace) is identical for all three BPH treatments.
Finally, because some BPH treatments may result in post-operative pain and/or reduction of ejaculation ability, Dr. Gelpi prioritizes having transparent and honest conversations with his BPH patients. He always presents all relevant treatment options to his patients and allows them to share their expectations and priorities before reaching a decision about BPH treatment.
[Dr. Jose Silva]
And when you do the GreenLight, are you doing the channels at five and seven, and then going down to the verumontanum and then resecting the median lobe and then lateral lobes?
[Dr. Francisco Gelpi]
So I do something that you probably haven't seen. It's kind of like using the HoLEP technique where you would create these channels at five and seven. And then I connect those and I enucleate that middle portion with the beak of the scope. And then after I leave that tissue hanging, I blast it with 180 and I mean, again, prostate from today, perfect example. 170 grams, most of it was a median lobe, and the procedure took me 15, 16 minutes because most of what I do is concentrate on that median lobe, enucleate using the scope as if it was my finger. And then by the time you're done there's stuff on the sides, yes, you shave it off, but you don't have to be overly aggressive. Once you've done that, those incisions which mimic the transurethral incisions of the prostate. And then when you take that valve like mechanism of the median lobe, I mean, those guys are going to pee like a champ.
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