Fernando, very interesting. A couple of questions for you!

I understood that fluid was passed in and out of the  bladder to flush
away material but there doesn't seem to be much fluid removing the
material as you go though the procedure in this video, does it all just
vapourise and not require flushing out?

If you do flush it out, do you fill and then empty the bladder or is
it a continuous process? If the former how often is this done?

What sort of pressures are in the bladder while this is going on and
can you control them?

and finally, when you press on the bladder at the end fluid comes out.
Why does the sphincter allow this? You show the sphincter closing in
the video so is it because  the anasthetic relaxes the sphincter enough
for you to push the fluid out?

Thankyou for your continued professional input into this group, it
removes much speculation and it is good to have an authoritative source
of information for those of us who are considering pvp. Perhaps you
could persuade some of your other European colleagues who do PVP to add
their comments and experiences?

Thankyou again, magna

Dr. Sancha
     Is there anyway that you can get your blog  and video in English?
Dear All,

I have found a way to upload videos in my blog. I have already placed a
video of a PVP of a 44 gram prostate, you might want to have a look.

I am working on a video of a 100 gram prostate and also a video with
real time transrectal ultrasound control of a PVP procedure, I will
post them as soon as I can.

I hope this will help you understand what it is like from the surgeon's
point of view.

All the best,

Fernando Gómez Sancha
http://drgomezsancha.blogspot.com

Hi everyone...I have a computer question about Dr. Sancha's video, which I
would love to watch, but unfortunately I can't due to the snail dialup I
have.  Is there any way I can download the video to my hard drive and then
watch it, instead of just clicking it on at his website and then have it
just stall due to my dialup.  Thanks...Pete

Dr. Sancha...I have a few rudimentary questions about your video (please
forgive my ignorance), since I have never looked up someone's urethra with
an endoscope :-) .  BTW, if you keep traveling all over the world, you won't
have an office left in Madrid with any patients to see :-).  You seem to be
coming terribly busy (I don't see how you do it), so thank you so much again
for taking the time to visit our group and providing all the invaluable
information.

Here are my questions about the video.  I found a way to view it in dial up,
but it doesn't last long since the temp int file won't work more than a day
or so (don't know how your site works).  Not to worry, my problem.  So my
questions are based on watching it a couple days ago.  I know you don't
answer in line, but it may be easier if you did.

-  What is the structure right at the very beginning of the video where you
are inserting the scope (it almost looks like a penis for lack of a better
word) and you can only see it for a split second.  And then there is some
kind of moundy orifice looking thing that jumped into view so to speak (kind
of like the transverse rings in the colon for a comparison - that's all I
could think of) - is that the external sphincter or what.  And then you are
above the veru montanum I guess, and looking at the bladder neck and the
arcing starts.

- I am confused by the probe (which looks like a rod) with a "glass looking
thing" at the end that the arcs are coming from, and how it is tied in with
the scope (can we call it a resectoscope, or what is the word you use).
Where is the camera in relation to the rod that is producing the arcs.  Is
the fiber inside the rod.  The camera must be behind the rod some how
because you are taking a picture of it - very confusing to me.  A picture of
the scope with the rod and fibers would be worth a thousand words.

- At the end of the video you are withdrawing the scope and point out that
the external sphincter is closing nicely.  So how come, when you said that
you pressed on the bladder, the urine flowed out of the penis (you showed a
camera shot of urine flowing out of the penis).  How did the urine come out
if the external sphincter was closed.

- I went to the Laserscope site and could not find any pictures of the
endoscope or resectoscope and how (what I am calling a rod) and the fibers
tie in.  Can you provide a web site that will show the whole endoscope with
the rod/fiber etc.  I don't mean the console which it is tied into.  I am
interested in the scope with the rod/fiber.  Also when you do these
procedures are you ever looking through an eyepiece, or is that passe stuff
(before the video tapes etc) and you are always looking at a video monitor.

If you have the time, I would appreciate your response.  Thanks...Pete