UH Urology Institute - Fall 2017
EHUD GNESSIN, MD
UH Urologist at UH Cleveland Medical Center; Clinical Professor of Urology, Case Western Reserve University School of Medicine
Ehud Gnessin, MD is the only surgeon in northeast Ohio – and one of only a few in the United States – who performs holmium laser enucleation of the prostate (HoLEP) for treatment for BPH. He underwent a two-year fellowship at Indiana University Health Methodist Hospital for extensive training in HoLEP, as well as all aspects of kidney stone disease.
For decades, the most common surgical treatment for BPH has been transurethral resection of the prostate (TURP). However, up to one-quarter of patients undergoing TURP experience complications ranging from bleeding and urinary incontinence to erectile dysfunction. In addition, the procedure is not as effective for patients with prostate glands in excess of 80 grams.
Dr. Gnessin performs the HoLEP procedure with patients under general anesthesia. Utilizing a laser, he goes through the urethra, excises the gland tissue and leaves the capsule intact. The enucleated prostate gland tissue is ground up using a morcellation device and removed via suction.
“Probably the best modality available today is the HoLEP procedure,” says Dr. Gnessin. “We get excellent outcomes, and the patient is usually discharged either the day of surgery or the next day.” Other advantages include immediate symptom relief, next-day catheter removal, few complications and a re-treatment rate of less than 1 percent.
Dr. Gnessin has performed more than 700 HoLEP procedures and has done more than 80 since joining University Hospitals. One of his patients was a 67-year-old with a 150-gram prostate and urinary tension. “His local urologist suggested open surgery because the prostate was so large. But that was a problem because the patient had hernia repair with mesh and multiple lower abdomen surgeries,” says Dr. Gnessin. “I did the minimally-invasive HoLEP procedure, and the next morning the patient went home without a catheter.”
Another innovative procedure Dr. Gnessin offers patients is percutaneous nephrolithotripsy (PCNL) for large kidney stones. Patients are placed under general anesthesia, and Dr. Gnessin makes a small incision (1 centimeter) in the back to directly access the kidney. He inserts a small telescope into the kidney, uses various instruments to fragment the stones and then suctions them out. While many surgeons rely on a radiologist to help locate the stones and gain access to the kidney, Dr. Gnessin is trained in fluoroscopy guidance.
PCNL is a good option for patients whose kidney stones are too large for ureteroscopy or extracorporeal shockwave lithotripsy, or for those with complex anatomy. The procedure typically takes one to two hours, and patients often are discharged the next day. Dr. Gnessin has performed more than 600 PCNL procedures and more than 70 in the past year since joining University Hospitals.
In addition to the minimally-invasive surgery, he provides patients metabolic evaluation for prevention of kidney stones, including a blood test and 24-hour urine collection. “After the evaluation, I know in close to 90 percent of the cases the exact reason a person has a kidney stone, and we can offer medication or suggest lifestyle changes that prevent the stones from coming back,” says Dr. Gnessin.