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Najdi J, Hawa ME, El-Achkar A, Naji N, Telvizian T, Romani M, Hajj AE, Mukherji D. Smoking cessation counselling patterns in cancer patients - survey of Lebanese physicians. Ecancermedicalscience 2024; 18:1699. [PMID: 38774569 PMCID: PMC11108051 DOI: 10.3332/ecancer.2024.1699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Tobacco smoking is a known risk factor for cancer development and smoking cessation can lower this risk and improve outcomes in some cancer patients. Despite that, many cancer patients do not quit smoking after a cancer diagnosis, and smoking cessation counselling is still not routinely provided in cancer care. The aim of this study is to examine patterns in smoking cessation counselling to cancer patients by their treating physicians. Methods A self-administered, web-based (mobile-friendly), anonymous questionnaire was developed on LimeSurvey and sent by e-mail to Lebanese physicians of different specialties between June 2020 and January 2022. Data were analysed using SPSS and associations between the different items were determined using the χ2 test. Results A total of 146 physicians filled out the questionnaire. Almost all physicians ask cancer patients about their smoking status, but only 45.9% provide smoking cessation counselling, and only 24% refer patients to smoking cessation counselling programs. Only 27.4% of all respondents have received formal smoking cessation training, and only 27.4% feel capable of providing smoking cessation counselling in their clinic. Specifically, family medicine physicians were more likely to provide smoking cessation counselling in the clinic (69%), more likely to refer patients to a smoking cessation counselling program (44%), and more likely to have received formal smoking cessation counselling training (67%) and more likely to feel capable of providing smoking cessation counselling (93%). Lack of training, lack of knowledge of available programs and the lack of availability of enough programs are leading obstacles contributing to low rates of smoking cessation counselling in cancer patients as reported by the physicians. Conclusion Our data reveals a deficiency in smoking cessation counselling and referral of cancer patients to smoking cessation counselling programs in our region. This highlights the need for dedicated smoking cessation counselling training for practicing physicians and physicians in training.
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Affiliation(s)
- Jad Najdi
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- https://orcid.org/0000-0001-6224-894X
| | - Mariana El Hawa
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Adnan El-Achkar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- https://orcid.org/0000-0002-3656-4217
| | - Nour Naji
- Department of Hematology and Oncology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
- https://orcid.org/0009-0004-4761-7435
| | - Talar Telvizian
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
- https://orcid.org/0000-0002-6407-6501
| | - Maya Romani
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- https://orcid.org/0000-0001-5437-0128
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- https://orcid.org/0000-0002-0043-7195
| | - Deborah Mukherji
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- https://orcid.org/0000-0002-3635-0083
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Sayan M, Langoe A, Aynaci O, Eren AA, Eren MF, Kazaz IO, Ibrahim Z, Al-Akelie OT, Al-Mansouri L, Abu-Hijlih R, Moningi S, Abou Chawareb E, El Hajj A, Orio PF, Mula-Hussain L. Prostate cancer presentation and management in the Middle East. BMC Urol 2024; 24:35. [PMID: 38336732 PMCID: PMC10858578 DOI: 10.1186/s12894-024-01427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Although prostate cancer is a prevalent malignancy worldwide, its clinical presentation and management in the Middle East are not well-documented. This study aims to provide insights into the initial clinical presentation and management of prostate cancer in this region. METHODS A retrospective review was conducted on seven institutional databases from six Middle Eastern countries, including Türkiye, Lebanon, Iraq, Syria, Bahrain, and Jordan, to identify patients diagnosed with prostate cancer in 2021. Descriptive analysis was performed on the collected data to provide an overview of the demographic, clinical, and treatment variables. RESULTS A total of 1,136 patients were identified with a median age of 70 (range, 50-84). Most patients (78%) received their prostate cancer diagnosis after presenting with symptoms, as opposed to routine PSA screening. At the time of diagnosis, 35% of men had clinical T3 or T4 disease, 54% with Stage IV disease and 50% with Gleason score ≥ 8. Regarding treatment, 20% of non-metastatic and 22% of metastatic patients received no treatment. CONCLUSION Most men in this study sought prostate cancer evaluation due to symptoms and were subsequently diagnosed with advanced-stage disease, providing a foundation for future research aimed at understanding the underlying factors behind the observed trends and enabling informed interventions.
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Affiliation(s)
- Mutlay Sayan
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | | | - Ozlem Aynaci
- Karadeniz Technical University, Trabzon, Türkiye, Turkey
| | - Ayfer Ay Eren
- Kartal Dr. Lütfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Fuat Eren
- Marmara University, Istanbul Pendik Education and Research Hospital, Istanbul, Türkiye, Turkey
| | | | | | | | | | | | - Shalini Moningi
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Albert El Hajj
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Peter F Orio
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Layth Mula-Hussain
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- College of Medicine, Ninevah University, Mosul, Ninevah, Iraq
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Yacoubian A, Demerouti E, Degheili JA, El Hajj A. A survey-based study about burnout among postgraduate medical trainees: implications for leaders in healthcare management. Front Public Health 2023; 11:1209191. [PMID: 37501948 PMCID: PMC10369186 DOI: 10.3389/fpubh.2023.1209191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction The goal of the study is to assess burnout among postgraduate medical trainees, evaluate the association with sociodemographic features and offer potential wellness strategies for leaders responsible for their education, training, management, and wellbeing. Methods The Oldenburg Burnout Inventory was used. The web-based, voluntary, and anonymous survey was sent to postgraduate medical trainees from various specialties and all years of training in a tertiary medical center in Beirut, Lebanon. Additional questions were added after the survey regarding reporting channels for burnout and possible interventions for wellbeing. Results The total number of valid responses are 188. The prevalence rates of high burnout are 37.2% for disengagement and 51.1% for exhaustion. There is a significant difference between the mean of exhaustion and gender (p = 0.003). There is a significant difference between the mean of disengagement and year of training (p = 0.017). There is a significant difference between the mean of exhaustion and year of training (p = 0.029). There is a significant difference between the frequency of disengagement and year of training (p = 0.027). Conclusion The study reveals how postgraduate medical training program is impacted by the existing challenges from social, health, and financial standpoint, along with the instabilities encountered such as multiple wars and port blast in 2020 and how these variables aggravate burnout. Burnout severely impacts the education and training of PGMT and promoting wellbeing can help reverse the process. Findings contribute to establishing effective strategic interventions for leaders in healthcare management to adopt.
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Affiliation(s)
- Aline Yacoubian
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Evangelia Demerouti
- Dept. Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Jad A. Degheili
- Department of Urology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Albert El Hajj
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Ayoub CH, Haber R, Amine R, Mikati D, Mahfoud ZR, El Hajj A. Comparison of Postoperative Outcomes of Trans-urethral Resection of the Prostate, Laser Vaporization, and Laser Enucleation: A Double Propensity Score Matched Analysis. Urology 2023; 177:148-155. [PMID: 37182649 DOI: 10.1016/j.urology.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To compare postoperative outcomes of 3 types of endourologic surgeries (trans-urethral resection of the prostate [TURP], laser vaporization [LVP], and laser enucleation [LEP]) for benign prostatic hypertrophy (BPH) treatment using the ACS-NSQIP database. METHODS The ACS-NSQIP database was queried for men who underwent TURP, PVP, and LEP for treatment of BPH from 2011 till 2019. Demographics, clinical, operative characteristics, and 30-day outcomes were compared. Univariate and multivariate regression models were constructed. Propensity score matching was then performed as a sensitivity analysis. RESULTS A total of 74,273 patients underwent endourologic surgeries for BPH, 65.4% had TURP, 28.6% PVP, and 5.9% LEP. Patients undergoing TURP were more likely to be older with higher ASA class, abnormal labs, and comorbidities (diabetic, congestive heart failure, and bleeding requiring transfusion) (P-value <.001). After adjusting for covariates and propensity score matching, LVP demonstrated shorter hospital stays, shorter operative times, less reoperation rates, decreased DVT/PE risk, with, however, higher odds of urinary tract infection and sepsis as compared to TURP (P-value<.028). Furthermore, LEP was found to have shorter hospital stays, longer operative times, and decreased odds of urinary tract infections and sepsis as compared to TURP (P-value<.006). CONCLUSION LVP and LEP showed better surgical outcomes and characteristics as compared to TURP. Further research is needed to account for longer duration of follow-up and patient-specific urologic outcomes, such as prostate size, urinary incontinence, erectile dysfunction, and retrograde ejaculation.
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Affiliation(s)
- Christian Habib Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Rachelle Haber
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Reem Amine
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Diana Mikati
- Salim El-Hoss Bioethics & Professionalism Program, American University of Beirut Medical Center, Beirut, Lebanon.
| | | | - Albert El Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon.
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Ayoub CH, Abou Chawareb E, Kasti AE, Alhalabi E, El-Asmar JM, Abou Mrad A, El Hajj A. The 5-item frailty index predicts 30-day morbidity and mortality in radical nephrectomy patients: A propensity matched analysis. Urol Oncol 2023; 41:329.e1-329.e7. [PMID: 37120371 DOI: 10.1016/j.urolonc.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/19/2023] [Accepted: 03/24/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To assess the ability of the 5-item frailty index (5-IFi) score to predict 30-day morbidity and mortality post-radical nephrectomy (RN). METHODS ACS-NSQIP database was used to select patients who underwent RN from 2011 to 2020. 5-IFi score was calculated by assigning a point for each of the following comorbidities: chronic obstructive pulmonary disease or pneumonia, congestive heart failure, dependent functional status, hypertension, and diabetes. Patients were divided into 3 frailty groups 0, 1, and ≥2. Patient demographics, medical comorbidities, prolonged length of stay, and prolonged operative time were compared between different groups; mortality and morbidity using the Clavien-Dindo classification (CVD). Multivariable logistic regression models and propensity score matching were performed as a sensitivity analysis to control for possible confounders. RESULTS Cohort consisted of 36,682 patients whereby 5-IFi class 0, 1, and ≥2 included 11,564 (31.5%), 16,571 (45.2%), and 8,547 (25.3%) patients respectively. A multivariable analysis and propensity score matching revealed that patients with 5-IFi classes 1 and ≥ 2 were more likely to have a prolonged length of stay (OR = 1.11, 1.3, respectively) and to mortality (OR = 1.85 for frailty class ≥2); in addition to CVD class 1 & 2 (OR = 1.51, OR = 1.13, respectively), and CVD ≥ 4 (OR = 1.41, 1.86, respectively) as compared to 5-IFi class 0 (P < 0.001). CONCLUSION The 5-IFi score was found to be an independent predictor of prolonged length of stay, morbidity, and mortality after RN. This tool can play a major role in preoperative risk assessment and patient counseling based on individualized risks.
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Affiliation(s)
- Christian Habib Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elia Abou Chawareb
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdallah El Kasti
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eliane Alhalabi
- Department of Anesthesiology, Henry Ford Health System, Detroit, MI
| | - Jose M El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anthony Abou Mrad
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Albert El Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon..
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Ayoub CH, El-Asmar JM, El-Achkar A, Dakroub A, Abou Chawareb E, El-Khoury L, Tamim H, Chalhoub V, El Hajj A. A novel nephrectomy-specific respiratory failure index using the ACS-NSQIP dataset. Int Urol Nephrol 2023; 55:813-822. [PMID: 36787087 DOI: 10.1007/s11255-023-03507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Post-operative pulmonary failure is a major complication of nephrectomy that may lead to severe morbidity and mortality. Hence, we aimed to derive a nephrectomy-specific post-operative respiratory failure index. METHODS Our cohort was derived from The American College of Surgeons-National Surgical Quality Improvement Program database between 2005 and 2019. The outcome of interest was post-operative respiratory failure (PRF) defined as any incidence of unplanned intubation post-operatively or requiring mechanical ventilation post-operatively for a period > 48 h. A multivariable logistic regression model was constructed, and model calibration and performance were assessed using a ROC analysis and the Hosmer-Lemeshow test. Finally, we derived the nephrectomy-specific respiratory failure (NSRF) index and compared it to Gupta's index. RESULTS Seventy-nine thousand five hundred and twenty-three patients underwent nephrectomy between the years 2005 and 2019 of which nine hundred and sixty-two patients developed PRF. The final NSRF model encompassed ten variables: age, smoking status, American society of anesthesiology class, abnormal creatinine (≥ 1.5 mg/dL), anemia (< 36%), functional health status, chronic obstructive pulmonary disease, surgical approach, emergency case, and obesity (≥ 40 kg/m2). The NSRF ROC analysis provided C-statistic = 0.78, calibration R2 = 0.99, and proper goodness of fit. In comparison, the C-statistics of Gupta's index was found to be 0.71 (p value < 0.001). CONCLUSION The NSRF is a procedure tailored index for predicting post-operative respiratory failure. It is a valuable tool in the pre-operative evaluation setting that can help identify high-risk patients who will require additional respiratory evaluation and preparation for their surgery.
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Affiliation(s)
- Christian H Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Jose M El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Adnan El-Achkar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Ali Dakroub
- Medical School, American University of Beirut, American University of Beirut, Beirut, Lebanon
| | - Elia Abou Chawareb
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Layane El-Khoury
- Medical School, American University of Beirut, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Viviane Chalhoub
- Department of Anesthesia and Intensive Care, Saint-Joseph University Medical School, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Albert El Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon.
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Ayoub CH, Chalhoub V, El-Achkar A, Abou Heidar N, Tamim H, Maroun-Aouad M, El Hajj A. Sedation as an alternative anesthetic technique for frail patients in transurethral resection of the prostate. Ther Adv Urol 2023; 15:17562872221150217. [PMID: 36699641 PMCID: PMC9869224 DOI: 10.1177/17562872221150217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023] Open
Abstract
Background Transurethral resection of the prostate (TURP) under Monitored Anesthesia Care MAC/Sedation (macTURP), as compared with TURP under general (genTURP) or spinal (spTURP) anesthesia, is a safer and infrequently used technique reserved for high-risk patients. Objectives The aim of this study is to compare 30-day postoperative outcomes of TURP using the three types of anesthesia techniques. Design and methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TURP between 2008 and 2019. Demographics, lab values, medical history, and 30-day outcomes were compared. Univariate and multivariate regression models for postoperative complications were constructed. A propensity score-matched analysis was then performed for genTURP and macTURP and for spTURP and macTURP as a sensitivity analysis. Results A total of 53,182 patients underwent TURP. Older patients (>80) with diabetes requiring insulin (7.9%), leukocytosis (7.4%), history of chronic obstructive pulmonary disease (COPD) (7.8%), dyspnea (7.2%), and of ASA > 2 (58.8%) were more likely to undergo macTURP as compared with genTURP (p < 0.013). SpTURP showed lower rates of urinary tract infection (UTI) [odds ratio (OR) = 0.869] as compared with genTURP (p = 0.049), whereas macTURP showed higher rates of major adverse cardiovascular events (OR = 2.179) as compared with genTURP (p = 0.005). All other postoperative complications showed similar rates between the three procedures. The propensity-matched cohorts demonstrated that no differences in postoperative complication rates were noted between macTURP and genTURP and between macTURP and spTURP. Conclusion MacTURP was found to be feasible with a good safety profile as compared with genTURP and spTURP. MacTURP could be used in elderly, frail, and co-morbid patients with a similar safety profile as compared with more invasive anesthetic techniques.
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Affiliation(s)
| | | | - Adnan El-Achkar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nassib Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Marie Maroun-Aouad
- Department of Anesthesiology, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon
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Zein M, Nasrallah AA, Abou Heidar NF, Najdi J, Hneiny L, El Hajj A. Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis. Ther Adv Urol 2023; 15:17562872231171757. [PMID: 37188157 PMCID: PMC10176578 DOI: 10.1177/17562872231171757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Urothelial carcinoma can arise from the urinary bladder or from the upper urinary tract. In some instances, urinary bladder cancer (UBC) and upper tract urothelial carcinoma (UTUC) can be concurrently diagnosed, necessitating a combined radical cystectomy (RC) with radical nephroureterectomy (RNU). A systematic review was done on the combined procedure exploring outcomes and indications, in addition to a comparative analysis between the combined procedure and cystectomy alone. Methods For the systematic review, three databases (Embase, PubMed, and Cochrane) were queried, selecting only studies that included intraoperative and perioperative data. For the comparative analysis, using the NSQIP database, CPT codes for RC and RNU were used to identify two cohorts, one with RC and RNU and one with RC alone. A descriptive analysis was performed on all preoperative variables, and propensity score matching (PSM) was performed. Postoperative events were then compared between the two matched cohorts. Results For the systematic review, 28 relevant articles were included amounting to 947 patients who underwent the combined procedure. The most common indication was synchronous multifocal disease, the most common approach was open surgery, and the most common diversion technique was using an ileal conduit. Almost 28% of patients required blood transfusion and remained in the hospital for an average of 13 days. The most common postoperative complication was prolonged paralytic ileus. For the comparative analysis, 11,759 patients were included of which 97.5% underwent RC only and 2.5% underwent the combined procedure. After PSM, the cohort that had undergone the combined procedure showed an increased risk of renal injury, increased readmission rates, and increased reoperation rates. Whereas the cohort that had undergone RC only showed an increased risk of deep venous thrombosis (DVT), sepsis, or septic shock. Conclusion A combined RC and RNU is a treatment option for concurrent UCB and UTUC that should be cautiously utilized as it is associated with high morbidity and mortality. Patient selection, discussion of the risks and benefits of the procedure, and explanation of the available treatment options remain the most important pillars in managing patients with this complex disease.
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Affiliation(s)
| | | | | | - Jad Najdi
- American University of Beirut Medical Center,
Beirut, Lebanon
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9
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Tfaily MA, Tamim H, El Hajj A, Mukherji D. Muscle invasive bladder cancer and radical cystectomy: a risk predictive model. Ecancermedicalscience 2022; 16:1456. [PMID: 36405942 PMCID: PMC9666275 DOI: 10.3332/ecancer.2022.1456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Radical cystectomy (RC) for muscle invasive bladder cancer (MIBC) remains the historical gold standard for treatment despite significant perioperative morbidity and subsequent quality of life concerns. Trimodal therapy (TMT) is gaining acceptance as an alternative bladder preserving approach. We aim to identify patients for whom TMT may be the optimal approach by constructing risk calculators of morbidity and mortality associated with RC. Methods Using the American College of Surgeons National Surgical Quality Improvement Program database, we selected patients diagnosed with MIBC undergoing RC, with a total of 10,642 patients identified. The primary outcome was mortality and secondary outcome was morbidity within 30 days of the procedure. We conducted multivariate logistic regression to obtain the best fit model for each outcome on 70% of the sample. Validation of the models was then performed on the remaining 30% of the sample. Model performance was assessed using discrimination and calibration abilities and a risk calculator was constructed for pre-operative counselling. Results Of the full cohort, 199 patients (1.9%) died and 2,328 patients (21.9%) experienced morbidity. Variables selected for the model predicting mortality included age, frailty, the American Society of Anesthesiologists status and preoperative creatinine. For the mortality model, the area under the curve was 72% with a Hosmer–Lemeshow statistic of 0.722. For the morbidity model, the area under the curve was 60% with a Hosmer–Lemeshow statistic of 0.287. Variables significant in the model included continent diversion, smoking and frailty. Conclusion We have constructed statistically significant and clinically relevant models using readily available health indicators to be used in multi-disciplinary discussion to provide high-risk patients with individualised risks of morbidity and mortality from RC, allowing for counselling for alternative treatments such as TMT.
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Affiliation(s)
- Mohamad Ali Tfaily
- Department of Internal Medicine, Emory University, Atlanta, GA 30322, USA
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Deborah Mukherji
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
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10
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Ayoub CH, El-Asmar JM, Abou Heidar NF, Najm N, Nasrallah AA, Tamim H, Dakik HA, El Hajj A. A novel radical prostatectomy specific index (PSI) for the prediction of major cardiovascular events following surgery. Int Urol Nephrol 2022; 54:3069-3078. [PMID: 35982275 DOI: 10.1007/s11255-022-03293-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Prostate cancer patients tend to be older with multiple comorbidities and are thus at increased risk for postoperative cardiovascular events after radical prostatectomy (RP). Thus, proper patient selection strategies are essential to decide for or against a surgical approach. We aimed to derive a prostatectomy specific index (PSI) for patients undergoing RP and compare its performance to universally used indices. METHODS The cohort was derived from National Surgical Quality Improvement Program database between 2005 and 2012. The primary outcome was incidence of major adverse cardiovascular events at 30 days post-surgery including: death, myocardial infarction, or stroke. A multivariable logistic regression model was constructed, performance and calibration were evaluated using a ROC analysis and the Hosmer-Lemeshow test, the PSI index was derived and compared to the RCRI and AUB-HAS2 indices. RESULTS A total of 17,299 patients were included in our cohort, with a mean age of 62 ± 7.4 years. Seventy three patients had a cardiac event post RP. The final PSI index encompassed six variables: history of heart disease, age, anemia, American society of anesthesiology class, surgical approach, and hypertension. The PSI ROC analysis provided C-statistic = 0.72, calibration R2 = 0.99 and proper goodness of fit. In comparison, the C-statistics of RCRI and AUB-HAS2 were found to be 0.57 and 0.65, respectively (p value < 0.001). CONCLUSION The PSI model is a procedure tailored index for prediction of major cardiovascular events post RP. It was calibrated using a large national database aiming to optimize treatment selection strategies for prostate cancer patients.
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Affiliation(s)
- Christian H Ayoub
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon
| | - Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon
| | - Nassib F Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon
| | - Nicolas Najm
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Ali A Nasrallah
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon.
| | - Habib A Dakik
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon.
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO BOX 11-0236, Beirut, 1107 2020, Lebanon.
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Hajj AE, Labban M, Ploussard G, Zarka J, Abou Heidar N, Mailhac A, Tamim H. Patient characteristics predicting prolonged length of hospital stay following robotic-assisted radical prostatectomy. Ther Adv Urol 2022; 14:17562872221080737. [PMID: 35321053 PMCID: PMC8935550 DOI: 10.1177/17562872221080737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 01/27/2022] [Indexed: 01/21/2023] Open
Abstract
Objective: The objective of this study is to determine the preoperative patient characteristics predicting prolonged length of hospital stay (pLOS) following robotic-assisted radical prostatectomy (RARP). Methods: The National Surgical Quality Improvement Program (NSQIP) database was used to select patients who underwent RARP without other concomitant surgeries between 2008 and 2016. Patients’ demographics, comorbidities, and laboratory markers were collected to evaluate their role in predicting pLOS. The pLOS was defined as length of stay (LOS) >2 days. A multinomial logistic regression was constructed adjusting for postoperative surgical complications to assess for the predictors of pLOS. Results: We obtained data for 31,253 patients of which 20,774 (66.5%) patients stayed ⩽1 day, 6993 (22.4%) patients stayed for 2 days, and 3486 (11.2%) patients stayed for >2 days. Demographic variables – including body mass index (BMI) <18.5: odds ratio (OR) = 2.8, 95% confidence interval (CI) = [1.7–4.8]; smoking: OR = 1.2, 95% CI = [1.1–1.4]; and dependent functional status: OR = 3.1, 95% CI = [1.6–6.0] – were predictors of pLOS. Comorbidities – such as heart failure: OR = 4.6, 95% CI = [2.0–10.8]; being dialysis dependent: OR = 2.7, 95% CI = [1.4–5.0]; and predisposition to bleeding: OR = 2.0, 95% CI = [1.5–2.7] – were the strongest predictors of extended hospitalization. In addition, pLOS was more likely to be associated with postoperative bleeding, renal, or pulmonary complications. Conclusion: Preoperative patient characteristics and comorbidities can predict pLOS. These findings can be used preoperatively for risk assessment and patient counseling.
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Affiliation(s)
- Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut, Beirut, Lebanon
| | - Muhieddine Labban
- Division of Urology, Department of Surgery, American University of Beirut, Beirut, Lebanon
| | | | - Jabra Zarka
- Division of Urology, Department of Surgery, American University of Beirut, Beirut, Lebanon
| | - Nassib Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut, Beirut, Lebanon
| | - Aurelie Mailhac
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
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12
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Nasrallah AA, Dakik HA, Abou Heidar NF, Najdi JA, Nasrallah OG, Mansour M, Tamim H, Hajj AE. Major adverse cardiovascular events following partial nephrectomy: a procedure-specific risk index. Ther Adv Urol 2022; 14:17562872221084847. [PMID: 35321052 PMCID: PMC8935558 DOI: 10.1177/17562872221084847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction: Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index. Methods: The cohort was derived from the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction, stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer–Lemeshow test and compared to the RCRI and the AUB-HAS2 index. Results: In a cohort of 4795 patients, MACE occurred in 52 (1.1%) patients. A univariate analysis yielded 13 eligible variables for entry into the multivariate model. The final PN-A4CH model utilized six variables: Age ⩾75 years, ASA class >2, Anemia, surgical Approach, Creatinine >1.5, and history of Heart disease. Index ROC analysis provided a C-statistic of 0.81, calibration R2 was 0.99, and sensitivity was 85%. In comparison, the RCRI and AUB-HAS2 C-statistics were 0.59 and 0.68, respectively. Conclusion: This study proposes a novel procedure-specific cardiovascular risk index. The PN-A4CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection.
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Affiliation(s)
- Ali A. Nasrallah
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Habib A. Dakik
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nassib F. Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jad A. Najdi
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Oussama G. Nasrallah
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Mansour
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon
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Ayoub CH, Dakroub A, El-Asmar JM, Ali AH, Beaini H, Abdulfattah S, El Hajj A. Preoperative MELD score predicts mortality and adverse outcomes following radical cystectomy: analysis of American College of Surgeons National Surgical Quality Improvement Program. Ther Adv Urol 2022; 14:17562872221135944. [PMID: 36407007 PMCID: PMC9669693 DOI: 10.1177/17562872221135944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/12/2022] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND The model for end-stage liver disease (MELD) has been widely used to predict the mortality and morbidity of various surgical procedures. OBJECTIVES We aimed to correlate a high preoperative MELD score with adverse 30-day postoperative complications following radical cystectomy. DESIGN AND METHODS Patients who underwent elective, non-emergency radical cystectomy were identified from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2017. Patients were categorized according to a calculated MELD score. The primary outcomes of this study were 30-day postoperative mortality, morbidity, and length of hospital stay following radical cystectomy. For further sensitivity analysis, propensity score matching was used to yield a total of 1387 matched pairs and primary outcomes were also assessed in the matched cohort. RESULTS Compared with patients with a MELD < 10, those with MELD ⩾ 10 had significantly higher rates of mortality [odds ratio (OR) = 1.71, p = 0.004], major complications (OR = 1.42, p < 0.001), and prolonged hospital stay (OR = 1.29, p < 0.001) on multivariate analysis. Following risk-adjustment for race, propensity-matched groups revealed that patients with MELD score ⩾ 10 were significantly associated with higher mortality (OR = 1.85, p = 0.008), major complications (OR = 1.34, p < 0.001), yet similar length of hospital stay (OR = 1.17, p = 0.072). CONCLUSION MELD score ⩾ 10 is associated with higher mortality and morbidity in patients undergoing radical cystectomy compared with lower MELD scores. Risk-stratification using MELD score may assist clinicians in identifying high-risk patients to provide adequate preoperative counseling, optimize perioperative conditions, and even consider nonsurgical alternatives.
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Affiliation(s)
- Christian Habib Ayoub
- Division of Urology, Department of Surgery,
American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Dakroub
- American University of Beirut Medical School,
American University of Beirut, Beirut, Lebanon
| | - Jose M. El-Asmar
- Division of Urology, Department of Surgery,
American University of Beirut Medical Center, Beirut, Lebanon
| | - Adel Hajj Ali
- Cleveland Clinic, Heart, Vascular &
Thoracic Institute, Cleveland, Ohio, USA
| | - Hadi Beaini
- American University of Beirut Medical School,
American University of Beirut, Beirut, Lebanon
| | - Suhaib Abdulfattah
- American University of Beirut Medical School,
American University of Beirut, Beirut, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery,
American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh,
Beirut 1107 2020, Lebanon
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14
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Nasrallah AA, Mansour M, Abou Heidar NF, Ayoub C, Najdi JA, Tamim H, El Hajj A. Risk factors for wound dehiscence following radical cystectomy: a prediction model. Ther Adv Urol 2021; 13:17562872211060570. [PMID: 35173813 PMCID: PMC8842309 DOI: 10.1177/17562872211060570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: Radical cystectomy (RC) is a complex urologic procedure performed for the
treatment of bladder cancer and causes significant morbidity. Wound
dehiscence (WD) is a major complication associated with RC and is associated
with multiple risk factors. The objectives of this study are to identify
clinical risk factors for incidence of WD and develop a risk-prediction
model to aid in patient risk-stratification and improvement of perioperative
care. Materials and Methods: The American College of Surgeons – National Surgical Quality Improvement
Program (ACS-NSQIP) database was used to derive the study cohort. A
univariate analysis provided nine variables eligible for multivariate model
entry. A stepwise logistic regression analysis was conducted and refined
considering clinical relevance of the variables, and then bootstrapped with
1000 samples, resulting in a five-factor model. Model performance and
calibration were assessed by a receiver operated curve (ROC) analysis and
the Hosmer–Lemeshow test for goodness of fit, respectively. Results: A cohort of 11,703 patients was identified from years 2005 to 2017, with 342
(2.8%) incidences of WD within 30 days of operation. The final five-factor
model included male gender [odds ratio (OR) = 2.5, p <
0.001], surgical site infection (OR = 6.3, p < 0.001),
smoking (OR = 1.8, p < 0.001), chronic obstructive
pulmonary disease (COPD) (OR = 1.9, p < 0.001), and
weight class; morbidly obese patients had triple the odds of WD (OR = 2.9,
p < 0.001). The ROC analysis provided a C-statistic
of 0.76 and calibration R2 was 0.99. Conclusion: The study yields a statistically robust and clinically beneficial five-factor
model for estimation of WD incidence risk following RC, with good
performance and excellent calibration. These factors may assist in
identifying high-risk patients, providing preoperative counseling and thus
leading to improvement in perioperative care.
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Affiliation(s)
- Ali A. Nasrallah
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Mansour
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nassib F. Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Jad A. Najdi
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon
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15
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Nasrallah AA, Gharios C, Itani M, Bacha DS, Tamim HM, Habib RH, El Hajj A. Risk of Postoperative Renal Failure in Radical Nephrectomy and Nephroureterectomy: A Validated Risk Prediction Model. Urol Int 2021; 106:596-603. [PMID: 34802009 DOI: 10.1159/000519480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The study aimed to construct and validate a risk prediction model for incidence of postoperative renal failure (PORF) following radical nephrectomy and nephroureterectomy. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2005-2014 were used for the derivation cohort. A stepwise multivariate logistic regression analysis was conducted, and the final model was validated with an independent cohort from the ACS-NSQIP database years 2015-2017. RESULTS In cohort of 14,519 patients, 296 (2.0%) developed PORF. The final 9-factor model included age, gender, diabetes, hypertension, BMI, preoperative creatinine, hematocrit, platelet count, and surgical approach. Model receiver-operator curve analysis provided a C-statistic of 0.79 (0.77, 0.82; p < 0.001), and overall calibration testing R2 was 0.99. Model performance in the validation cohort provided a C-statistic of 0.79 (0.76, 0.81; p < 0.001). CONCLUSION PORF is a known risk factor for chronic kidney disease and cardiovascular morbidity, and is a common occurrence after unilateral kidney removal. The authors propose a robust and validated risk prediction model to aid in identification of high-risk patients and optimization of perioperative care.
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Affiliation(s)
- Ali A Nasrallah
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon,
| | - Charbel Gharios
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mira Itani
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dania S Bacha
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani M Tamim
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Robert H Habib
- Research Center, Society of Thoracic Surgeons, Chicago, Illinois, USA
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Daher M, Telvizian T, Dagher C, Abdul-Sater Z, Massih SA, Chediak AE, Charafeddine M, Shahait M, Alameddine R, Temraz S, Geara F, Youssef B, El Hajj A, Nasr R, Wazzan W, Bulbul M, Khauli R, Shamseddine A, Mukherji D. High rates of advanced prostate cancer in the Middle East: Analysis from a tertiary care center. Urol Ann 2021; 13:418-423. [PMID: 34759656 PMCID: PMC8525480 DOI: 10.4103/ua.ua_47_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives: Prostate cancer incidence is increasing in the Middle East (ME); however, the data of stage at the diagnosis and treatment outcomes are lacking. In developed countries, the incidence of de novo metastatic prostate cancer ranges between 4% and 14%. We hypothesized that the rates of presentation with advanced disease are significantly higher in the ME based on clinical observation. This study aims to examine the stage at the presentation of patients with prostate cancer at a large tertiary center in the ME. Methods: After Institutional Review Board approval, we identified the patients diagnosed with prostate adenocarcinoma and presented to a tertiary care center between January 2010 and July 2015. Clinical, demographic, and pathological characteristics were abstracted. Patients with advanced disease were stratified according to tumor volume based on definitions from practice changing clinical trials. Descriptive and Kaplan–Meier survival analysis was used. Results: A total of 559 patients were identified, with a median age at the diagnosis of 65 years and an age range of 39–94 years. Median prostate-specific antigen (PSA) at the presentation was 10 ng/ml, and almost a quarter of the men (23%) presented with metastatic disease. The most common site of metastasis was the bone (34/89, 38%). High-volume metastasis was present in 30.3%, 9%, and 5.2% of the cohort based on STAMPEDE, CHAARTED, and LATITUDE trial criteria, respectively. Conclusion: This is the first report showing the high proportion of men from ME presenting with de novo metastasis. This could be due to many factors, including the highly variable access to specialist multidisciplinary management, lack of awareness, and lack of PSA screening in the region. There is a clear need to raise the awareness about prostate cancer screening and early detection and to address the rising burden of advanced prostate cancer affecting men in the ME region.
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Affiliation(s)
- Marilyne Daher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Talar Telvizian
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle Dagher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zahi Abdul-Sater
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Department of Basic Sciences, Phoenicia University, Mazraat El Daoudiyeh, Amman, Jordan
| | - Sarah Abdel Massih
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alissar El Chediak
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed Shahait
- Division of Urology, Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Raafat Alameddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Temraz
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fady Geara
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Youssef
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Nasr
- Division of Urology, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Wazzan
- Division of Urology, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raja Khauli
- Division of Urology, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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17
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El-Asmar JM, Sebaaly R, Mailhac A, Bulbul M, Khauli R, Tamim H, El Hajj A. Use of Bariatric Ports in 4-Arm Robotic Partial Nephrectomy: A Comparative Study With the Standard 3-Arm Technique. Cureus 2021; 13:e16461. [PMID: 34422490 PMCID: PMC8370571 DOI: 10.7759/cureus.16461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives We aim to compare the outcomes of a 3-arm versus a 4-arm robotic assisted partial nephrectomy (RAPN) using the da Vinci Si model; as well as, illustrate the deployment of long ports to decrease arm collision during the 4-arm approach. Patients and Methods Results of RAPN in a Middle Eastern tertiary referral center from August 2013 to December 2017 are reported. Comparison between 3 versus 4-arm robotic approaches was done in regards to patient and tumor characteristics, operative parameters, and postoperative outcomes. Statistical analysis was performed with the Student’s t-test and chi-squared test. Results Forty consecutive 3-arm RAPNs and 40 consecutive 4-arm RAPNs were retrospectively evaluated. Differences in tumor complexity between the two groups were statistically insignificant. Similarly, surgical margin positivity, mean ischemia time, estimated blood loss, length of hospital stay, and mean change in serum creatinine were statistically insignificant between the two groups. Mean operative time was significantly shorter by 42 minutes in the 4-arm vs 3-arm group (p=0.01). Conclusions The addition of a 4th arm in RAPN can be of benefit in centers that still rely on the da Vinci Si model. The ease of hilar dissection, retraction, and surgeon independence instigated a statistically significant decrease in operative time with 4-arm use.
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Affiliation(s)
- Jose M El-Asmar
- Department of Urology, American University of Beirut Medical Center, Beirut, LBN
| | - Ralph Sebaaly
- Department of Urology, American University of Beirut Medical Center, Beirut, LBN
| | - Aurelie Mailhac
- Department of Urology, American University of Beirut Medical Center, Beirut, LBN
| | - Muhammad Bulbul
- Department of Urology, American University of Beirut Medical Center, Beirut, LBN
| | - Raja Khauli
- Department of Urology, American University of Beirut Medical Center, Beirut, LBN
| | - Hani Tamim
- Department of Urology, American University of Beirut Medical Center, Beirut, LBN
| | - Albert El Hajj
- Department of Urology, American University of Beirut Medical Center, Beirut, LBN
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18
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Halabi IE, Husseini ZE, Haibe Y, Charafeddine M, Mukherji D, Temraz S, Bulbul M, Khauli R, Nasr R, Wazzan W, Hajj AE, Geara F, Shamseddine A. Cystectomy vs. bladder preservation after neoadjuvant chemotherapy in muscle-invasive bladder cancer: A tertiary medical center experience. Cancer Treat Res Commun 2020; 25:100222. [PMID: 33080450 DOI: 10.1016/j.ctarc.2020.100222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Radical cystectomy (RC) remains the standard of care for muscle-invasive bladder cancer (MIBC). Because of the higher overall risks associated with RC, particularly in the elderly patients with multiple comorbidities, other less invasive bladder preservation strategies have been considered. METHODS This is a retrospective chart review of patients diagnosed with MIBC, pT2-4N0-2M0, at the American University of Beirut Medical Center between 2007 and 2017. RESULTS 98 patients, 85 (86.7%) males and 13 (13.3%) females, were included. Of the 98 patients, 19 (19.3%) patients were treated with upfront CRT, 35 (35.7%) were treated with upfront RC and 44 (45%) were treated with NAC. 26 (26.5%) patients underwent RC after NAC and 18 (18.4%) received CRT after NAC. The mean overall survival (OS) for the different treatment modalities was 69.4, 60.4, 56.1 and 44.2 months for RC, CRT, RC post-NAC and CRT post-NAC, respectively (p = 0.83). The median disease-free survival (DFS) was 29, 22, 21 and 16 months for RC, CRT, RC post-NAC and CRT post-NAC, respectively (p = 0.49). Patients with pT3/T4 had a higher risk of death by 3.335 folds compared to pT2 (95% CI [1.321-8.422], p<0.05). CONCLUSIONS No difference was noted in the OS and DFS between the groups who underwent RC post-NAC and CRT post-NAC. These findings further support the possibility of bladder preservation after the treatment with NAC for MIBC. The pathologic T stage at diagnosis is an important prognostic factor regardless of treatment modality.
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Affiliation(s)
- Ibrahim El Halabi
- Department of Internal Medicine, Albany Medical Center, New York, USA
| | - Ziad El Husseini
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yolla Haibe
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Temraz
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhammad Bulbul
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raja Khauli
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Nasr
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Wazzan
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Albert El Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fady Geara
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
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Labban M, Bulbul M, Wazzan W, Khauli R, El Hajj A. Robot-assisted radical prostatectomy in the Middle East: A report on the perioperative outcomes from a tertiary care centre in Lebanon. Arab J Urol 2020; 19:152-158. [PMID: 34104490 PMCID: PMC8158259 DOI: 10.1080/2090598x.2020.1814184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To report on the surgical, oncological and early functional outcomes of robot-assisted radical prostatectomy (RARP) at our tertiary care centre, as there is a scarcity of reports on outcomes of robotic surgery from the Middle East. Patients and methods We reviewed the electronic health records for patients undergoing RARP between 2013 and 2019 at the American University of Beirut Medical Center. We collected patients’ demographics and preoperative oncological factors including prostate-specific antigen (PSA), clinical oncological stage, and World Health Organization (WHO) grade. PSA persistence, biochemical recurrence (BCR) and positive surgical margin (PSM) were reported. Complications were categorised by Clavien–Dindo grade. Moreover, the postoperative oncological outcomes including the rates of adjuvant and salvage androgen-deprivation therapy (ADT) and external-beam radiation therapy (EBRT), chemotherapy, and metastasis were reported. Additionally continence and potency results were retrieved. Results For the designated period, 250 patients underwent RARP of which 182 (72.8%) underwent lymph node dissection. The median (interquartile range) anaesthesia time was 330 (285–371) min and the estimated blood loss was 200 (200–300) mL. The overall complication rate was 8%, with 2% Clavien–Dindo Grade III–IV complications. The PSM and BCR rates were 21.6% and 6.4%, respectively. Adjuvant ADT and EBRT was administered to 7.2% of the patients. Functional data was available for 112 patients. Continence was 68%, 82% and 97% of the patients at 3, 6 and 12 months, respectively. For 65 patients who had bilateral nerve sparing potency was 37%, 60% and 83% at 3, 6 and 12 months, respectively. Conclusion This is the largest RARP series from the Middle East. The surgical, oncological and functional outcomes are consistent with those published in the literature. This confirms the safety and efficacy of applying robotic technology in our region during the implementation phase. Abbreviations: ADT: androgen-deprivation therapy; AJCC: American Joint Committee on Cancer; AUBMC: American University of Beirut Medical Center; BCR: biochemical recurrence; CPT: Current Procedural Terminology; EBRT external beam radiation therapy; IQR, interquartile ranges; LOS: length of stay; PLND: pelvic lymph node dissection; PSM: positive surgical margin; (O)(RA)RP, (open) (robot-assisted) radical prostatectomy
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Affiliation(s)
- Muhieddine Labban
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Wassim Wazzan
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Raja Khauli
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
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20
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Merhe A, Labban M, Hout M, Bustros G, Abou Heidar N, El-Asmar JM, Bulbul M, El Hajj A. Development of a novel nomogram incorporating platelet-to-lymphocyte ratio for the prediction of lymph node involvement in prostate carcinoma. Urol Oncol 2020; 38:930.e1-930.e6. [PMID: 32736935 DOI: 10.1016/j.urolonc.2020.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The available nomograms used to predict lymph node involvement (LNI) are not comprehensive. We sought to derive a novel nomogram incorporating the platelet to lymphocyte ratio (PLR) to predict LNI and compare its performance to validated preoperative risk nomograms in a cohort of men undergoing robotic-assisted radical prostatectomy at our institution. METHODS Our electronic health record was queried for patients who underwent robotic-assisted radical prostatectomy with bilateral pelvic lymphadenectomy between 2013 and 2019. A bootstrapped multivariate logistic regression model was constructed for the predictors of LNI while adjusting for other covariates. Then, we used the derived logistic regression formula to estimate each patient's risk (%) for LNI. Individualized risks were also calculated using the following verified nomograms: Briganti-2012, Cagiannos, Godoy, and Memorial Sloan Kettering Cancer Center. Subsequently, we plotted the risks for our nomogram and the 4 verified nomograms into receiver operating characteristics curves. We reported the area under the curve (AUC) for each of the 5 nomograms and the corresponding 95% confidence interval (CI). RESULTS The cohort included 173 patients, of which 13.9% demonstrated LNI. LNI was associated with higher preoperative prostate-specific antigen (PSA) ≥ 10 [odds ratio [OR] = 4.89; 95% confidence interval [CI] (1.42-16.83)], higher grade (WHO group ≥ 3)[19.21; (2.23-195.25)], and higher percentage of positive biopsy cores (≥60%) [3.38, (1.04-11.00)]. With every 30-unit increase in PLR the risk of LNI increased by 47%. The nomogram derived from our data had the highest AUC [(AUC 0.877; 95% CI (0.806-0.947)]. The Memorial Sloan Kettering Cancer Center and Briganti 2012 displayed almost congruent ability [0.836; 95% CI (0.758-0.915)] and [0.827; (0.752-0.902)] to identify patients with positive nodes in our cohort with perfect sensitivity and negative predictive value. CONCLUSION The nomogram incorporating PLR demonstrated 94.7% sensitivity to predict LNI and avoided pelvic lymphadenectomy in half of the patients at a cut-off between 6.5% and 8.5%. A prospective study with a larger sample is needed to validate our findings.
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Affiliation(s)
- Ali Merhe
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Muhieddine Labban
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Mohammad Hout
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Gerges Bustros
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Nassib Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Lebanon.
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21
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Elterman D, Bach T, Rijo E, Misrai V, Anderson P, Zorn KC, Bhojani N, El Hajj A, Chughtai B, Desai M. Transfusion rates after 800 Aquablation procedures using various haemostasis methods. BJU Int 2020; 125:568-572. [PMID: 31901210 PMCID: PMC7187336 DOI: 10.1111/bju.14990] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine if athermal methods are as effective in preventing blood transfusions as the use of cautery across various prostate volumes following prostate tissue resection for benign prostatic hyperplasia using Aquablation. PATIENTS AND METHODS The current commercial AQUABEAM robot that performs Aquablation therapy was first used in 2014. Since then numerous clinical studies have been conducted in various countries; Australia, Canada, Germany, India, Lebanon, Spain, New Zealand, United Kingdom, and the United States. All of the clinical trial data since 2014 were pooled with the early commercial procedures from France, Germany, and Spain to determine the effectiveness of haemostatic techniques in reducing the transfusion rate in patients after Aquablation. RESULTS In all, 801 patients were treated with Aquablation therapy from 2014 to early 2019. The mean (SD, range) prostate volume was 67 (33, 20-280) mL and 31 (3.9%) transfusions were reported. The largest contributing factor to transfusion risk was prostate size and method of traction. There was an increasing risk of transfusions in larger prostates when robust traction using a catheter-tensioning device (CTD) without cautery was used, ranging from 0.8% to 7.8% in prostates ranging from 20 to 280 mL. However, when standard traction (taping the catheter to the leg, gauze knot synched up to the meatus, or no traction at all) was used and where the surgeon performed bladder neck cautery only when necessary, the risk of transfusion was 1.4-2.5% in prostates ranging from 20 to 280 mL. CONCLUSIONS While the athermal subgroup with robust traction with a CTD had comparable transfusion rates for smaller prostates, the risk increased significantly as prostate volume increased. With standard traction methods and selective bladder neck cautery, the risk of transfusion was reduced to 1.9% across all prostate sizes.
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Affiliation(s)
- Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Thorsten Bach
- Department of Urology, Asklepios Hospital Harburg, Hamburg, Germany
| | - Enrique Rijo
- Department of Urology, Hospital Quirón Salud, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Paul Anderson
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kevin C Zorn
- University of Montreal Hospital Center, Universite de Montreal, Montreal, QC, Canada
| | - Naeem Bhojani
- University of Montreal Hospital Center, Universite de Montreal, Montreal, QC, Canada
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, NY, USA
| | - Mihir Desai
- Department of Urology, University of Southern California, Los Angeles, CA, USA
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22
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Abstract
Human schistosomiasis or bilharzia is a parasitic disease that highly impacts a country’s health and economic systems specifically when it affects individuals residing in underdeveloped countries. Daughter eggs produced by colonized Schistosoma can lead to multisystem immune-mediated response, one of them is an intravesicular granulomatous reaction leading to intramural lesions. Such outcome is directly related to the incubation of adult worms within the perivesical urogenital venous plexus. We hereby report an incidental discovery of calcified bladder wall lesions in a female patient residing in the United States for the last 27 years who presented with lower urinary tract symptoms. Despite a negative past medical history of schistosomiasis, intraoperative biopsies confirmed the presence of a calcified Schistosoma haematobium ova. Following that, a brief literature review of the pathogenesis and urogenital manifestations of Schistosoma is highlighted.
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Affiliation(s)
- Jad A Degheili
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, LBN
| | - Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, LBN
| | - Moustafa Moussally
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, LBN
| | - Nassib Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, LBN
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, LBN
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23
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El Hajj A, Yacoub B, Mansour M, Khauli R, Bulbul M, Nassif S, Haidar MB. Diagnostic performance of Gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography in intermediate and high risk prostate cancer. Medicine (Baltimore) 2019; 98:e17491. [PMID: 31689752 PMCID: PMC6946244 DOI: 10.1097/md.0000000000017491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography (Ga-68 PSMA PET/CT) is an imaging modality that promises improved sensitivity and specificity of detection of prostate cancer lesions based on their increased uptake of PSMA-based radiotracers. It remains an emerging modality that has not yet been endorsed in the guidelines for the management of prostate cancer pending more established evidence to prove its efficacy. The objective of the study is to assess the value of Ga-68 PSMA PET/CT in the detection and localization of patients diagnosed with intermediate or high risk prostate cancer.Twenty three patients with intermediate or high risk prostate cancer had undergone Ga-68 PSMA PET/CT imaging prior to robotic assisted radical prostatectomy. Surgical specimens were then submitted for histological examinations. Lesions visualized on PET/CT and histology were independently mapped unto a 36-segment (Prostate Imaging Reporting and Data System version 2 [PI-RADS v.2]) map of the prostate. Concordance of visualization on PET/CT as compared to the histology as gold standard reference was then assessed. Lesions visualized on PET/CT and histology were independently mapped unto a 36-segment (PI-RADS v.2) map of the prostate. Concordance of visualization on PET/CT as compared to the histology as gold standard reference was then assessed.Sensitivity for all lesions identified on Ga-68 PSMA PET/CT was 42.37%; specificity was 88.61%. Both parameters were higher when considering only index lesions for which sensitivity was 68.42% and specificity was 98.23%. Sensitivity for the index lesions in intermediate risk group was 53.2% and was higher in the high risk group reaching 83.33%.Ga-68 PSMA PET/CT provides accurate localization of tumor lesions in patients with intermediate and high risk prostate cancer.
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Affiliation(s)
| | | | | | | | | | - Samer Nassif
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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24
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Mukherji D, Abed El Massih S, Daher M, Chediak A, Charafeddine M, Shahait M, Temraz SN, Geara FB, El Hajj A, Nasr R, Wazzan W, Bulbul M, Khauli R, Shamseddine A. Prostate cancer stage at diagnosis: First data from a Middle-Eastern cohort. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.e552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e552 Background: Current data suggest that prostate cancer incidence is increasing in the Middle East and North Africa (MENA) region however remains significantly lower than the United States and Europe. No data are available regarding stage at diagnosis or treatment. SEER data from the US suggest that only 4% of patients present with metastatic disease. We hypothesized that rates of presentation with stage 4 disease are significantly higher in the MENA region. Methods: After IRB approval, a review of prostate cancer cases presenting to the leading tertiary referral center in Lebanon from January 2010 to July 2015 was undertaken. From September 2014 these data were collected prospectively. The American University of Beirut Medical Center sees approximately one third of all cancer cases in the country and is a major referral center for Syria and Iraq. Results: 582 cases were identified, median age at diagnosis was 68 (range 43-97); median PSA at diagnosis was 10.2ng/ml (range 2.3 – 3490), median Gleason score was 7. 480 patients had staging data available; 77.4% (449) presented with organ-confined disease, 22.6% (136) presented with stage 4 disease at diagnosis. 12% of this cohort were from Iraq, 57.6% presenting with stage 4 disease. Increasing age correlated with higher stage at presentation in this cohort. In patients presenting with PSA > 20, 62.3% were found to have stage 4 disease. Conclusions: This is the first report of prostate cancer stage at diagnosis from a large cohort of patients from the Middle East showing a median age at diagnosis of 68 and 22.6% presenting with stage 4 disease. These data highlight the importance of multi-disciplinary management and health-care system planning for the rising burden of prostate cancer affecting the MENA population.
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Affiliation(s)
- Deborah Mukherji
- The American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Marilyne Daher
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Alissar Chediak
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | - Fady B. Geara
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Albert El Hajj
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Nasr
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Wazzan
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Bulbul
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Raja Khauli
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- American University of Beirut Medical Center, Beirut, Lebanon
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25
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Chalhoub V, Kallab R, El Hajj A, Hachem K, Yazbeck P. Septic shock due to Clostridium tertium in an immunocompetent patient following colitis without inflammatory bowel disease. Anaesth Crit Care Pain Med 2016; 35:167-8. [PMID: 26862069 DOI: 10.1016/j.accpm.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/06/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Viviane Chalhoub
- Department of anesthesiology and intensive care, Saint Joseph University Medical, School Hotel Dieu de France Hospital, Boulevard Alfred Naccache, P.O. Box 166830, Beirut, Lebanon.
| | - Rita Kallab
- Department of anesthesiology and intensive care, Saint Joseph University Medical, School Hotel Dieu de France Hospital, Boulevard Alfred Naccache, P.O. Box 166830, Beirut, Lebanon
| | - Albert El Hajj
- Department of surgery, American University of Beirut Medical Center, P.O. Box 110236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Kamal Hachem
- Department of anesthesiology and intensive care, Saint Joseph University Medical, School Hotel Dieu de France Hospital, Boulevard Alfred Naccache, P.O. Box 166830, Beirut, Lebanon
| | - Patricia Yazbeck
- Department of anesthesiology and intensive care, Saint Joseph University Medical, School Hotel Dieu de France Hospital, Boulevard Alfred Naccache, P.O. Box 166830, Beirut, Lebanon
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26
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Abou Yehia Z, Faraj W, Morad D, El Hajj A, Haydar A. Bilateral absent uterine arteries. Assoc Med J 2016. [DOI: 10.1136/bmj.i50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Shahait M, Saoud R, El Hajj A. Laparoscopic treatment of giant renal cystic echinococcosis. Int J Infect Dis 2016; 42:58-60. [DOI: 10.1016/j.ijid.2015.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/31/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022] Open
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Hajj AE, Thanigasalam R, Boulay I, Molinié V, Escudier B, Baumert H. Feasibility of nephron-sparing surgery in giant oncocytoma. Can Urol Assoc J 2014; 8:E96-8. [PMID: 24554983 DOI: 10.5489/cuaj.1552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Oncocytomas represent 3 to 7% of renal masses and behave as benign tumours. Nephron-sparing procedures are preferred for biopsy confirmed lesions; however, giant oncocytomas have been generally treated by radical nephrectomy. We report the first case of partial nephrectomy in a 45-year-old man who presented with a 20-cm oncocytoma. At the 1 year follow-up, he had a normal functioning kidney. Despite the difficulty of this procedure, partial nephrectomy for very large benign tumours can be considered in appropriately selected young patients.
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Affiliation(s)
- Albert El Hajj
- Saint Joseph Hospital Trust, Department of Urology, Paris, France; ; American University of Beirut Medical Center, Division of Urology, Beirut, Lebanon
| | | | - Isabelle Boulay
- Saint Joseph Hospital Trust, Department of Radiology, Paris, France
| | - Vincent Molinié
- Saint Joseph Hospital Trust, Department of Pathology, Paris, France
| | | | - Hervé Baumert
- Saint Joseph Hospital Trust, Department of Urology, Paris, France
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29
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Massoud W, Thanigasalam R, El Hajj A, Girard F, Théveniaud PE, Chatellier G, Baumert H. Does the use of a barbed polyglyconate absorbable suture have an impact on urethral anastomosis time, urethral stenosis rates, and cost effectiveness during robot-assisted radical prostatectomy? Urology 2013; 82:90-4. [PMID: 23806395 DOI: 10.1016/j.urology.2013.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 01/18/2013] [Accepted: 02/01/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the use of a single needle driver with the V-Loc (Covidien, Dublin, Ireland) running suture and compare this with the use of 2 needle drivers with polyglactin interrupted sutures (IS) in dividing the dorsal venous complex (DVC) and forming the urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS A prospective cohort study was performed to compare V-Loc (n = 40) with polyglactin (n = 40) sutures. Division of the dorsal venous complex and formation of the UVA during robot-assisted radical prostatectomy using V-Loc or polyglactin sutures were studied. Preoperative, intraoperative, and postoperative parameters were measured. RESULTS V-Loc sutures were associated with a statistically significant reduction in mean dorsal vein suture time (3.15 minutes V-Loc vs 3.75 minutes IS, P = .02) and UVA anastomosis time (8.5 minutes V-Loc vs 11.5 minutes IS, P = .001). No significant difference was noted between operative time (121 minutes V-Loc vs 130 minutes IS, P = .199), delayed healing rates (5% V-Loc vs 7.5% IS, P = .238), continence rate at 12 months (97.5% V-Loc vs 95% IS, P = .368), and urethral stenosis rates (2.5% V-Loc vs 2.5% IS, P = .347) in both groups. CONCLUSION The use of a V-Loc running suture with a single needle driver is a feasible, reproducible, and economic technique with no significant difference in continence rates and urethral stenosis rates, compared with the use of a traditional interrupted suture.
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Affiliation(s)
- Walid Massoud
- Department of Urology, Hôpital Saint Joseph, Paris, France
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El Hajj A, Ploussard G, de la Taille A, Allory Y, Vordos D, Hoznek A, Abbou CC, Salomon L. Patient selection and pathological outcomes using currently available active surveillance criteria. BJU Int 2013; 112:471-7. [DOI: 10.1111/bju.12154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Albert El Hajj
- Department of Urology; APHP, CHU Henri Mondor; Créteil; France
| | | | | | - Yves Allory
- Department of Pathology; APHP, CHU Henri Mondor; Créteil; France
| | - Dimitri Vordos
- Department of Urology; APHP, CHU Henri Mondor; Créteil; France
| | - Andras Hoznek
- Department of Urology; APHP, CHU Henri Mondor; Créteil; France
| | | | - Laurent Salomon
- Department of Urology; APHP, CHU Henri Mondor; Créteil; France
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El Hajj A, Thanigasalam R, Molinié V, Massoud W, Fourati M, Girard F, Escudier B, Baumert H. Feasibility and oncological outcomes of laparoscopic treatment for local relapse of renal cell carcinoma. BJU Int 2013; 112:E307-13. [DOI: 10.1111/j.1464-410x.2012.11724.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Albert El Hajj
- Department of Urology; Paris Saint Joseph Hospital Trust; Paris; France
| | | | - Vincent Molinié
- Department of Pathology; Paris Saint Joseph Hospital Trust; Paris; France
| | - Walid Massoud
- Department of Urology; Paris Saint Joseph Hospital Trust; Paris; France
| | - Mohamed Fourati
- Department of Urology; Paris Saint Joseph Hospital Trust; Paris; France
| | - Frederic Girard
- Department of Urology; Paris Saint Joseph Hospital Trust; Paris; France
| | - Bernard Escudier
- Department of Oncology; Gustave Roussy Institute; Villejuif; France
| | - Hervé Baumert
- Department of Urology; Paris Saint Joseph Hospital Trust; Paris; France
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El Hajj A, Ploussard G, de la Taille A, Allory Y, Vordos D, Hoznek A, Abbou CC, Salomon L. Analysis of outcomes after radical prostatectomy in patients eligible for active surveillance (PRIAS). BJU Int 2012; 111:53-9. [DOI: 10.1111/j.1464-410x.2012.11276.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Albert El Hajj
- Department of Urology; APHP, CHU Henri Mondor; Créteil; France
| | | | | | - Yves Allory
- Department of Pathology; APHP, CHU Henri Mondor; Créteil; France
| | - Dimitri Vordos
- Department of Urology; APHP, CHU Henri Mondor; Créteil; France
| | - Andras Hoznek
- Department of Urology; APHP, CHU Henri Mondor; Créteil; France
| | | | - Laurent Salomon
- Department of Urology; APHP, CHU Henri Mondor; Créteil; France
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El Hajj A, Ploussard G, Radulescu C, Defourmestraux A, Gillion N, Hoznek A, Vordos D, Yiou R, Allory Y, de la Taille A, Abbou CC, Salomon L. 377 PATHOLOGICAL RESULTS IN PATIENTS ELIGIBLE FOR SIX INTERNATIONAL ACTIVE SURVEILLANCE PROTOCOLS. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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