Jose Benito A. Abraham Urology and Kidney Transplantation

06/10/2026

Every patient, every kidney deserves a chance…An elderly gentleman with diabetes and hypertension undergoes routine imaging. What appears is an “incidentaloma”—an incidentally discovered, asymptomatic renal tumor. The mass is solid, centrally located, and perilously close to the hilar vessels.

The RENAL Nephrometry Score is 10, signaling very high complexity. By conventional wisdom, this predicts an arduous minimally invasive partial nephrectomy.

Most surgeons, weighing risk against feasibility, would recommend either a radical nephrectomy or an open partial nephrectomy.

Yet, a visionary surgical team—guided by a mindset of nephron preservation and minimal invasiveness—chooses a different path. For them, saving the kidney is not optional but imperative. They deliberately reject nephrectomy, embracing the challenge of a complex minimally invasive nephron‑sparing surgery.

This philosophy reflects a deeper conviction: that even in the most difficult scenarios, the kidney deserves preservation, and the patient deserves the chance to retain function, dignity, and hope.

16/09/2026

Salvage PAUL: A Masterclass in Endourology—When Retrograde Fails, Strategic Antegrade Access Saves the Kidney.

A 2cm impacted upper ureteric stone. Prolonged obstruction. Retrograde was a dead end at every turn:

· Guidewire couldn't bypass
· Semirigid scope couldn't see past ureteral tortuosity
· Flexible laser achieved only partial fragmentation
· Stenting failed—ureteric perforation, stent loop outside the renal pelvis
· Emergent nephrostomy placed

The kidney was on the line.

The strategic decision that changed everything:

A lower pole nephrostomy was already in place—the easy tract to use. But it would have meant working upward against the anatomy: poor angle to the renal pelvis, compromised view of the upper ureter and misplaced stent.

Instead: antegrade pyelogram first, then a deliberate puncture of an upper pole calyx.

Why? A straight, in-line trajectory—direct visualization of the misplaced stent, the inferior calyceal stone, and the impacted ureteric calculus. One tract. One line of sight. Three targets.

The salvage procedure:
Percutaneous antegrade ureteroscopic laser lithotripsy (PAUL), treatment of the inferior calyceal stone, extraction of the misplaced stent, complete lithotripsy of the ureteric stone, antegrade ureteral stenting.

The outcome:
Complete clearance. Stent retrieved. Ureteric patency restored. Kidney saved.

Why this matters:
When retrograde is impossible, antegrade isn't just an alternative—it's definitive. You control the proximal ureter. You see what retrograde couldn't. Literature supports it: antegrade flexible ureteroscopy for impacted upper ureteric stones >10mm achieves 92% stone-free vs 74% retrograde, with fewer auxiliary procedures (4% vs 18%). In salvage cases, 100% stone-free rates.

The takeaway:
Don't inherit the access you were given. Plan the access you need. Antegrade pyelogram is your roadmap—choose the calyx that gives you a straight line to your target, even if it means a new puncture. Five extra minutes of planning saves an hour of struggling.

When the ureter wins the first battle, change the battlefield. The kidney doesn't have to lose the war.

05/09/2026

Day 3 UAA 2026: More learning opportunities, rekindling friendships, strengthening bonds, collaborating with colleagues from the region...

09/03/2026

34 years ago, Dr. Ralph Clayman changed the course of urology forever. ⚕️

In 1991, he performed the first laparoscopic nephrectomy—a bold procedure that proved we could remove a diseased kidney without the large incisions, significant blood loss, and lengthy hospital stays that patients once endured. It wasn't just a new surgery; it was a paradigm shift that revolutionized patient care and became the undeniable gold standard.

For me, this history is deeply personal.

In 2006, Dr. Clayman was my Program Director during my Minimally Invasive Urology Fellowship at University of California Irvine Medical Center. It has now been 20 years since I learned the intricate caveats of laparoscopic urological surgery directly from the pioneer himself. That experience didn't just teach me a technique; it fundamentally changed the trajectory of my career.

It instilled in me a lifelong mission: to be a relentless promoter of this minimally invasive philosophy. I carry his lessons into the OR every day, not just to operate, but to honor the principle that innovation is about constantly asking, "How can we do this better for our patients?" Smaller incisions, less pain, faster recovery—these aren't just benefits; they are the standard we owe every person who trusts us with their care.

Thank you, Dr. Clayman, for changing the field—and for shaping the surgeon and advocate I am today. 🥂

09/12/2025

🎯 The Trifecta in Stage 1 Renal Cell Carcinoma Therapy

Minimally Invasive Excellence in Partial Nephrectomy and Tumor Enucleation

In the management of stage 1 renal cell carcinoma, the trifecta of partial nephrectomy remains the gold standard:

🔹 Negative margins
🔹 Minimal warm ischemia time
🔹 No perioperative complications

But innovation continues to evolve. Laparoscopic tumor enucleation—a technique that dissects along the natural tumor-parenchyma interface—has emerged as a novel yet equally effective alternative. With careful case selection and precise ex*****on, it offers:

✅ Comparable oncologic outcomes
✅ Enhanced nephron preservation
✅ Reduced hilar manipulation

Whether through standard partial nephrectomy or enucleation, the goal remains the same: oncologic control, functional preservation, and surgical safety. These successes reflect not just technical mastery, but the strength of a multidisciplinary team and the trust of our patients.

🩺 Technique refined.
💡 Options expanded.
🤝 Outcomes honored.

23/07/2025

Laparoscopic dismembered pyeloplasty... definitive treatment from congenital UPJO presenting as recurrent febrile urinary tract infection for several years...

This is a minimally invasive reconstructive procedure that rectifies the stenosis at the level of the ureteropelvic junction, thus relieving the obstruction and recovering renal function.

This is unique skill that we teach our fellow at the Laparoscopic Urology and Endourology Fellowship at the NKTI. Leading the fellow by the hand allows them to gain confidence when performing this surgery independently.

Saving kidneys, one day at a time...

21/04/2025

Thank you for the opportunity to share my insights on Organ Transplantation at Donation at the AFP Radio...

https://www.facebook.com/share/r/1C3hY3U3HN/

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