Jose Benito A. Abraham Urology and Kidney Transplantation

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.

27/11/2025

Renal Masses Among ESRD Patients

Patients with end-stage renal disease (ESRD) on chronic dialysis often develop progressive cardiovascular complications, placing them at high risk for any surgical intervention. In addition, they are predisposed to acquired renal cystic disease, which carries the potential for malignant transformation.

Minimally invasive radical nephrectomy offers a gentler approach to tumor removal in this population. By utilizing small incisions, the procedure minimizes the inflammatory response, reduces blood loss, alleviates postoperative pain, and facilitates faster recovery with shorter hospital stays. These advantages are particularly valuable for dialysis patients, as they help optimize their condition for future kidney transplantation while reducing the risk of sensitization that may result from blood transfusions.

Importantly, Stage I renal cancer is not considered a contraindication to renal transplantation. Thus, timely and minimally invasive management of these tumors can preserve transplant eligibility and improve long-term outcomes.

25/11/2025

🩺 Kidney Transplantation in High‑Risk Candidates: Preparing Beyond Boundaries

Kidney transplant candidates with high immunological risk and significant cardiovascular risk represent one of the most challenging groups in modern transplantation. Yet, with meticulous preparation, they can achieve outcomes far superior to remaining on dialysis.

🔬 Immunological Preparation
- Plasmapheresis & Immunoadsorption: Reduce circulating donor‑specific antibodies, lowering the risk of hyperacute or antibody‑mediated rejection.
- Antibody Induction Therapy: Tailored use of agents such as anti‑CD20 or anti‑IL‑2 receptor antibodies to modulate immune response and improve graft survival.
- Close Monitoring: Dynamic assessment of antibody titers and immune profiles ensures interventions are timely and effective.

❤️ Cardiovascular Preparation
- Risk Stratification: Comprehensive cardiac evaluation—stress testing, echocardiography, and coronary imaging—identifies silent but significant disease.
- Optimization: Aggressive management of hypertension, diabetes, dyslipidemia, and anemia prior to surgery.
- Intervention: Revascularization or medical therapy when indicated, ensuring the patient can withstand the physiologic stress of transplantation.

🌟 Why It Matters
Dialysis, while life‑sustaining, carries relentless cardiovascular burden and accelerates morbidity. Transplantation—when preceded by immunological desensitization and cardiovascular optimization—offers:
- Better survival
- Improved quality of life
- Freedom from the long‑term complications of dialysis

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Impact Statement:
> High‑risk does not mean no‑hope. With science, preparation, and compassion, we can transform outcomes. Every patient deserves the chance to live beyond dialysis.

07/11/2025

15 Years of Excellence in Transplantation... time flies!

My journey to becoming a transplant surgeon has been nothing short of extraordinary. I first came to the United States to pursue a fellowship in minimally invasive urology under the esteemed Dr. Ralph V. Clayman. During this transformative period, I had a chance encounter that would change the course of my career.

While training at University of California Irvine Medical Center for endourology, I met a former classmate—then a Liver Transplant Surgical Fellow at UCLA—who came to our hospital to perform a multiorgan retrieval from a deceased donor. He would later become a world-renowned transplant surgeon, having worked at some of the most prestigious transplant centers across the United States.

During that visit, he encouraged me to consider a transplant surgical fellowship after completing my endourology and laparoscopy training. He suggested I apply to the University of Texas Medical School in Houston. At the time, the idea seemed far-fetched. But the thought of becoming the "First and probably the Only" Filipino urologist with dual fellowship training—in both minimally invasive urology and transplant surgery—sparked a sense of purpose.

To my surprise, I was accepted into the program. At the University of Texas Medical School, I had the privilege of training under Dr. Barry D. Kahan—a world-renowned transplant surgeon, immunologist, and former president of the American Society of Transplant Surgeons (ASTS). His mentorship was instrumental in shaping my understanding of transplant science and surgical excellence.

Suddenly, I was facing four years of intensive and prolonged training in the United States. Those two pivotal moments—meeting my classmate and being accepted into the transplant fellowship—were "game-changers" in my journey as a physician.

I remain deeply grateful to the Lord for opening doors I never imagined and for guiding me through a path that has shaped not just my career, but my calling.

20/09/2025

There's nothing quite like having the world to yourself on an early morning bike ride. 🌄

Tackled the rolling hills of Havila as the sun came up. Challenging terrain, fresh air, and breathtaking sights around every corner. It’s this kind of struggle that makes you feel truly alive.

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/

Send a message to learn more

03/03/2025

When patients with chronic kidney disease develop renal tumors, there is a pressing need to remove the tumor while preserving as much normal functioning renal tissue (partial as opposed to total or radical nephrectomy) in order to avoid renal failure that requires chronic dialysis.

However, when the tumor is located in a critical location such as in this case (central or hilar) where the mass is adjacent to delicate structures such as the renal vessels (artery and vein) and ureter, it now becomes "almost impossible" to save that kidney.

A collaboration of two of the most highly qualified minimally invasive surgeons: Drs. Joben Abraham and Ernesto Gerial Jr., is therefore needed to make this possible:

Indeed, laparoscopic enucleation of a hilar renal tumor is feasible in the hands of experts.

Saving kidneys, and patients, one at a time.

24/02/2025

When mentoring in Surgery becomes more than just a task but a passion for minimally invasive surgery... teaching PCNL to young aspiring endourologists

03/02/2025

Would like to reiterate that I don't endorse any product for the Prostate or any other diseases. NEYGOLD PLUS is using my name without my authority. They are scammers!

25/01/2025

Glad to have finished Level 2 Accreditation with the new Toumai (MedBot) Robotic Surgical System. Another tool for minimally invasive urological procedures...

25/01/2025

"Renal-preservation (nephron-sparing) surgery"

Most complex renal tumors are treated by the majority with a radical (total) nephrectomy (kidney removal.)

With the proper planning and collaboration, two expert minimally invasive surgeons can cooperate to remove complex renal tumors T1b (>4cm, in this case 6cm.,) while preserving normal renal parenchyma.

This procedure may be performed exclusively with laparoscopic means (without the need for robotic assistance), thus saving the patient gargantuan costs that are associated with the use of the robotic surgical system.

Saving kidneys, and patients, one day at a time...