Publications by authors named "Johnny Boustany"

7 Publications

  • Page 1 of 1

Management of proximal penile prosthetic cylindrical complications: a novel direct crural approach.

Basic Clin Androl 2020 Nov 3;30(1):17. Epub 2020 Nov 3.

Department of Urology, La Croix Saint Simon Hospital, Paris, France.

Introduction: Patients with proximal penile prosthetic cylindrical complications (PPPCC) can be treated with a direct crural technique without using the original traditional approach. In this article we present our novel direct crural approach for management of patients with PPPCC.

Materials And Methods: Between 2014 and 2019, data were retrospectively collected from 13 patients who underwent surgical revision using our novel direct crural approach for PPPCC. The procedure commences with identification of the affected zone. The patient is in a low lithotomy position. A 2-centimeter longitudinal incision is made directly over the affected site. Dissection is carried down through Colles' fascia, followed by a longitudinal incision through the tunica albuginea at the proximal part of the affected cylinder. Via the incision we can deliver out the cylinder and manage its problem.

Results: Mean operative time was 40 min. No intra or post-operative complications were reported. All patients (Mean age = 57) were discharged on the same day. Postoperative follow-up found correction of all existing deformities at month 1, 3 and 6. All patients were satisfied and reported less pain and faster recovery than the first procedure.

Conclusion: Our technique, which can be used for all types of penile prosthesis, is both feasible and safe. It may simplify PPPCC revision by avoiding adhesions below the original incision, without jeopardizing the already implanted materials or the urethra. It may also improve patients' safety and satisfaction, by reducing iatrogenic injury and post-operative recovery time.
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http://dx.doi.org/10.1186/s12610-020-00115-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607683PMC
November 2020

Large Cell Neuroendocrine Carcinoma of the Bladder with Adenocarcinomatous Component.

Case Rep Urol 2020 5;2020:8827646. Epub 2020 Oct 5.

Department of Urology, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.

Large cell neuroendocrine carcinoma (LCNC) is one of the rarest types of bladder cancer occurring in <1%. Either pure or mixed with another component, it remains one of the most aggressive types of bladder cancer. We report a case of LCNC of the bladder with an adenocarcinomatous component. The patient was a 64-year-old smoker male, who presented for the first time with dysuria and hematuria. A bladder tumor invading the anterior and right lateral bladder walls was discovered, without any secondary localizations. Tumor biopsy showed an LCNC with adenocarcinomatous components. The patient was treated by recurrent tumor resections, chemotherapy, and radiotherapy. No improvement was noted despite close follow-up and adequate treatment. Neuroendocrine bladder tumor is known to have an aggressive, rapid, and disadvantageous evolution. Multiple case reports were published so far, and a recent review was conducted in March 2020 by Sanguedolce et al. (2020). More cases are needed to establish the best management plan for this type of tumor.
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http://dx.doi.org/10.1155/2020/8827646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557901PMC
October 2020

Bilateral Laparoscopic Transperitoneal Pyelolithomy: Dare You Do This?

J Endourol Case Rep 2020 4;6(2):99-102. Epub 2020 Jun 4.

Department of Urology, Notre Dame des Secours, University Medical Center, Byblos, Lebanon.

The aim of this article is to describe our technique of bilateral laparoscopic pyelolithotomy (LP) in a 54-year-old patient with bilateral large stones of which one is a staghorn stone (SS). The patient's legs were extended and spaced from each other; the table was tilted to the right and to the left in a way to use only five trocars for both sides. The calculi were delivered intact at the end of the procedure. Operating time was 208 minutes. Blood loss was 250 mL. Hospital stay was 3 days. Double-J stents were removed 4 weeks later. The patient was stone free with a stable serum creatinine. This case report is the first to describe a bilateral LP for large and SS. This procedure can minimize the postoperative morbidity and is associated with high stone-free rates. It is safe when done by expert surgeons, but further investigations are required to assess its reproducibility.
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http://dx.doi.org/10.1089/cren.2019.0126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383464PMC
June 2020

Recurrent metastatic clear cell renal carcinoma with sarcomatoid dedifferentiation treated with surgery and Cabozantinib.

Oncotarget 2020 May 19;11(20):1922-1928. Epub 2020 May 19.

Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon.

Renal cell carcinoma with sarcomatoid dedifferentiation is an entity of RCC that has undergone an anaplastic transformation with both a carcinomatous and a sarcomatous component. The standard treatment in metastatic patients is immunotherapy. The aim of this article is to describe our case of metastatic recurrent RCC with sarcomatoid dedifferentiation in a 59 year old male patient treated with nephrectomy and multiple metastasectomies followed by Cabozantinib. Consecutive PET-CT scans showed no evidence of recurrence, three years after the last metastasectomy, and the patient is having currently a normal life. Sarcomatoid dedifferentiation remains a poor prognosis factor in RCC. Surgery for metastases followed by Cabozantinib may be a therapeutic option in metastatic young patients. However, a prospective randomized trial would be the best option to validate this approach.
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http://dx.doi.org/10.18632/oncotarget.27543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244017PMC
May 2020

Bellini Duct Carcinoma Misdiagnosed with Urothelial Papillary Carcinoma.

Case Rep Oncol Med 2020 10;2020:3174674. Epub 2020 Feb 10.

Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.

Background: Collecting (Bellini) duct carcinoma (CDC) or Bellini duct carcinoma (BDC) is a rare subtype of kidney tumors, accounting for less than 3% and known to have the worst prognosis. It is known to have multiple clinical presentations; this is why it can be easily misdiagnosed. The aim of this article is to present a case of CDC that was initially misdiagnosed with urothelial papillary carcinoma (UPC) in a 41-year-old male. . Our patient presented with a left flank pain evolving for one month and one episode of gross macroscopic hematuria. Upon presentation, he had left costovertebral angle tenderness. Initial lab tests were normal. Computed tomography revealed a 5 cm solid mass of the left renal pelvis and multiple infracentimetric perihilar lymph nodes. Subsequently, the patient had left nephroureterectomy. Microscopic examination showed the presence of a high-grade urothelial papillary carcinoma of the renal pelvis' lumen. All four of the dissected lymph nodes showed disease metastasis. Three years after establishing the diagnosis, the patient presented again for chronic abdominal pain, with a recent history of weight loss. CT scan showed a left paraaortic mass infiltrating the left psoas muscle over a length of 12 cm. Immunohistochemical profiling of this mass confirmed the diagnosis of Bellini duct carcinoma, rejecting the initial diagnosis of UPC. Therefore, the patient required a cisplatin-gemcitabine-based chemotherapy regimen.

Conclusion: BDC remains one of the rare aggressive subtypes of RCC, having a multitude of initial clinical presentations and an unfavorable prognosis. In this patient, CDC was masquerading as a transitional cell carcinoma that should always be kept in mind as a possible presentation. Corresponding early imaging and histopathology exams are primordial for a correct diagnosis and thus a better prognosis.
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http://dx.doi.org/10.1155/2020/3174674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035507PMC
February 2020

Endourologic treatment for a fibroepithelial ureteral polyp protruding from the urethra.

J Surg Case Rep 2019 Nov 11;2019(11):rjz320. Epub 2019 Nov 11.

Notre Dame des Secours-University Medical Center, Byblos, Lebanon.

Fibroepithelial polyps (FP) of the ureter are rare and benign mesodermal tumors frequently mistaken for transitional cell carcinoma. We hereby report a rare case of a 19-year-old patient with two FPs, originating from the distal left ureter that were successfully treated with ureteroscopy. One of these polyps was completely protruding outside the bladder through the urethra, which makes this case unique in the literature. Ureteroscopy is currently the best method available for identification, histologic diagnosis and treatment of these polyps.
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http://dx.doi.org/10.1093/jscr/rjz320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6846958PMC
November 2019

Bilateral laparoscopic ureterolysis using hydrodissection in retroperitoneal fibrosis: a new application of an old technique.

Res Rep Urol 2019 1;11:131-135. Epub 2019 May 1.

Urology Department, Notre Dame Des Secours University Medical Center, Byblos, Lebanon.

To describe our new laparoscopic approach in ureterolysis using the ERBEJET 2 device to hydrodissect the ureters in idiopathic retroperitoneal fibrosis. Bilateral laparoscopic ureterolysis was done after medical therapy failure (steroids) in a 47 year old patient with retroperitoneal fibrosis. Ureteral stents were placed before surgery. Only five trocars were used for both sides, Toldt's fascia was opened and the dissection was performed till the psoas muscle. The ureters were completely freed from the fibrotic tissue using the ERBEJET 2 device (pure hydrodissection). An omental wrap was passed behind the colonic flexure at the right and placed around the ureter. At the left, we closed Toldt's fascia by running sutures back to the freed ureter. The operating time was 198 mins. The blood loss was 50 cc. The hospital stay was 3 days. The double J stents were removed at 4 weeks postoperatively. After 2 years, the patient is free of symptoms with normal creatinine level and no urinary tract obstructions. Hydrodissection of the ureter in retroperitoneal fibrosis is a new application in the upper urinary tract laparoscopic approach that has not been described in literature before. It seems to offer excellent midterm outcomes. The use of ERBEJET 2 device seems to simplify the procedure and make it feasible and safe (less trauma to the ureter and more conservation of its blood supply). We believe that comparative studies are needed to assess the role of hydrodissection in ureterolysis for retroperitoneal fibrosis.
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http://dx.doi.org/10.2147/RRU.S201396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6507073PMC
May 2019
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