Meet Raja B. Khauli, M.D., F.A.C.S.
Dr. Raja Khauli is a urologist with extensive experience in the diagnosis and treatment of general urological disorders and conditions. Our practice is dedicated to offering quality service. We use the least-invasive and most promising solutions available, and we focus on patient education.
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Urology is the medical and surgical specialty that deals with problems of the male and female urinary tract (kidneys, ureter, bladder, and urethra) and the male reproductive system. The following are some of the more common conditions that a urologist treats:
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- Benign prostatic hyperplasia (BPH)
- Bladder control problems
- Erectile dysfunction (impotence)
- Prostate cancer
- Prostate disorders
- Urinary incontinence
Practice Philosophy, Mission Statement and Goals
Our vision for the Division of Urology at The American University is to deliver the highest quality patient care, postgraduate teaching and specialization, and research in the field of urologic surgery. The standards that are set are those that are practiced by American medical schools and health systems in the USA. The Division currently offers a full spectrum strategy for the evaluation and management of urologic problems in adults and children, and offers expertise in all urological sub-specialties. These include the following: urologic oncology, prostate cancer, diseases of the adrenal and its surgery, stone disease, renal transplantation and immunobiology, renovascular diseases, female urology, urinary incontinence, endourology and endoscopic surgery, pediatric urology, erectile dysfunction, infertility, and general adult urology. The Division has maintained its strong tertiary care patient-based programs serving Lebanon and nearby countries in the Middle East Region.
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Practice Specialties or Special Programs:
Over the past year, the Division has emphasized some specific urological entities including the development of a Prostate Cancer Center, Kidney Transplantation Unit, and the introduction of ESWL and a Stone Therapy center at the Medical Center for the management of stone disease. While these programs have been fully endorsed and introduced, their expansion is currently underway, and the progress is rather rapid. I will go over these three clinical fields one by one.
1. The Prostate Center
The Prostate Center has been established in multidisciplinary fashion involving the Division of Urology, Department of Radiology, Department of Radiation Oncology, and Department of Pathology. The AUBMC, Division of Urology has pioneered the concept of PSA screening for early detection of prostate cancer along US accepted standards and guidelines. The educational programs introduced to expand the awareness of PSA and prostate cancer where initiated as part of the American College of Surgeons Lebanese Chapter meeting in October 1998, and the Middle East Medical Assembly Meeting in April 1998. These heralded the campaigns that were later initiated by the Lebanese Urologic Society in Association with the Lebanese Ministry of Health screening for prostate cancer in 1999, in which AUB was a major player. Currently, the Division of Urology at AUB is the most active center managing prostate diseases in the Middle East, and has pioneered the procedure of Radical Retropubic Prostatectomy (complete surgical ablation of the prostate) for the management of organ-confined cancer of the prostate in the area. Our work in the field has resulted in several abstracts that were presented in regional and international meetings. We have been also involved as moderators and visiting professors in the region present our work on prostate specific antigen and its use for the early detection in prostate cancer, as well as surgical techniques and modifications in performing the radical retro pubic prostatectomy (see later under CME).
Currently, we are focusing on the management of state T2 disease (cancer of the prostate with extension into the prostatic capsule and seminal vesicle) in conjunction with the Department of Radiation Oncology. This has been introduced with the possibility of neo-adjuvant hormonal therapy in combination with radiotherapy following surgical ablation of the prostate. Young patients who meet criteria of clinical T3 disease are offered the option of radical retropubic prostatectomy with adjuvant hormonal ablation-radiation therapy. We are currently embarking on two such ongoing programs. In addition, we are looking at introducing Cryotherapy and Brachytherapy, and are working closely on treatment protocols with the University of Massachusetts Medical Center, Division of Urology and the Massachusetts Prostate Cancer Research Institute.
Since 1998 the numbers of prostate cancer surgeries has tripled. We anticipate that radical prostatectomies will continue to increase along with other therapeutic interventions at our Medical Center. The increased awareness of prostate cancer and its early diagnosis is currently seen throughout the Middle East.
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The AUBMC has established a state-of-the-art center for managing end-stage kidney disease since 1997. In the past year, we have extended this program to a multi-disciplinary, multi-departmental service (medicine, nephrology, infectious diseases, hepatology, surgery & urology and pathology (laboratory medicine) and the Department of Immunology). We are an affiliate of the University of Massachusetts Transplantation Center and currently are applying the same protocols. We have performed over 110 renal transplants in the past 4 years that have enjoyed 97% graft and patient success rate. The enormous success and low grade of graft rejection (<8%) in over 120 patients treated with triple immunosuppression (Cyclosporine Neoral, Mycophenolate Mofetil and Prednisone) is probably a result of modern immunosuppressive protocols and less toxic agents than prior induction protocols using monoclonal and polyclonal antibodies. The use of meticulous surgical techniques and rapid steroid tapering has abolished the post operative wound infection and pulmonary complications. Study protocols have included the evaluation of triple and quadruple immunosuppressive protocols in modulating chronic allograft rejection. We are also evaluating chronic rejection and have presented on this subject in several international and national meetings. In addition we have published on diminishing the rate of chronic allograft rejection, which remains the major cause of graft loss after kidney transplantation.
Despite our interests and dedicated efforts to promote organ donation, the number of cadaver organ donors remains small in the country. This is probably complicated by hurdles like cultural complexities as well as geographic and religious restrictions, and has prohibited the expansion of the cadaveric transplant program, which remains a rare occurrence in Lebanon. The AUBMC utilizes mostly live donor organs as well as the expanded-emotionally-related living donation in the past year.
The AUBMC continues to see its share of referrals from external transplant programs with major surgical and medical complications. This has increased dramatically since 1998 especially with patients that are being transplanted with a more liberal attitude, and with significant co-morbid risk factors in nearby countries and told to return here for the management of their surgical complications and for immune monitoring.
The enormous clinical success of the transplantation program has (Currently AUB enjoys the best patient and graft survival among Lebanese Centers) resulted in continued referral from Middle Eastern and Arab States including Turkey and Europe. As mentioned previously, our ongoing clinical research, especially that on chronic allograft rejection and ameliorating the process, in the conjunction of the University of Massachusetts Medical Center has led to several original publications on the subject and participation in international scientific programs.
In the past 4 years, AUBMC has initiated the first laparoscopic donor nephrectomy program in the Middle East. Over 90 donor-recipient transplants have been performed with excellent graft success rates (95%), similar to the outcome achieved with the open nephrectomy procedure. In a recently published controlled trial comparing the outcome of transplantation based on kidney retrieval technique (open versus laparoscopic donor nephrectomy), there was no difference in graft function or recipient outcome in these arms, but there was a clear benefit to the donor in the laparascopic nephrectomy arm with significantly shorter recovery and resumption of normal activity.
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The American University of Beirut Medical Center installed the Philips Diagnost M Lithotriptor in February 1998. This is a cost-efficient system whose modular design is adaptable to several particular requirements and permits upgrading in several stages. The features include urological X-ray diagnosis, cystoscopy, and URS. Also the system is adaptable to percutaneous endo-urology (PCN), digital radiography and fluoroscopy, with real time image processing. The most outstanding feature of the litho Diagnost M system is the ability of performing anesthesia-free ESWL with high shock rate. This system which combines all round access to patient, with latest X-ray technology for digital spot imaging, and swiveling shock-wave bb applicator system for greater efficiency of shock wave delivery, presents a state-of-the-art progress in our armamentarium in managing stone disease in Lebanon and in the region. The ESWL - lithotripsy unit has been functional since February 1998 but most of the treatments were performed in 1999. The clinical application was initiated with intensive training of the four urologists at the University in March of 1998, and the acquisition of a full-time urologic technician, who is currently stationed in our ambulatory-lithotripsy unit in the basement level (near X-ray, extension 5925/6/7). Since July 1998 the total number of patient-lithotripsy therapies equaled 198 cases, in 112 patients. The total number of patients requiring two or more sessions for stone fragmentation was 60. Most patients (80%) underwent the procedure without any anesthesia but with minor sedation. More than 50% underwent this procedure with analgesics without IV sedation. The fragmentation rate has exceeded 85%, but is higher for upper tract stones particularly in the upper ureter and the kidney pelvis. The inclusion of lower ureteral stones has diminished the rate of success, yet is more attractive to patients because of its minimal invasiveness and the possibility of undergoing lithotripsy when the extra-corporeal lithotripsy fails. Thus the encouraging success rate in the upper ureter and kidney has tempted us to utilize the Diagnost M lithotriptor for virtually all stones in the urinary tract regardless of the position in the ureter, realizing that the success rates for the lower ureteral stones are higher with endoscopic lithotripsy than extra-corporeal shock wave lithotripsy.
Last year, we acquired the Holmium: YAG laser which has been almost exclusively utilized for endolithotripsy of upper ureteral calculiin conjunction with flexible ureteroscopy and form managing stricture disease.
We believe that the introduction of the Diagnost M lithotriptor and the Holmium:YAG laser to the University is a great advance in our ability to expend our urology armamentarium in managing stone disease.
The Division has continued to expand other sub-specialties including infertility-impotence, neurourology, female urology and pediatric urology.
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4. Laparoscopic and Minimally Invasive Urologic Surgery
The Division initiated laparoscopic urologic surgery in January 2000 when it performed the first laparoscopic donor nephrectomy in the Middle East, and since then over 100 procedures were performed, thereby enhancing the visibility of the program, and increasing
dramatically the willingness to donate kidneys for transplantation. In a recently published controlled trial comparing the outcome of transplantation based on kidney retrieval techniques (open versus laparoscopic donor nephrectomy), there was no difference in graft function or recipient outcome, but there was a clear benefit to the donor in the laparascopic nephrectomy arm
with significantly shorter recovery and time to resumption of normal activity. Our enthusiasm in laparoscopic donor nephrectomy heralded the introduction of laparoscopic urologic oncology, namely laparoscopic radical nephrectomy and adrenalectomy for cancer. Furthermore, we have initiated Laparoscopic reconstructive urology, and performd a multitude of procedures including
laparoscopic pyelolithotomy, pyeloplasty, partial nephrectomy, as well as other reconstructive prcedures, placing our Division at a world-class level of academic and clinical care.
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