Mohammad Abufaraj

• M.D
• Professor (Associate) at University of Jordan

Objectives To evaluate the concordance rate of lymphovascular invasion (LVI) and variant histology (VH) of transurethral resection (TUR) with radical cystectomy (RC) specimens. Furthermore, to evaluate the value of LVI and VH at TUR for predicting non-organ confined (NOC) disease, lymph node metastasis, and survival outcomes. Patients and methodsTw...

Context: The optimal treatment of urothelial bladder cancer (UBC) with micropapillary (MP) variant histology is not clear. Objective: To review the current literature on disease characteristics and treatment outcomes of MP UBC. Evidence acquisition: A systematic search was performed according to the Preferred Reporting Items for Systematic Reviews...

Background: Inflammatory reaction has been linked to bladder cancer (BCa). Diet drives systemic inflammation and may be considered a modifiable risk factor for BCa. Objective: To examine the association between diet with pro-inflammatory potential and BCa risk using the novel empirical dietary inflammatory pattern (EDIP) score comprised of pre-d...

Purpose To assess the accuracy of [⁶⁸Ga]-PSMA-11 PET/CT or [⁶⁸Ga]-PSMA-11 PET/MRI (PSMA-11 PET/CT(MRI)) for lymph node (LN) staging using salvage LN dissection (SLND) in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). Patients and methods In a prospective study, 65 consecutive patients who developed BCR after RP underw...

Background: With three out of four new bladder cancer (BCa) cases occurring in men, an apparent gender disparity exists. We aimed to investigate the role of hormonal and reproductive factors in BCa risk using two large female US prospective cohorts. Methods: Our study population comprised 118 256 and 115 383 female registered nurses who were rec...

Background The Bosniak classification for cystic renal masses has undergone refinements since its inception. The 2019 version provides more objective criteria to enhance interrater agreement but needs validation. This study compares the interrater agreement of the 2005 and 2019 Bosniak classifications for cystic renal masses. Methods Forty cysti...

Background Health services should anticipate the changing pattern of illnesses associated with population aging to promote healthy aging. Aim We aimed to evaluate health indices and chronic illnesses and their relationship with functional independence in community Syrian refugees & Jordanian elderly. Methods A stratified sample of 1,718 community...

Objective To compare the value of flexible blue‐light cystoscopy (BLC) vs flexible white‐light cystoscopy (WLC) in the surveillance setting of non‐muscle‐invasive bladder cancer (NMIBC). Methods All major databases were searched for articles published before May 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analys...

Objective To evaluate the impact of adjuvant therapy on oncological outcomes in patients with intermediate‐risk non‐muscle‐invasive bladder cancer (NMIBC), as due to the poorly‐defined and overlapping diagnostic criteria optimal decision‐making remains challenging in these patients. Patients and Methods In this multicentre study, patients treated...

Importance Prostate magnetic resonance imaging (MRI) is increasingly integrated within the prostate cancer (PCa) early detection pathway. Objective To systematically evaluate the existing evidence regarding screening pathways incorporating MRI with targeted biopsy and assess their diagnostic value compared with prostate-specific antigen (PSA)–base...

Purpose of review This article aims to comprehensively review and critique the existing literature on the role of metastatic- directed therapy in patients with metastatic bladder cancer, particularly in oligometastatic disease state. Recent findings The role of metastasectomy in metastatic bladder cancer is still controversial. Several studies have...

Neuroendocrine prostate cancer (NEPC) is a rare subtype of prostate cancer (PCa) that usually results in poor clinical outcomes and may be accompanied by paraneoplastic syndromes (PNS). NEPC is becoming more frequent. It can initially manifest as PNS, complicating diagnosis. Therefore, we reviewed the literature on the different PNS associated with...

Simple Summary Upper tract urinary carcinoma (UTUC) is a rare type of cancer affecting the urinary system. Patients with UTUC often undergo surgeries like kidney-sparing surgery or radical nephroureterectomy. However, even after treatment, there remains a risk of the cancer recurring in different parts of the body. This narrative review aims to bet...

Objectives The clinical course of coronavirus disease 2019 (COVID-19) infection is often aggressive, with unfavorable outcomes for those with comorbidities such as type 2 diabetes mellitus (T2DM). We aimed to assess the prevalence and risk factors of COVID-19 infection, mortality, and post-infection lung fibrosis in patients with COVID-19 infection...

Background: Healthcare providers (HCPs) are frontline workers during the COVID-19 pandemic. They are prone to increased risk of infection and psychological stress. Aims: To measure levels of knowledge, awareness, and stress about COVID-19 among HCPs. Methods: This cross-sectional study of 397 HCPs utilized an internet-based validated questionnaire...

Importance: Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors. Objective: To ascertain the incidence of, explore risk factors for, and determine the health...

Purpose The present systematic review and network meta-analysis (NMA) compared the current different neoadjuvant chemotherapy (NAC) regimes for bladder cancer patients to rank them. Methods We used the Bayesian approach in NMA of six different therapy regimens cisplatin, cisplatin/doxorubicin, (gemcitabine/cisplatin) GC, cisplatin/methotrexate, me...

Objective Overactive bladder (OAB) is a common condition affecting both men and women and has been shown to affect the quality of life. We conducted this study to estimate the prevalence of OAB, and to incorporate symptom severity, symptom bother and health-related quality of life (HRQL) in the assessment of OAB and evaluate associated factors. Me...

Background: There are currently no guideline recommendations regarding the treatment of cisplatin-ineligible, clinically lymph node-positive (cN+) bladder cancer (BCa). Objective: To investigate the oncological efficacy of gemcitabine/carboplatin induction chemotherapy (IC) in comparison to cisplatin-based regimens in cN+ BCa. Design setting an...

Background and objectives: We aimed to assess the work-life balance, job satisfaction, and life satisfaction and their correlates among physicians in Jordan. Materials and methods: This study utilized an online questionnaire to collect information about work-life balance and related factors from practicing physicians in Jordan from August 2021 u...

Aim: To evaluate the association between male pattern baldness (MPB) and benign prostatic hyperplasia (BPH). Methodology: Cohort study, data collected by co-authors. All extracted data were input to Excel sheets and further imported into STATA version 14. The study’s results were reported in the form of descriptive statistics. Results: This study f...

Background While family history (FHx) of prostate cancer (PCa) increases the risk of PCa, comparably less is known regarding the impact of FHx on pathologic and oncologic outcomes after radical prostatectomy (RP). Methods We retrospectively reviewed our multicenter database comprising 6,041 nonmetastatic PCa patients treated with RP. Patients with...

Objective To assess the association between cystoscopic findings and oncological outcomes in patients with non‐muscle‐invasive bladder cancer (NMIBC) given that the oncological impact of quantity and quality assessment of tumours with cystoscopy has not been well verified. Methods Multiple databases were queried in May 2022 for studies investigati...

Cytoreductive cystectomy appears to have survival advantages as a part of multimodal approach for well-selected patients with bladder cancer. Patient with clinical lymph node metastases might benefit from surgical consolidation after achieving a measurable response to chemotherapy. The exact role of cytoreductive/consolidative cystectomy is yet to...

Purpose To assess the prognostic value of sex for non-muscle-invasive/muscle-invasive bladder urothelial carcinoma (NMIBC/MIBC) treated with radical surgery. Methods The PubMed, Web of Science, and Scopus databases were searched in November 2021 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies w...

Purpose of review: The purpose of this article is to review and synthesize the current literature on the epidemiology of urolithiasis. Recent findings: The global patterns of urolithiasis are changing, as the prevalence of urolithiasis appears to be increasing across the world. Geographical variation in the prevalence of urolithiasis is noted ac...

PurposeThere is no consensus on which items of Enhanced Recovery After Surgery (ERAS) should and should not be implemented in radical cystectomy (RC). The aim of this study is to report current practices across European high-volume RC centers involved in ERAS.Methods Based on the recommendations of the ERAS society, we developed a survey with 17 qu...

Background: Radical cystectomy (RC) is indicated in primary or secondary muscle-invasive bladder cancer (primMIBC, secMIBC) and in primary or recurrent high- or very high-risk non-muscle-invasive bladder cancer (primHR-NMIBC, recHR-NMIBC). The optimal timing for RC along the disease spectrum of nonmetastatic urothelial carcinoma remains unclear....

Objectives: Insulin-like growth factor-I and its binding proteins are involved in cancer development, progression, and metastasis. In urothelial carcinoma, the impact of this pathway is still poorly investigated. The present large cohort study aimed to evaluate the association of preoperative circulating levels of insulin-like growth factor-I, ins...

Objective: To present an update of the available literature on external beam radiation therapy (EBRT) with or without brachytherapy (BT) compared to radical prostatectomy (RP) for patients with high-risk localised prostate cancer (PCa). Methods: We conducted a systematic review and meta-analysis of the literature assessing the survival outcomes...

Context Platinum-based combination chemotherapy is the standard treatment for advanced or metastatic urothelial carcinoma (AMUC). However, data comparing the efficacy of different platinum agents are limited. Objective This review aimed to assess the efficacy of carboplatin as a first-line treatment for AMUC using phase 3 randomized trial data. E...

Context Surveillance of the urethra and management of urethral recurrence (UR) after radical cystectomy (RC) is an area with poor evidence. Objective We aimed to summarize the available evidence and provide clinicians with practical recommendations on how to prevent and manage UR after RC for bladder cancer. Evidence acquisition The MEDLINE and E...

Background Angiogenesis-related marker vascular cell adhesion molecule-1 (VCAM-1) has been shown to be elevated in urothelial carcinoma of the bladder (UCB), but its predictive/prognostic role has not been determined. Thus, this study aimed to investigate the predictive/prognostic role of VCAM-1 for patients who have UCB treated with radical cystec...

Introduction: Although upper tract urothelial carcinoma (UTUC) is more common in the elderly, outcomes of neoadjuvant chemotherapy (NAC) in this population have never been explored. The objective of the study was to assess the impact of NAC on pathologic response and oncological outcomes stratified by age. Patients and Methods: This multicenter stu...

Purpose The HGF/MET pathway is involved in cell motility, angiogenesis, proliferation, and cancer invasion. We assessed the clinical utility of plasma HGF level as a prognostic biomarker in patients with MIBC. Methods We retrospectively analyzed 565 patients with MIBC who underwent radical cystectomy. Logistic regression and Cox regression models...

Background Preoperative plasma levels of Interleukin 6 (IL6) and its soluble receptor (IL6sR) have previously been associated with oncologic outcomes in urothelial carcinoma of the bladder (UCB); however, external validation in patients treated with radical cystectomy (RC) for UCB is missing. Patients/methods We prospectively collected preoperativ...

Purpose We assessed the prognostic value of systemic immune-inflammation index (SII) to refine risk stratification of the heterogeneous spectrum of patients with non-muscle-invasive bladder cancer (NMIBC) Methods In this multi-institutional cohort, preoperative blood-based SII was retrospectively assessed in 1117 patients with NMIBC who underwent...

Introduction: The prognostic role of prior history of bladder cancer (BCa) among patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) is poorly addressed. We aimed to investigate the role of prior BCa on any recurrence, distant metastases, and bladder recurrence following RNU among low-grade (LG) and h...

Purpose To summarize the available evidence on the survival and pathologic outcomes after deferred radical prostatectomy (RP) in men with intermediate- and high-risk prostate cancer (PCa). Methods The PubMed database and Web of Science were searched in November 2020 according to the PRISMA statement. Studies were deemed eligible if they reported t...

Purpose To investigate the predictive and prognostic value of the preoperative systemic immune-inflammation index (SII) in patients undergoing radical cystectomy (RC) for clinically non-metastatic urothelial cancer of the bladder (UCB). Methods Overall, 4,335 patients were included, and the cohort was stratified in two groups according to SII usin...

Introduction: This study aimed to evaluate the concordance in tumor stage and grade between ureteroscopic (URS) biopsy and radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC). Patients and methods: Records of 1,214 UTUC patients who had undergone URS biopsy followed by RNU were included. Univariable and mult...

Elevated preoperative plasma level of endoglin has been associated with worse oncologic outcomes in various malignancies. The present large-scale study aimed to determine the predictive and prognostic values of preoperative endoglin with regard to clinicopathologic and survival outcomes in patients treated with radical cystectomy (RC) for nonmetast...

PurposeThe HGF/MET pathway is involved in cell motility, angiogenesis, proliferation, and cancer invasion. We assessed the clinical utility of plasma HGF level as a prognostic biomarker in patients with MIBC.Methods We retrospectively analyzed 565 patients with MIBC who underwent radical cystectomy. Logistic regression and Cox regression models wer...

Purpose Androgen-regulated enzymes such as the angiotensin-converting enzyme 2 (ACE2) and the transmembrane serine protease 2 (TMPRSS2) are involved in the SARS-CoV-2 infection process. The expression of TMPRSS2 and its fusion gene, which are increased in the epithelium of the human prostate gland during prostate carcinogenesis, are regulated by an...

Purpose To investigate the prognostic role of the preoperative systemic immune–inflammation index (SII) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and methods We retrospectively analyzed our multi-institutional database to identify 2492 patients. SII was calculated as platelet...

INTRODUCTION AND OBJECTIVE: The heterogeneous behavior of bladder cancer (BC) demands for biomarkers (BM) with sufficient prognostic and predictive value. The preoperative systemic immune-inflammation index (SII) in patients who underwent radical cystectomy (RC) for BC was identified as an independent prognostic factor for worse survival outcomes i...

INTRODUCTION AND OBJECTIVE: This systematic review and network meta-analysis (NMA) aimed to summarize the available evidence on the oncologic outcomes of intravesical therapy in patients with intermediate-risk NMIBC. METHODS: The MEDLINE, EMBASE, and ‘clinicaltrials.gov' databases were searched in October 2020, according to the PRISMA statement. St...

Objectives To perform a systematic review and network meta‐analysis to compare the efficacy and safety of currently available treatments for the management of metastatic hormone‐sensitive prostate cancer (mHSPC), as there has been a paradigm shift with the use of next‐generation androgen receptor inhibitors (ARIs) and docetaxel. Methods Multiple d...

Context Degarelix is associated with high rates of injection site reaction. The US Food and Drug Administration approved relugolix, an oral gonadotropin-releasing hormone (GnRH) antagonist, for the treatment of advanced prostate cancer patients. Objective This systematic review and network meta-analysis aimed to compare the efficacy and safety of...

Purpose The accurate selection of patients who are most likely to benefit from neoadjuvant chemotherapy is an important challenge in oncology. Serum AGR has been found to be associated with oncological outcomes in various malignancies. We assessed the association of pre-therapy serum albumin-to-globulin ratio (AGR) with pathologic response and onco...

We aimed to conduct a systematic review and meta-analysis assessing the incidence and risk factors of urethral recurrence (UR) as well as summarizing data on survival outcomes in patients with UR after radical cystectomy (RC) for bladder cancer. The MEDLINE and EMBASE databases were searched in February 2021 for studies of patients with UR after RC...

Purpose: To validate the association of plasma-levels of urokinase-type plasminogen activator (uPA), its soluble receptor (SuPAR) and its inhibitor (PAI-One) with oncologic outcomes in a large cohort of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Methods: We collected preoperative blood samples fr...

Purpose To evaluate the potential predictive value of the preoperative serum albumin to globulin ratio (AGR) for oncological outcomes in patients treated with radical prostatectomy (RP) for clinically non-metastatic prostate cancer (PCa). Methods Pre-operative AGR was assessed in a multi-institutional cohort of 6041 patients treated with RP. Logis...

BACKGROUND Patients undergoing intestinal urinary diversion (IUD) may have a higher risk of osteoporosis and risk of fractures due to metabolic acidosis and decrease of intestinal absorption surface. OBJECTIVE We performed a systematic review of the available literature on the impact of IUD on bone demineralization. METHODS We systematically sear...

Aim Diabetic kidney disease (DKD) is a major long-term complication of diabetes mellitus (DM). Given the paucity of data on DKD in Jordan, we aimed to evaluate the prevalence, characteristics and correlates of DKD in Jordanian patients with type 2 DM. Methods This cross-sectional study included 1398 adult patients with type 2 DM who sought medical...

Background Grade group (GG) 4 prostate cancer (PC) is considered a single entity; however, there are questions regarding prognostic heterogeneity. This study assessed the prognostic differences among various Gleason scores (GSs) classified as GG 4 PC on biopsy before radical prostatectomy (RP). Methods We conducted a multicenter retrospective stud...

Background: To investigate the predictive and prognostic value of the preoperative modified Glasgow Prognostic Score (mGPS) in patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC). Methods: We conducted a retrospective analysis of an established multicenter database consisting of 4,335 patients who were tr...

Objectives Adjuvant chemotherapy (ACT) is recommended for non-organ-confined bladder cancer (BCa) after radical cystectomy (RC) and pelvic lymph node dissection (PLND), but there are sparse data regarding its specific efficacy in patients with histological variants. The aim of our study was to evaluate the role of ACT on survival outcomes in patien...

PurposeThe De Ritis ratio (aspartate aminotransferase/alanine aminotransferase, DRR) has been linked to oncological outcomes in several cancers. We aimed to assess the association of DRR with recurrence-free survival (RFS) and progression-free survival (PFS) in patients with non-muscle-invasive bladder cancer (NMIBC).Methods We conducted a retrospe...

Context The question of the ability of frozen section analysis (FSA) to accurately detect malignant pathology intraoperatively has been discussed for many decades. Objective We aimed to conduct a systematic review and meta-analysis assessing the diagnostic estimates of FSA of the urethral and ureteral margins in patients treated with radical cyste...

Objectives: To compare sedoanalgesia achieved using propofol-fentanyl-ketamine(PFK) combination with general anesthesia (GA) in terms of safety, hemodynamic stability, and perioperative complications. Methods: Patients in the GA group were anesthetized using fentanyl (2 μg kg-1) and propofol (2 mg kg-1). The PFK group was anesthetized using a mixtu...

To evaluate oncological outcomes of primary versus secondary muscle-invasive bladder cancer treated with radical cystectomy. Medline, Embase, Scopus and Cochrane Library were searched for eligible studies. Hazard ratios for overall survival (OS), cancer specific survival (CSS) and progression free survival (PFS) were calculated using survival data...

Purpose of review: Conventional transurethral resection (TURBT) with tumor fragmentation is the primary step in the surgical treatment of nonmuscle invasive bladder cancer. Recently, new surgical techniques and training modalities have emerged with the aim to overcome short-comings of TURBT and improve oncologic outcomes. In this review, we provid...

Background Several groups have proposed features to identify low-risk patients who may benefit from endoscopic kidney-sparing surgery in upper tract urothelial carcinoma (UTUC). Objective To evaluate standard risk stratification features, develop an optimal model to identify ≥pT2/N+ stage at radical nephroureterectomy (RNU), and compare it with th...

Background Among various clinicopathologic factors used to identify low-risk upper tract urothelial carcinoma (UTUC), tumor grade and stage are of utmost importance. The clinical value added by inclusion of other risk factors remains unproven. Objective To assess the performance of a tumor grade- and stage-based (GS) model to identify patients wit...

Objectives To determine the predictive and prognostic value of a panel of systemic inflammatory response (SIR) biomarkers relative to established clinicopathological variables in order to improve patient selection and facilitate more efficient delivery of peri‐operative systemic therapy. Materials and Methods The preoperative serum levels of a pan...

Background COVID-19 has an inevitable burden on public health, potentially widening the gender gap in healthcare and the economy. We aimed to assess gender-based desparities during COVID-19 in Jordan in terms of health indices, mental well-being and economic burden. Methods A nationally representative sample of 1300 participants ≥18 years living i...

Purpose The present systematic review aimed to identify prognostic values of blood-based biomarkers in patients treated with neoadjuvant chemotherapy (NAC) for urothelial carcinoma of the bladder (UCB). Material and Methods The PubMed, Web of Science, and Scopus databases were searched in August 2020 according to the PRISMA statement. Studies were...

Purpose of review: To systematically review the most recent evidence on the role of surgery in patients with urothelial carcinoma of bladder and lymph node metastasis. Recent findings: Patients with urothelial carcinoma of bladder and lymph node metastasis have a poor prognosis. The mainstay treatment for these patients is systemic chemotherapy....

Purpose: To assess the diagnostic performance of urine telomerase activity (TA) in detecting bladder cancer (BCa) using the modified Telomeric Repeat Amplification Protocol (TRAP) and the Real Time Telomeric Repeat Amplification Protocol with double Polymerase Chain Reaction (RT-TRAP-2PCR). Methods: In this case-control study, matching urine (in...

Background Women are disproportionally affected by urinary incontinence compared to men. Urinary incontinence results in physical and psychological adverse consequences and impaired quality of life and contributes to significant societal and economic burden. Previous studies reported high urinary incontinence burden in the US. However, the current...

Background The association between total and truncal body fat and kidney stone (KS) remains unclear. Objective To evaluate the association between total and truncal body fat and KS in the US adult population. Design, setting, and participants The National Health and Nutrition Examination Survey (NHANES) comprises a series of nationally representa...

Context Patients with intermediate-risk non–muscle-invasive bladder cancer (NMIBC) may pose a clinical dilemma without an agreed evidence-based decision tree for personalized treatment. Objective To perform a systematic review and network meta-analysis (NMA) to summarize available evidence on the oncologic outcomes of intravesical therapy in patie...

Background The European Association of Urology risk stratification dichotomizes patients with upper tract urothelial carcinoma (UTUC) into two risk categories. Objective To evaluate the predictive value of a new classification to better risk stratify patients eligible for kidney-sparing surgery (KSS). Design, setting, and participants This was a...

Objective: To assess the value of preoperative albumin to globulin ratio for predicting pathologic and oncological outcomes in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy in a large multi-institutional cohort. Materials and methods: Preoperative albumin to globulin ratio was assessed in a multi-institut...