Surgical Specialist, Urologists
29 years of experience

Accepting new patients
Brookdale Hospital Medical Center
1 Brookdale Plz
East Flatbush, Brooklyn, NY 11212
718-240-5071
Locations and availability (15)

Education ?

Medical School
Universidad Central Del Caribe (1981)

Awards & Distinctions ?

Appointments
Suny Health Science Center At Brooklyn College Of Medicine, Brooklyn, Ny (1989 - Present)
Suny Downstate Medical Center College Of Medicine, Brooklyn, Ny (1989 - Present)
Associations
American Urological Association
Member
American Urological Association (urologyhealth.org)
Member

Affiliations ?

Dr. Gulmi is affiliated with 12 hospitals.

Hospital Affilations

Score

Rankings

  • NewYork-Presbyterian / Weill Cornell
    Urology
    525 E 68th St, New York, NY 10065
    • Currently 4 of 4 crosses
    Top 25%
  • New York Presbyterian Hospital / Columbia
    Urology
    630 W 168th St, New York, NY 10032
    • Currently 4 of 4 crosses
    Top 25%
  • Brookdale Hospital Medical Center
    1 Brookdale Plz, Brooklyn, NY 11212
    • Currently 2 of 4 crosses
  • Brooklyn Hospital Center/Downtown Campus
    121 Dekalb Ave, Brooklyn, NY 11201
    • Currently 2 of 4 crosses
  • University Hospital of Brooklyn at Long Island Hospital
    Urology
    340 Henry St, Brooklyn, NY 11201
    • Currently 2 of 4 crosses
  • Beth Israel Medical Center - Kings Highway Division
    Urology
    3201 Kings Hwy, Brooklyn, NY 11234
    • Currently 1 of 4 crosses
  • Suny Downstate Mc at Lich
  • Nyp-Weill Cornell
  • Jamaica Hospital
  • Brookdale Hospital
  • New York Presbyterian HospitalNew York Weill Cornell Center
  • Lich
  • Publications & Research

    Dr. Gulmi has contributed to 20 publications.
    Title Atorvastatin Protects Renal Function in the Rat with Acute Unilateral Ureteral Obstruction.
    Date May 2010
    Journal Urology
    Excerpt

    To examine the effects of atorvastatin on renal hemodynamics and urinary microalbumin levels in rats with acute unilateral ureteral obstruction (UUO). Previous studies have demonstrated that treatment with statins attenuated renal structural damages in rodents with chronic UUO. However, it is not known whether statins afford protection of renal function.

    Title Cutaneous Bcg of the Penis After Intravesical Therapy for Bladder Cancer: a Case Report in a 66-year-old Male.
    Date November 2009
    Journal The Canadian Journal of Urology
    Excerpt

    Transitional cell carcinoma of the bladder is commonly treated with intravesical BCG. We report a cutaneous complication of BCG after therapy in 66-year-old male 4 years after initiating treatment.

    Title Atorvastatin Ameliorates Tubulointerstitial Fibrosis and Protects Renal Function in Chronic Partial Ureteral Obstruction Cases.
    Date October 2009
    Journal The Journal of Urology
    Excerpt

    Tubulointerstitial fibrosis, the histological feature of chronic obstructive nephropathy, is delineated in complete unilateral ureteral obstruction models. Histological changes during chronic partial ureteral obstruction are not well studied. We describe changes in a rat model of partial ureteral obstruction. We examined the effects of atorvastatin on histological alterations, fibrosis and function in this model.

    Title Multi-drug-resistant Bacteremia After Transrectal Ultrasound Guided Prostate Biopsies in Hospital Employees and Their Relatives.
    Date August 2008
    Journal Urology
    Excerpt

    OBJECTIVES: To evaluate the incidence of multi-drug-resistant (MDR) organisms causing bacteremia in hospital employees and their relatives after transrectal ultrasound (TRUS) guided prostate biopsies. METHODS: We retrospectively reviewed all TRUS-guided prostate biopsies between November 2006 and November 2007. Of the 378 patients, we identified 4 cases of post-procedure bacteremia requiring hospital admission. All 4 of these patients had MDR organisms causing bacteremia. These patients were then contacted to determine whether they or their relatives were hospital employees. RESULTS: We identified 4 patients among a total of 378 who developed MDR bacteremia after TRUS prostate biopsy (1.06%). Three of these patients or their relatives were hospital employees (75%). All 3 of these patients had bacteremia caused by Escherichia coli that was resistant to ciprofloxacin and levofloxacin, the perioperative antibiotic given. CONCLUSIONS: In addition to the standard TRUS biopsy preoperative questions it is beneficial to ask patients whether they are hospital employees or live in the same household as hospital employees. This way, if patients return postoperatively with fever and chills, there is a higher index of suspicion that bacteremia may be caused by MDR organisms and empiric broad spectrum parenteral antibiotics can be started immediately.

    Title Atorvastatin Preserves Renal Function in Chronic Complete Unilateral Ureteral Obstruction.
    Date February 2007
    Journal The Journal of Urology
    Excerpt

    The pleiotropic effects of hMG-CoA (3-hydroxy-3-metylglutaryl coenzyme A) reductase inhibitors may provide renal protection in chronic kidney disease. We examined whether atorvastatin administration preserved renal function in rats with chronic unilateral ureteral obstruction.

    Title Renal Responses to Atrial Natriuretic Peptide Are Preserved in Bilateral Ureteral Obstruction and Augmented by Neutral Endopeptidase Inhibition.
    Date March 2005
    Journal The Journal of Urology
    Excerpt

    Atrial natriuretic peptide (ANP) contributes to post-obstructive diuresis in bilateral ureteral obstruction (BUO). In this study we examined the activity of neutral endopeptidase (NEP), an enzyme responsible for degradation of ANP, in the kidney in rats subjected to BUO for 24 hours.

    Title Alterations of Renal Hemodynamics in Unilateral Ureteral Obstruction Mediated by Activation of Endothelin Receptor Subtypes.
    Date November 2003
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Unilateral ureteral obstruction (UUO) for 21 hours causes severe renal vasoconstriction. We examined the role of endothelin (ET)-A receptor in renal hemodynamic alterations induced by UUO. MATERIALS AND METHODS: Hemodynamic and clearance experiments were performed in 3 groups of anesthetized dogs. In group 1, 6 sham operated dogs received intrarenal infusion of the specific ET-A receptor antagonist BQ-610 (Peninsula Laboratories, Inc., Belmont, California), followed by infusion of the nitric oxide synthase substrate L-arginine. In the 7 group 2 dogs release of 21-hour UUO was followed by intrarenal infusion of BQ-610 and L-arginine. In the 5 group 3 dogs release of 21-hour UUO was followed by L-arginine infusion. RESULTS: UUO caused marked decreases in renal blood flow (RBF) and glomerular filtration rate (GFR) in groups 2 and 3 compared with group 1. In group 1 BQ-610 and L-arginine infusion did not alter RBF or GFR. In contrast, BQ-610 infusion in group 2 after UUO release led to a significant increase in RBF and GFR as well as additional increases after L-arginine infusion. After UUO release in group 3 L-arginine infusion alone did not change RBF or GFR. CONCLUSIONS: After UUO release blockade of the ET-A receptor ameliorates renal vasoconstriction. The addition of L-arginine, which is a substrate for nitric oxide synthase, superimposed on ET-A receptor blockade confers a further decrease in renal vascular resistance, suggesting that the ET and L-arginine-nitric oxide systems are involved in renal hemodynamic alterations caused by UUO.

    Title Pharmacological Characterization of Isolated Human Prostate.
    Date September 2003
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Human prostate contains alpha-1 adrenergic, cholinergic and nonadrenergic noncholinergic neuroreceptors. Using agonistic and antagonistic agents at these neuroreceptors we studied the resultant contractile responses in isolated human prostate. MATERIALS AND METHODS: Human prostate tissue was obtained at prostatectomy for benign prostatic hyperplasia in 37 adult male patients. Tissues were suspended in tissue bath chambers connected to force displacement transducers. Specimens were subjected to agonist induced contractions, the first always being norepinephrine (NE). Specimens were pretreated with antagonist (adrenergic, cholinergic, nonadrenergic noncholinergic or none if control), followed by contraction with a second agonist (NE or other). Contractile tensions were recorded on a polygraph and then statistically analyzed. RESULTS: The order of highest to lowest agonist induced tensile forces was NE, dopamine, acetylcholine, bethanechol, histamine and serotonin. Excitatory concentration EC(50) values were determined for each agonist tested. Significant differences were found between specific alpha-1 adrenergic receptor blockers (terazosin, prazosin and the experimental drug LY253352). In addition, many other agents antagonized the alpha-1 adrenergic receptor. Inhibitory concentration IC(50) values were obtained and the order of alpha-1 adrenergic antagonistic strengths from strongest to weakest was LY253352, prazosin, terazosin, ketanserin, SCH23390, diphenhydramine, DO710, dopamine, serotonin and histamine. CONCLUSIONS: Human prostate neuroreceptors were determined to be alpha-1 adrenergic, dopaminergic, muscarinic cholinergic, 2A serotonergic and H1 histaminergic. Dopamine, serotonin, histamine and their antagonists blocked the adrenergic response, indicating possible receptor-receptor interaction. Further study of the pharmacology of human prostate would likely identify new drugs for treating patients with bladder outlet obstruction due to benign prostatic hyperplasia.

    Title Activation of Endothelium-derived Relaxing Factor System in Acute Unilateral Ureteral Obstruction.
    Date October 1998
    Journal The Journal of Urology
    Excerpt

    To investigate the effects of 1-arginine, a substrate for nitric oxide (NO) synthase, on renal hemodynamics in acute ureteral obstruction (UUO).

    Title Contribution of Endothelin-1 to Renal Vasoconstriction in Unilateral Ureteral Obstruction: Reversal by Verapamil.
    Date October 1998
    Journal The Journal of Urology
    Excerpt

    In unilateral ureteral obstruction (UUO) vasoconstriction occurs both during and after release of UUO. ET-1, an endogenous peptide, causes marked vasoconstriction mediated by an increase in cytosolic calcium. We measured renal output of endothelin-1 (ET-1) in dogs with UUO and examined if the renal vasoconstriction that persisted after release of UUO could be reversed by a calcium antagonist, verapamil.

    Title Renal Actions of Endothelin-1 Under Endothelin Receptor Blockade by Be-18257b.
    Date July 1998
    Journal The Journal of Urology
    Excerpt

    Endothelin-1 (ET-1), a peptide produced by the vascular endothelium, causes profound renal vasoconstriction by binding to ET-A receptors. The present study examined the renal actions of ET-1 after ET-A receptors were blocked by BE-18257B to unmask the functions of ET-B receptors.

    Title Renal Hemodynamics in Acute Unilateral Ureteral Obstruction: Contribution of Endothelium-derived Relaxing Factor.
    Date June 1995
    Journal The Journal of Urology
    Excerpt

    The increase in ureteral pressure after acute unilateral ureteral obstruction (UUO) is associated with an initial increase in renal blood flow (RBF). The present study examines the role of nitric oxide, a major endothelium-derived relaxing factor (EDRF), in UUO-induced renal hyperemia in anesthetized dogs. In Group 1, vehicle solution was infused into the left renal artery. In Group 2, nitric oxide formation from L-arginine was competitively inhibited by intrarenal infusion of N omega-monomethyl-L-arginine (L-NMMA) (50 micrograms/kg./min.) before UUO. In Group 3, L-arginine (2 mg./kg./min.) was infused together with L-NMMA (50 micrograms/kg./min.) into the renal artery. After UUO, ureteral pressure increased in all groups, averaging 69 mm.Hg. In Group 1, RBF at 10 and 20 minutes after UUO increased 7.9 +/- 1.6% and 16.5 +/- 5.2%, respectively, significantly greater than in Group 2 (1.2 +/- 1.6% and 2.4 +/- 1.5%). After L-NMMA was discontinued in Group 2, RBF increased 17%, reaching a level similar to that in Group 1. In Group 3, L-arginine infusion abolished the effects of L-NMMA, and RBF was similar to that in Group 1 at all postobstructive intervals. Our data indicate that release of nitric oxide in the kidney is augmented by UUO and mediates the early renal hyperemia induced by UUO.

    Title Volume Expansion Enhances the Recovery of Renal Function and Prolongs the Diuresis and Natriuresis After Release of Bilateral Ureteral Obstruction: a Possible Role for Atrial Natriuretic Peptide.
    Date March 1995
    Journal The Journal of Urology
    Excerpt

    Plasma atrial natriuretic peptide (ANP) levels are elevated in patients with bilateral ureteral obstruction (BUO). To further evaluate the role of ANP in postobstructive diuresis, natriuresis and recovery of renal function, 3 groups of dogs were studied: Group 1, 6 dogs that underwent 48 hours of unilateral ureteral obstruction (UUO); Group 2, 6 dogs that underwent 48 hours of BUO; and Group 3, 6 dogs volume replete with normal saline during 48 hours of BUO. All 3 groups underwent hourly hemodynamic and clearance studies for 15 hours after the release of obstruction. Group 1 experienced no increase in either urine output or sodium excretion from the ipsilateral or contralateral kidney after release of obstruction. Groups 2 and 3 both experienced an initial diuresis and natriuresis after BUO (p < 0.01). However, in Group 2 diuresis and natriuresis after BUO ceased at 5 and 2 hours, respectively, while in Group 3 both persisted for 10 and 9 hours, respectively. Before obstruction the GFR was similar in all three groups. In Group 1 the GFR decreased significantly in the ipsilateral kidney (34.5 +/- 1.4 to 14.48 +/- 1.5 ml. per minute, (p < 0.01)) and increased significantly in the contralateral kidney (32.4 +/- 2.8 to 44.4 +/- 2.0 ml. per minute, (p < 0.05)) and remained so throughout the postobstruction period. The GFR in Groups 2 and 3 decreased to a similar level 1 hour after release (13.3 +/- 1.7 and 17.5 +/- 3.4 ml. per minute, respectively); however, Group 2 remained decreased during the period after release while group 3 increased to 23.4 +/- 3.4 ml. per minute (p < 0.01) at 11 hours after release of obstruction. In Group 2 the control plasma ANP level was 17.9 +/- 3.7 pg./ml. and was not altered by BUO, whereas ANP increased significantly after 48 hour BUO in Group 3, from 30.6 +/- 6.7 to 63.7 +/- 11.7 pg./ml. (p < 0.01). Before and after 48 hours of BUO, the pulmonary capillary wedge pressure was 5.0 +/- 2.0 mm. Hg and 7.0 +/- 1.0 mm. Hg (NS) in Group 2, while it increased from 7.18 +/- 1.5 mm. Hg to 11.6 +/- 1.9 mm. Hg (p < 0.01) in Group 3. We conclude that volume expansion during BUO enhances postobstructive diuresis and natriuresis and allows a greater recovery of GFR after release of the obstruction. This effect may be mediated through elevated plasma levels of ANP as measured in this study.

    Title The Renal Hemodynamic Response to Endothelin in Chronic Cyclosporine-treated Dogs.
    Date April 1993
    Journal The Journal of Urology
    Excerpt

    Use of the immunosuppressive agent cyclosporine A (CyA) is limited by its associated nephrotoxicity, characterized by an increase in renal vascular resistance (RVR) and reductions in renal blood flow (RBF) and glomerular filtration rate (GFR). The vascular endothelium produces vasoactive substances including endothelium derived relaxation factor (EDRF) and endothelin (ET), which modulate vascular tone. Since CyA has been shown to damage the endothelium, we examined the renal hemodynamic response to intrarenal ET infusion (4 micrograms./kg./minute) in chronic cyclosporine-treated dogs. Prior to ET infusion, CyA-treated dogs had a lower RBF and a greater RVR than normal dogs. In normal dogs, after ET infusion RVR increased from 30.24 +/- 0.64 to 44.60 +/- 1.66 mmHg./ml./minute (p < 0.001), RBF decreased from 4.26 +/- 0.28 to 2.90 +/- 0.30 ml./min./g. (p < 0.001) and GFR decreased from 50.20 +/- 5.90 to 36.50 +/- 7.90 ml. per minute (p < 0.001). In contrast, there was no change in RBF, GFR and RVR after intrarenal ET infusion in CyA-treated dogs. Prior to ET infusion, arterial plasma ET concentration was 5.0 +/- 1.1 pg./ml. in CyA-treated dogs, similar to 7.5 +/- 1.4 pg./ml. in normal dogs, and was not significantly altered in either group after intrarenal ET infusion. We conclude that ET may not contribute to the increased RVR in chronic cyclosporine nephrotoxicity, and suggest a vascular toxicity of CyA, rendering renal vessels unresponsive to the vasoconstrictive effect of ET.

    Title Effect of Neuropeptide-y and Bradykinin on the Smooth Muscle Contraction of Human Prostate Adenoma: an in Vitro Study.
    Date February 1991
    Journal Proceedings of the Western Pharmacology Society
    Title Comparative Alpha-adrenergic Receptor Activity in Isolated Human Prostate Obtained by Open and Transurethral Prostatectomy.
    Date February 1991
    Journal Proceedings of the Western Pharmacology Society
    Title Atrial Natriuretic Peptide in Patients with Obstructive Uropathy.
    Date August 1989
    Journal The Journal of Urology
    Excerpt

    Renal response to release of bilateral ureteral obstruction resembles that to intravenous administration of atrial natriuretic peptide. In a prospective study we measured plasma atrial natriuretic peptide levels before and serially after relief of obstruction in 9 patients (mean age 65 +/- 2 years old) with bilateral ureteral obstruction and azotemia. Obstruction was documented by renal ultrasonography. Before relief of obstruction blood urea nitrogen and serum creatinine levels were 85 +/- 18 (mean +/- standard error) and 8.2 +/- 1.3 mg. per dl., respectively, accompanied by metabolic acidosis but not hyperkalemia. Mean plasma atrial natriuretic peptide (measured by radioimmunoassay) was 129 +/- 28, which was markedly elevated compared to 46 +/- 7 pg. per ml. in 7 age-matched control subjects (p less than 0.01). After relief of obstruction, prominent post-obstructive diuresis and natriuresis ensued; the plasma atrial natriuretic peptide level progressively decreased to that noted in the control group, accompanied by improvement in renal function, and diminishing diuresis and natriuresis. These findings were associated with a significant weight loss and an increase in plasma renin activity (from a mean of 1.57 +/- 0.68 to 5.27 +/- 1.82 ng. per ml. per hour, p less than 0.01). These results suggest that atrial natriuretic peptide release is augmented in patients with bilateral ureteral obstruction and azotemia, probably due to hypervolemia, and may contribute to post-obstructive diuresis and natriuresis.

    Title Primary Localized Amyloidosis of Ureter.
    Date September 1988
    Journal Urology
    Excerpt

    Primary localized amyloidosis of the ureter is very rare, and only 22 cases have been reported in the world literature. We report the twenty-third case along with a review of the relevant literature. Due to its radiologic resemblance to malignancy, many cases were treated by nephroureterectomy in the past. The case being reported here was successfully treated by local excision and ureteroneocystostomy.

    Title Penile Fracture: Preoperative Evaluation and Surgical Technique for Optimal Patient Outcome.
    Date
    Journal Bju International
    Excerpt

    OBJECTIVE: To review the preoperative diagnostic evaluation and surgical treatment of penile fracture, as the condition is a urological emergency that requires immediate surgical exploration and repair. PATIENTS AND METHODS: Between January 2003 and October 2007 eight patients presented to the emergency department with penile fracture after sexual intercourse. The clinical presentation, preoperative evaluation and imaging, surgical technique, and postoperative care were assessed to determine the optimal patient outcome. RESULTS: Seven of the eight patients were treated surgically and one refused surgical intervention. Four cases involved unilateral corporal injury, two involved unilateral corporal injury with an associated urethral injury, and one involved bilateral corporal injury with an associated urethral injury. Although retrograde urethrogram were taken of all three urethral injuries, none of them revealed the injury. Diagnostic cavernosography or magnetic resonance imaging were not used in any of the patients. No complications occurred in the patients treated surgically. CONCLUSIONS: Preoperative imaging should not delay surgical repair. If an associated urethral injury is suspected, flexible cystoscopy is recommended in the operating room, as opposed to a retrograde urethrogram. A subcoronal circumcising incision is recommended to deglove the entire penile shaft and have complete access to all three corporal bodies, as well as the neurovascular bundle. Saline mixed with indigo carmine can be injected both into the corpora cavernosum or corpus spongiosum via the glans penis, after a tourniquet is placed at the base of the penis, to evaluate the surgical repair and to determine if there are any missed injuries.

    Title Transitional Cell Carcinoma of the Bladder Manifestating As Malignant Lymphoma with Generalized Lymphadenopathy.
    Date
    Journal Case Reports in Oncology
    Excerpt

    Bladder cancer usually spreads via the lymphatic and hematogenous routes, the most common sites of metastases of urinary bladder cancers being the regional lymph nodes, liver, lung, bone, peritoneum, pleura, kidney, adrenal gland and intestines. Generalized lymph node metastasis of transitional cell cancer of the bladder is extremely rare. According to our literature search, there has been no case report of transitional cell cancer of the bladder that manifests as an extensive large lymph node metastasis involving the intraparotid, supraclavicular thoracic inlet, axillary and regional abdominal and pelvic lymph nodes without bone or visceral organs involved. Such a presentation could be mistaken as malignant lymphoma and the importance of a biopsy of the lymph nodes is emphasized. The clinical course of rapid progression of the disease and the presence of wild-type p53 with rapid response to chemotherapy and a short remission may represent a unique case, which is discussed here.

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