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Gomes CM, Hisano M, Souza JD, Henriques JVT, de Bessa J, Moromizato J, Bosi T, Mazoni R, Gismondi J, Camargo B, Sammour ZM, Bruschini H, Battistella LR, Nahas WC. Lower Urinary Tract Symptoms in a prospective cohort of COVID-19 survivors. Int Braz J Urol 2024; 50:287-295. [PMID: 38498685 DOI: 10.1590/s1677-5538.ibju.2023.0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/07/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE To analyze the prevalence of lower urinary tract symptoms (LUTS) in patients who survived moderate and severe forms of COVID-19 and the risk factors for LUTS six months after hospitalization. MATERIALS AND METHODS In this prospective cohort study, patients were evaluated six months after hospitalization due to COVID-19. LUTS were assessed using the International Prostate Symptom Score. General health was assessed through the Hospital Anxiety and Depression Scale and the EQ5D-L5 scale, which evaluates mobility, ability to perform daily activities, pain and discomfort and completed a self-perception health evaluation. RESULTS Of 255 participants, 54.1% were men and the median age was 57.3 [44.3 - 66.6] years. Pre-existing comorbidities included diabetes (35.7%), hypertension (54.5%), obesity (30.2%) and physical inactivity (65.5%). One hundred and twenty-four patients (48.6%) had a hospital stay >15 days, 181 (71.0%) were admitted to an ICU and 124 (48.6%) needed mechanical ventilation. Median IPSS was 6 [3-11] and did not differ between genders. Moderate to severe LUTS affected 108 (42.4%) patients (40.6% men and 44.4% women; p=0.610). Nocturia (58.4%) and frequency (45.9%) were the most prevalent symptoms and urgency was the only symptom that affected men (29.0%) and women (44.4%) differently (p=0.013). LUTS impacted the quality of life of 60 (23.5%) patients with women more severely affected (p=0.004). Diabetes, hypertension, and self-perception of worse general health were associated with LUTS. CONCLUSIONS LUTS are highly prevalent and bothersome six months after hospitalization due to COVID-19. Assessment of LUTS may help ensure appropriate diagnosis and treatment in these patients.
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Affiliation(s)
- Cristiano M Gomes
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Marcelo Hisano
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Julia D Souza
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | | | - Jose de Bessa
- Departamento de Cirurgia, Universidade Estadual de Feira de Santana, Bahia, Brasil
| | - Julyana Moromizato
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Thulio Bosi
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Rachel Mazoni
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - João Gismondi
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Bruno Camargo
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Zein M Sammour
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Homero Bruschini
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Linamara R Battistella
- Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - William C Nahas
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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Braga AVNM, Nunes NC, Santos EN, Veiga ML, Braga AANM, de Abreu GE, de Bessa J, Braga LH, Kirsch AJ, Barroso U. Use of ChatGPT in Urology and its Relevance in Clinical Practice: Is it useful? Int Braz J Urol 2024; 50:192-198. [PMID: 38386789 PMCID: PMC10953603 DOI: 10.1590/s1677-5538.ibju.2023.0570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/30/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOUSE One of the many artificial intelligence based tools that has gained popularity is the Chat-Generative Pre-Trained Transformer (ChatGPT). Due to its popularity, incorrect information provided by ChatGPT will have an impact on patient misinformation. Furthermore, it may cause misconduct as ChatGPT can mislead physicians on the decision-making pathway. Therefore, the aim of this study is to evaluate the accuracy and reproducibility of ChatGPT answers regarding urological diagnoses. MATERIALS AND METHODS ChatGPT 3.5 version was used. The questions asked for the program involved Primary Megaureter (pMU), Enuresis and Vesicoureteral Reflux (VUR). There were three queries for each topic. The queries were inserted twice, and both responses were recorded to examine the reproducibility of ChatGPT's answers. Afterwards, both answers were combined. Finally, those rwere evaluated qualitatively by a board of three specialists. A descriptive analysis was performed. RESULTS AND CONCLUSION ChatGPT simulated general knowledge on the researched topics. Regarding Enuresis, the provided definition was partially correct, as the generic response allowed for misinterpretation. For VUR, the response was considered appropriate. For pMU it was partially correct, lacking essential aspects of its definition such as the diameter of the dilatation of the ureter. Unnecessary exams were suggested, for Enuresis and pMU. Regarding the treatment of the conditions mentioned, it specified treatments for Enuresis that are ineffective, such as bladder training. Therefore, ChatGPT responses present a combination of accurate information, but also incomplete, ambiguous and, occasionally, misleading details.
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Affiliation(s)
| | - Noel Charlles Nunes
- Centro de Distúrbios Urinários Infantis (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Emanoel Nascimento Santos
- Centro de Distúrbios Urinários Infantis (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Maria Luiza Veiga
- Centro de Distúrbios Urinários Infantis (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | | | - Glicia Estevam de Abreu
- Centro de Distúrbios Urinários Infantis (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Jose de Bessa
- Faculdade de Medicina, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | | | - Andrew J Kirsch
- Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States
| | - Ubirajara Barroso
- Centro de Distúrbios Urinários Infantis (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
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Gomes CM, Marchini G, de Bessa J, Carvalhal G, Caldeira MPR, Saldiva PH, Krieger JE, Agena F, Reis S, Paschoal C, Froes M, Srougi M, Nahas WC, Favorito LA. The landscape of biomedical research funding in Brazil: a current overview. Int Braz J Urol 2024; 50:209-222. [PMID: 38386791 PMCID: PMC10953608 DOI: 10.1590/s1677-5538.ibju.2024.9905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE The objective of this narrative review is to discuss the current state of research funding in Brazil. MATERIALS AND METHODS This study is based on the most recent edition of the course Funding for Research and Innovation in the University of Sao Paulo School of Medicine which was a three-day course with 12 hours of instruction. The course brought together leading experts in the field to comprehensively discuss the current state of research funding in Brazil. Each speaker provided a presentation on a specific topic related to research funding. After the workshop, speakers assembled relevant topics in this manuscript. RESULTS collaborative research is critical for securing research funding. It optimizes proposal competitiveness, amplifies societal impact, and manages risks effectively. As such, fostering and supporting these collaborations is paramount for both researchers and funding agencies. To maintain the highest integrity in research, investigators involved in these collaborations must disclose any relationships that could potentially influence the outcomes or interpretation of their projects. CONCLUSIONS In Brazil, the mainstay of research funding stems from public entities, with agencies such as CNPq, CAPES, and state bodies like FAPESP, FAPERJ, FAPEMIG and others at the forefront. Concurrently, industry funding offers viable pathways, especially through industry-sponsored studies, investigator-led projects, and collaborative initiatives. The Brazilian funding landscape is further enriched by innovative platforms, including crowdfunding and the contributions of institutions like the Serrapilheira Institute. Internationally, esteemed organizations such as the National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation stand out as potential funders.
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Affiliation(s)
- Cristiano M. Gomes
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Giovanni Marchini
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Jose de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de CirurgiaFeira de SantanaBABrasilDepartamento de Cirurgia, Universidade Estadual de Feira de Santana - UEFS, Feira de Santana, BA, Brasil;
| | - Gustavo Carvalhal
- Pontificia Universidade Catolica do Rio Grande do SulPorto AlegreRSBrasilPontificia Universidade Catolica do Rio Grande do Sul – PUC RS, Porto Alegre, RS, Brasil;
| | - Marina P. R. Caldeira
- Universidade de São PauloFaculdade de MedicinaUnidade de Apoio à Pesquisa e InovaçãoSão PauloSPBrasilUnidade de Apoio à Pesquisa e Inovação, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Paulo Hilario Saldiva
- Universidade de São PauloFaculdade de MedicinaDepartamento de PatologiaSão PauloSPBrasilDepartamento de Patologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Jose Eduardo Krieger
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil.
| | - Fabiana Agena
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Sabrina Reis
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Candice Paschoal
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Milena Froes
- Universidade de São PauloEscola de EnfermagemSão PauloSPBrasilEscola de Enfermagem da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - Miguel Srougi
- Instituto D'Or de Pesquisa e EnsinoSão PauloSPBrasilInstituto D'Or de Pesquisa e Ensino, São Paulo, SP, Brasil;
| | - William C. Nahas
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Luciano A. Favorito
- Universidade Estadual do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital – Universidade Estadual do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil
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Fornari A, Toledo LGM, Canalini AF, Brandão TBV, Anzolch KMJ, Fernandes RDC, de Bessa J, Gomes CM. Impact of COVID-19 on surgical procedures for stress urinary incontinence in the Brazilian public health system. Int Urogynecol J 2023; 34:1949-1954. [PMID: 36811634 PMCID: PMC9944800 DOI: 10.1007/s00192-023-05475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/11/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to characterize the impact of the COVID-19 pandemic on the surgical treatment of female stress urinary incontinence (FSUI) in Brazil. METHODS This study was conducted with population-based data from the Brazilian public health system database. We obtained data on the number of surgical procedures for FSUI in 2019 (before the coronavirus disease [COVID-19] pandemic), 2020, and 2021 (during the pandemic) in each of the 27 Brazilian states. We included official Brazilian Institute of Geography and Statistics (IBGE) data on the population, Human Development Index (HDI), and annual per capita income of each state. RESULTS A total of 6,718 surgical procedures for FSUI were performed in the Brazilian public health system in 2019. The number of procedures was reduced by 56.2% in 2020, and an additional reduction of 7.2% was seen in 2021. The distribution of procedures by state showed important differences, ranging from 4.4 procedures/1,000,000 inhabitants in Paraíba and Sergipe to 67.6 procedures/1,000,000 inhabitants in Paraná (p<0.01) in 2019. The number of surgical procedures was higher in states with a higher HDI (p=0.0001) and per capita income (p=0.042). The decrease in the number of surgical procedures affected the whole country and its rate did not correlate with HDI (p=0.289) or per capita income (p=0.598). CONCLUSION The impact of the COVID-19 pandemic on the surgical treatment of FSUI in Brazil was significant in 2020 and persisted in 2021. Access to surgical treatment of FSUI varied according to geographic region, HDI, and per capita income, even before COVID-19.
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Affiliation(s)
- Alexandre Fornari
- Division of Urology, Santa Casa de Porto Alegre, Porto Alegre, Brazil.
- Division of Urology, Hospital Moinhos de Vento, Rua General Vitorino, 330/1101, Porto Alegre, RS, 90020-170, Brazil.
| | | | | | | | - Karin Marise Jaeger Anzolch
- Division of Urology, Hospital Moinhos de Vento, Rua General Vitorino, 330/1101, Porto Alegre, RS, 90020-170, Brazil
| | | | - Jose de Bessa
- Department of Surgery, State University of Feira de Santana, Feira de Santana, Brazil
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de Paula LIDS, de Oliveira LF, Cruz BP, de Oliveira DM, Miranda LM, de Moraes Ribeiro M, Duque RO, Figueiredo AA, de Bessa J, Netto JMB. Corrigendum to "Parasacral transcutaneous electrical neural stimulation (PTENS) once a week for the treatment of overactive bladder in children: A randomized controlled trialˮ [J Pediatr Urol 13 (2017) 263.e1-236.e6]. J Pediatr Urol 2021; 17:e1. [PMID: 33839035 DOI: 10.1016/j.jpurol.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Brysa Paiva Cruz
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil
| | - Dayana Maria de Oliveira
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil
| | - Laıs Maini Miranda
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil
| | - Mauro de Moraes Ribeiro
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil
| | - Raphaela Ornellas Duque
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil
| | - Andre Avarese Figueiredo
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil
| | - Jose de Bessa
- Division of Urology, Department of Surgery, State University of Feira de Santana (UEFS), BA, Brazil
| | - Jose Murillo B Netto
- Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil; Division of Urology, Department of Surgery, Hospital and Maternity Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de For a (HMTJ/Suprema), MG, Brazil.
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Prezotti JA, Henriques JVT, Favorito LA, Canalini AF, Machado MG, Brandão TBV, Barbosa AMV, Moromizato JKM, Anzolch KMJ, Fernandes RDC, Rodrigues FRA, Bellucci CHS, Silva CS, Pompeo ACL, de Bessa J, Gomes CM. Impact of COVID-19 on education, health and lifestyle behaviour of Brazilian urology residents. Int Braz J Urol 2021; 47:753-776. [PMID: 33848067 PMCID: PMC8321480 DOI: 10.1590/s1677-5538.ibju.2021.99.09] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives: To evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents. Materials and Methods: A web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents’ concerns, and access to personal protective equipment (PPE). Results: Massive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 – 7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifications in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents’ concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues. Conclusions: COVID-19 had a massive impact in Brazilian urology residents´ training, health and lifestyle behavior, which may reflect what happened in other medical specialties. Studies should confirm these findings to help developing strategies to mitigate residents’ losses.
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Affiliation(s)
- José Antonio Prezotti
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - João Victor T Henriques
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Luciano A Favorito
- Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Alfredo F Canalini
- Disciplina de Urologia, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Marcos G Machado
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Thulio B V Brandão
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Akemi M V Barbosa
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Julyana K M Moromizato
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Karin M J Anzolch
- Serviço de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | - Roni de C Fernandes
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | | | - Carlos H S Bellucci
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Caroline S Silva
- Departamento de Cirurgia, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | | | - Jose de Bessa
- Departamento de Cirurgia, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | - Cristiano M Gomes
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
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Tiraboschi RB, Neto FSL, da Cunha Tirapelli DP, de Bessa J, Miranda EP, de Assis Cirino ML, Tirapelli LF, Tucci S, Molina CAF. Expression of MicroRNAs (miR-15b, miR-16, miR-138, miR-221, and miR-222) as Biomarkers of Endothelial Corpus Cavernosum Dysfunction in a Diabetic Alcoholic Murine Model. Sex Med 2021; 9:100326. [PMID: 33676226 PMCID: PMC8072178 DOI: 10.1016/j.esxm.2021.100326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION MicroRNAs (miRNAs) are short noncoding RNA molecules that regulate gene expression and are related to endothelial dysfunction (EnD). Recently, miRNAs have also been explored as potential biomarkers and target molecular therapy of erectile dysfunction (ED). Could the miRNAs be the tip of the iceberg of chronic arterial disease foreshadowed by the ED? AIM To investigate the expression of miR-15b, miR-16, miR-138, miR-221, and miR-222 in corpus cavernosum (CC) and peripheral blood in a rat model of endothelium dysfunction secondary to diabetes (DM) and alcohol consumption to assess potential endothelial lesion biomarkers. METHODS Twenty males Wistar rats were divided into 4 groups: control group (C), alcohol consumption group (A), diabetic group (D), diabetic-alcohol consumption group (D + A). DM was alloxan-induced and alcohol consumption was through progressive increase of ethanol concentration in drinkable water. After 7 weeks, miRNAs expressions from CC and blood sample were evaluated by real-time PCR. Functional assessment of CC was performed in an acetylcholine endothelium-dependent relaxation pharmacological study. MAIN OUTCOME MEASURE miRNA expression in CC and blood were evaluated; pharmacological study in CC strips was conducted to validate EnD. RESULTS We found that 3 miRNAs (miR-16, miR-221, and miR-222) were downregulated in the CC in the D+A group, while all 5 miRNAs were downregulated in the blood of D and D + A groups. The endothelium-dependent relaxation induced by acetylcholine was significantly decreased in groups A, D, and D + A. Diagnostic accuracy estimated by AUC, to discriminating groups A, D, and D + A from controls, was superior to >0.9 in all plasmatic miRNAs. CONCLUSION miRNAs downregulation was identified in both CC and blood notably in DM associated with alcohol consumption animals (D + A), the greatest endothelial injury potential group. Serum miRNAs have also demonstrated high diagnostic accuracy properties in predicting CC relaxation dysfunction labeling EnD. RB Tiraboschi, FSL Neto, DP da Cunha Tirapelli, et al. Expression of MicroRNAs (miR-15b, miR-16, miR-138, miR-221, and miR-222) as Biomarkers of Endothelial Corpus Cavernosum Dysfunction in a Diabetic Alcoholic Murine Model. Sex Med 2021;9:100326.
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Affiliation(s)
- Ricardo Brianezi Tiraboschi
- Department of Surgery, Division of Urology, Universidade Estadual de Feira de Santana, Medical School, State University of Feira de Santana, Feira de Santana, Brazil; Division of Urology, University of São Paulo, Ribeirão Preto Medical School, Surgery and Anatomy, Ribeirao Preto, São Paulo, Brazil
| | | | | | - Jose de Bessa
- Department of Surgery, Division of Urology, Universidade Estadual de Feira de Santana, Medical School, State University of Feira de Santana, Feira de Santana, Brazil
| | | | - Mucio Luiz de Assis Cirino
- University of São Paulo, Ribeirão Preto Medical School, Surgery and Anatomy, Ribeirao Preto, São Paulo, Brazil
| | - Luis Fernando Tirapelli
- University of São Paulo, Ribeirão Preto Medical School, Surgery and Anatomy, Ribeirao Preto, São Paulo, Brazil
| | - Silvio Tucci
- Division of Urology, University of São Paulo, Ribeirão Preto Medical School, Surgery and Anatomy, Ribeirao Preto, São Paulo, Brazil
| | - Carlos Augusto Fernandes Molina
- Division of Urology, University of São Paulo, Ribeirão Preto Medical School, Surgery and Anatomy, Ribeirao Preto, São Paulo, Brazil
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Gomes CM, de Bessa J, Nunes RV, Prezotti J, Bruschini H, Gomes MM. Impact of a 1-day urodynamic course on knowledge, perceptions, and attitudes of urology residents. Neurourol Urodyn 2020; 40:443-450. [PMID: 33205844 DOI: 10.1002/nau.24581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 11/08/2022]
Abstract
AIMS No evidence-informed educational curriculum is available for designing urodynamics (UDS) courses. We evaluated the learning outcomes of a short-lasting urodynamic course for urology residents. METHODS Urology residents of postgraduate years 4 and 5 (n = 13 and n = 1316, respectively) attended a 1-day urodynamic course. Learning objectives included patient preparation, indication and technique, terminology, trace interpretation, and impact on patient management. Instructional methods consisted of short lectures (3 h) and case-based discussions (7.5 h). Learners' reactions, modifications of perceptions and attitudes, and acquisition of knowledge and skills were assessed by three written tests with a single group, pretest, posttest 1, and posttest 2 design. Tests were conducted precourse, 1 week after, and 4 months after the course. RESULTS All participants felt more confident in several urodynamic competencies after the course, including patient preparation, urodynamic indication and technique, terminology, trace interpretation, and impact for patient management. These perceptions remained unchanged after 4 months. Most became stricter in the indication of UDS, including 20 (87.0%) at posttest 1 and 8 (66.7%) at posttest 2. The mean number of correct answers in the knowledge evaluation was 52.2% versus 61.4% versus 56.7%, respectively at pretest, posttest 1, and posttest 2; p = 0.535). All participants rated the course as very useful or useful in both posttest evaluations. CONCLUSIONS Our study demonstrates that a 1-day urodynamic course can promote lasting improvements in self-reported perceptions, attitudes, and urodynamic-related competencies of urology residents. Further studies using evidence-informed educational principles are needed to determine the effect of specific educational interventions on urodynamic competencies in different contexts.
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Affiliation(s)
- Cristiano M Gomes
- Division of Urology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jose de Bessa
- Department of Surgery, State University of Feira de Santana, Feira de Santana, Bahia, Brazil
| | - Ricardo V Nunes
- Clinic of Urology, Military Hospital of Sao Paulo Area, Sao Paulo, Brazil
| | - Jose Prezotti
- Division of Urology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Homero Bruschini
- Division of Urology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcio M Gomes
- Department of Pathology and Laboratory Medicine, Royal College of Physicians and Surgeons of Canada, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
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9
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Welk B, Lenherr S, Elliott S, Stoffel J, Gomes CM, de Bessa J, Cintra LKL, Myers JB. The creation and validation of a short form of the Neurogenic Bladder Symptom Score. Neurourol Urodyn 2020; 39:1162-1169. [PMID: 32196732 DOI: 10.1002/nau.24336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Abstract
AIM To develop a short form (SF) of the 24-item Neurogenic Bladder Symptom Score (NBSS). METHODS We used three previously published datasets. First, we selected the most responsive questions within each of the domains. Internal validity of the NBSS-SF was assessed using Cronbach's α. External validity was assessed by evaluating hypothesized relationships with other questionnaires and testing correlations with the full NBSS domains. Test-retest reliability of the NBSS-SF domains was determined using an intraclass coefficient (ICC). RESULTS Using data from a prior responsiveness study, we selected questions for the NBSS-SF from the incontinence domain (three), storage/voiding domain (three), consequences domain (two); these would make up the NBSS-SF. We used the original NBSS validation cohort of 230 patients with multiple sclerosis (MS), spinal cord injury (SCI), or spina bifida, and found the Cronbach's α was .76 for the NBSS-SF; the external validity was high, with correlations between specific NBSS-SF domains/total scores and the Qualiveen-SF, ICIQ, and AUASS generally similar to those seen with the NBSS. Correlations between the NBSS-SF domains and the full NBSS domains were high. The NBSS-SF ICC in a subset of 120 patients was 0.84. The NBSS-SF performed similarly in two additional independent datasets. CONCLUSIONS The total score of the NBSS-SF has appropriate validity, reliability, and could be used instead of the full NBSS to minimize the assessment burden. The full NBSS may be better suited if the primary focus of the study is on neurogenic bladder symptoms, or if individual NBSS domains are of interest.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Sara Lenherr
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah
| | - Sean Elliott
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - John Stoffel
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cristiano M Gomes
- Department of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Jose de Bessa
- Department of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Lisley K L Cintra
- Department of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Jeremy B Myers
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah
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10
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Nelli ADM, Mrad FCDC, Alvaia MDA, Maia HAADS, Guimarães COS, Carvalho ESDS, Gomes CM, Bastos JM, de Bessa J. Prevalence of enuresis and its impact in quality of life of patients with sickle cell disease. Int Braz J Urol 2019; 45:974-980. [PMID: 31626520 PMCID: PMC6844344 DOI: 10.1590/s1677-5538.ibju.2019.0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease. MATERIALS AND METHODS This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals. RESULTS Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at fi ve years and about 15% of adolescents at 15 years of age. Enuresis was classifi ed as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identifi ed in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a signifi cant impact on the quality of life of 67% of the individuals. CONCLUSION Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life.
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Affiliation(s)
- Alana de Medeiros Nelli
- Departamento de Cirurgia Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | | | - Mateus de Andrade Alvaia
- Departamento de Cirurgia Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | | | | | | | - Cristiano Mendes Gomes
- Programa de Pós-Graduacao em Saude Coeltiva, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - José Murillo Bastos
- Departamento de Cirurgia, Faculdade de Ciencias Medicas e da Saude de Juiz de Fora.,Faculdade de Ciencias Medicas e da Saude de Juiz de Fora, MG, Brasil.,Hospital e Maternidade Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Jose de Bessa
- Departamento de Cirurgia Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil.,Programa de Pós-Graduacao em Saude Coeltiva, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
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11
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Gomes CM, de Bessa J, Bruschini H. Letter to the Editor. Neurourol Urodyn 2019; 38:1184. [PMID: 30859613 DOI: 10.1002/nau.23962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Cristiano M Gomes
- Division of Urology, Medical School, Sao Paulo University, Sao Paulo, SP, Brazil
| | - Jose de Bessa
- Division of Urology, Medical School, Sao Paulo University, Sao Paulo, SP, Brazil.,Department of Surgery, Medical School, State University of Feira de Santana, Feira de Santana, Brazil
| | - Homero Bruschini
- Division of Urology, Medical School, Sao Paulo University, Sao Paulo, SP, Brazil
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12
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Alencar VP, Gomes CM, Miranda EP, dos Santos Lelis MA, Fera P, de Bessa J, Srougi M, Bruschini H. Impact of the route of clean intermittent catheterization on quality of life in children with lower urinary tract dysfunction. Neurourol Urodyn 2018; 37:2833-2840. [DOI: 10.1002/nau.23789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/24/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Valeria P. Alencar
- Division of Urology; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - Cristiano M. Gomes
- Division of Urology; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - Eduardo P. Miranda
- Division of Urology; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | | | - Patrícia Fera
- Division of Urology; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - Jose de Bessa
- Division of Urology; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - Miguel Srougi
- Division of Urology; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - Homero Bruschini
- Division of Urology; University of Sao Paulo School of Medicine; Sao Paulo Brazil
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13
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de Bessa J, Rodrigues CM, Chammas MC, Miranda EP, Gomes CM, Moscardi PR, Bessa MC, Molina CA, Tiraboschi RB, Netto JM, Denes FT. Diagnostic accuracy of Onen's Alternative Grading System combined with Doppler evaluation of ureteral jets as an alternative in the diagnosis of obstructive hydronephrosis in children. PeerJ 2018; 6:e4791. [PMID: 29796345 PMCID: PMC5961622 DOI: 10.7717/peerj.4791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/27/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly leading to varying degrees of hydronephrosis (HN), ranging from no apparent effect on the renal function to atrophy. Evaluation of these children is based on Diuretic Renal Scintigraphy (DRS) and Ultrasonography (US). Recent studies have suggested that new parameters of conventional and color Doppler ultrasonography (CDUS) may be useful in discriminating which kidneys are obstructed. The present study aims to assess the diagnostic accuracy of such parameters in the diagnosis of obstruction in children with UPJO. Methods We evaluated 44 patients (33 boys) with a mean age of 6.53 ± 4.39 years diagnosed with unilateral high-grade hydronephrosis (SFU grades 3 and 4). All underwent DRS and index tests (conventional US and CDUS to evaluate ureteral jets frequency) within a maximum interval of two weeks. Hydronephrotic units were reclassified according to the alternative grading system (AGS) proposed by Onen et al. Obstruction in the DRS was defined as a differential renal function <40% on the affected side and/or features indicating poor drainage function like T1/2 >20 minutes after the administration of furosemide, and a plateau or ascending pattern of the excretion curve. Results Nineteen hydronephrotic units (43.1%) were obstructed. Some degree of cortical atrophy—grades 3 (segmental) or 4 (diffuse)—was present in those obstructed units. AGS grades had 100% sensitivity, 76% of specificity and 86.4% of accuracy. The absence of ureteral jets had a sensitivity of 73.68%, a specificity of 100% with an accuracy of 88.6%. When we analyzed the two aspects together and considered obstructed the renal units classified as AGS grade 3 or 4 with no jets, sensitivity increased to 78.9%, accuracy to 92%, remaining with a maximum specificity of 100%. These features combined would allow us to avoid performing DRS in 61% of our patients, leaving more invasive tests to inconclusive cases. Conclusions Although DRS remains the mainstay to distinguishing obstructive from non-obstructive kidneys, grade of hydronephrosis and frequency of ureteral jets, independently or in combination may be a reliable alternative in the mostly cases.This alternative approach has high accuracy, it is less invasive, easily reproducible and may play a role in the diagnosis of obstruction in pediatric population.
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Affiliation(s)
- Jose de Bessa
- Division of Urology/Public Health, Medical School, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil
| | - Cicilia M Rodrigues
- Division of Urology/Public Health, Medical School, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil
| | - Maria Cristina Chammas
- Department of Radiology, Medical School, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo P Miranda
- Division of Urology, Medical School, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Cristiano M Gomes
- Division of Urology, Medical School, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo R Moscardi
- Division of Urology, Medical School, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcia C Bessa
- Division of Pediatrics, Medical School, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil
| | - Carlos A Molina
- Division of Urology/Public Health, Medical School, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil
| | - Ricardo B Tiraboschi
- Division of Urology/Public Health, Medical School, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil
| | - Jose M Netto
- Division of Urology, Hospital e Maternidade Therezinha de Jesus of the School of Medical Science and Health of Juiz de Fora (HMTJ-SUPREMA), Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Francisco T Denes
- Division of Urology, Medical School, Universidade de São Paulo, São Paulo, SP, Brazil
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14
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Srougi V, de Bessa J, Tanno FY, Ferreira AM, Hoff AO, Bezerra JE, Almeida CM, Almeida MQ, Mendonça BB, Nahas WC, Chambô JL, Srougi M, Fragoso MCBV. Adjuvant radiotherapy for the primary treatment of adrenocortical carcinoma: Are we offering the best? Int Braz J Urol 2017; 43:841-848. [PMID: 28727379 PMCID: PMC5678514 DOI: 10.1590/s1677-5538.ibju.2017.0095] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/09/2017] [Indexed: 01/13/2023] Open
Abstract
Purpose: To evaluate the role of ARDT after surgical resection of ACC. Materials and Methods: Records of patients from our institutional ACC database were retrospectively assessed. A paired comparison analysis was used to evaluate the oncological outcomes between patients treated with surgery followed by ARDT or surgery only (control). The endpoints were LRFS, RFS, and OS. A systematic review of the literature and meta-analysis was also performed to evaluate local recurrence of ACC when ARDT was used. Results: Ten patients were included in each Group. The median follow-up times were 32 months and 35 months for the ARDT and control Groups, respectively. The results for LRFS (p=0.11), RFS (p=0.92), and OS (p=0.47) were similar among subsets. The mean time to present with local recurrence was significantly longer in the ARDT group compared with the control Group (419±206 days vs. 181±86 days, respectively; p=0.03). ARDT was well tolerated by the patients; there were no reports of late toxicity. The meta-analysis, which included four retrospective series, revealed that ARDT had a protective effect on LRFS (HR=0.4; CI=0.17-0.94). Conclusions: ARDT may reduce the chance and prolong the time to ACC local recurrence. However, there were no benefits for disease recurrence control or overall survival for patients who underwent this complementary therapy.
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Affiliation(s)
- Victor Srougi
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Jose de Bessa
- Divisão de Urologia, Universidade de Feira de Santana, BA, Brasil
| | - Fabio Y Tanno
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Amanda M Ferreira
- Unidade de Suprerrenal da Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, Brasil
| | - Ana O Hoff
- Divisão de Endocrinologia do Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - João E Bezerra
- Divisão de Endocrinologia do Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Cristiane M Almeida
- Divisão de Radioterapia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Madson Q Almeida
- Unidade de Suprerrenal da Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, Brasil.,Divisão de Endocrinologia do Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Berenice B Mendonça
- Unidade de Suprerrenal da Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, Brasil
| | - William C Nahas
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Jose L Chambô
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Maria C B V Fragoso
- Unidade de Suprerrenal da Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, Brasil.,Divisão de Endocrinologia do Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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15
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Gomes CM, Carvalho FL, Bellucci CHS, Hemerly TS, Baracat F, de Bessa J, Srougi M, Bruschini H. Update on complications of synthetic suburethral slings. Int Braz J Urol 2017; 43:822-834. [PMID: 28266818 PMCID: PMC5678512 DOI: 10.1590/s1677-5538.ibju.2016.0250] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/05/2016] [Indexed: 01/10/2023] Open
Abstract
Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.
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Affiliation(s)
- Cristiano Mendes Gomes
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | | | | | - Thiago Souto Hemerly
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Fábio Baracat
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Jose de Bessa
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Homero Bruschini
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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16
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de Bessa J, de Carvalho Mrad FC, Mendes EF, Bessa MC, Paschoalin VP, Tiraboschi RB, Sammour ZM, Gomes CM, Braga LH, Bastos Netto JM. Antibiotic prophylaxis for prevention of febrile urinary tract infections in children with vesicoureteral reflux: a meta-analysis of randomized, controlled trials comparing dilated to nondilated vesicoureteral reflux. J Urol 2015; 193:1772-7. [PMID: 25817142 DOI: 10.1016/j.juro.2014.10.092] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 10/23/2022]
Abstract
PURPOSE The followup and treatment of children with vesicoureteral reflux has been debated for many years. Antibiotic prophylaxis has a role for preventing urinary tract infection in these children. Recent studies and guidelines suggested that prophylaxis has little or no role in preventing urinary tract infection in those children, especially those with low grades (I and II) of reflux. MATERIALS AND METHODS We analyzed all published randomized, controlled trials comparing antibiotic prophylaxis vs no prophylaxis or placebo in children with vesicoureteral reflux. The children were divided into those with nondilated (grades I and II) and dilated (grades III and IV) vesicoureteral reflux. After data were analyzed the RIVUR study was published and, therefore, it was added to the analyzed data. RESULTS After analyzing the first published studies we found that antibiotic prophylaxis would be beneficial only in children with high grade vesicoureteral reflux. With the addition of the data in the RIVUR study these results changed. The new pooled data support antibiotic prophylaxis in all children with vesicoureteral reflux. CONCLUSIONS Vesicoureteral reflux management is still controversial. In contrast to recently published studies and guidelines, this meta-analysis supports antibiotic prophylaxis in all children with vesicoureteral reflux regardless of reflux grade. More studies are needed to support this finding.
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Affiliation(s)
- Jose de Bessa
- Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
| | - Flavia Cristina de Carvalho Mrad
- Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada
| | - Evilin Feitosa Mendes
- Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada
| | - Marcia Carvalho Bessa
- Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada
| | - Victor Pereira Paschoalin
- Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada
| | - Ricardo Brianezi Tiraboschi
- Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada
| | - Zein Mohamed Sammour
- Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada
| | - Cristiano Mendes Gomes
- Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada
| | - Luis H Braga
- Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada
| | - José Murillo Bastos Netto
- Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada
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Sammour ZM, Gomes CM, de Bessa J, Pinheiro MS, Kim CAE, Hisano M, Bruschini H, Srougi M. Congenital genitourinary abnormalities in children with Williams-Beuren syndrome. J Pediatr Urol 2014; 10:804-9. [PMID: 24582571 DOI: 10.1016/j.jpurol.2014.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 01/12/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Williams-Beuren syndrome (WBS) is an autosomal dominant disorder caused by a gene deletion on chromosome 7q11.23. Patients with WBS usually show a group of features such as developmental delay, cardiovascular anomalies, mental retardation, and characteristic facial appearance. Abdominal wall defects, external genitalia anomalies, and structural abnormalities of the urinary tract have been scarcely evaluated and were the focus of our study. MATERIALS AND METHODS We prospectively evaluated 41 boys and 38 girls with WBS, with a mean age of 8.8 ± 4.1 (range 3-19 years). All patients were examined for the evaluation of inguinal and umbilical hernias and genital anomalies. All patients were offered a radiological evaluation, including urinary tract ultrasound, voiding cystourethrogram, and dimercaptosuccinic acid renal scintigraphy (DMSA scan). RESULTS Of the 41 boys, 30 (73.1%) had abnormalities on physical examination, including bilateral undescended testis in 13 (31.7%), retractile testis in four (9.7%), hypospadias in four (9.7%), and unilateral cryptorchidism in three (7.3%) patients. Of the 38 female subjects, 17 (44.7%) had at least one abnormality, including umbilical hernia in 11 (28.9%), unilateral inguinal hernia in four (10.5%), and bilateral inguinal hernia in three (7.8%) patients. Uroradiological abnormalities were found in 41 patients (51.9%). On sonography, six (7.6%) patients had unilateral hydronephrosis, three (3.8%) had a duplicated collecting system, and two (2.5%) had kidney stones. On DMSA, performed in 36 patients, four (11.1%) had unilateral renal scarring and two (5.5%) had bilateral renal scarring. Cystourethrography was obtained from 56 patients, of whom 27 (48.2%) had bladder diverticulum, 18 (32.1%) had bladder wall trabeculation, and three (5.3%) had vesicoureteral reflux. We found no association of urological abnormalities with cardiovascular defects. CONCLUSIONS Patients with WBS have a high prevalence of abdominal wall, external genitalia, and urological abnormalities, emphasizing the importance of proper physical examination and radiological investigation in this population.
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Affiliation(s)
- Zein M Sammour
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Cristiano M Gomes
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
| | - Jose de Bessa
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Marcello S Pinheiro
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
| | - Chong A E Kim
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Marcelo Hisano
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Homero Bruschini
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Sammour ZM, Gomes CM, de Bessa J, Pinheiro MS, Kim CA, Honjo RS, Trigo-Rocha FE, Bruschini H, Srougi M. The Effects of Oxybutynin on Urinary Symptoms in Children with Williams-Beuren Syndrome. J Urol 2012; 188:253-7. [DOI: 10.1016/j.juro.2012.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Zein M. Sammour
- Division of Urology and Genetics Unit of the Children's Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Cristiano M. Gomes
- Division of Urology and Genetics Unit of the Children's Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jose de Bessa
- Division of Urology and Genetics Unit of the Children's Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Marcello S. Pinheiro
- Division of Urology and Genetics Unit of the Children's Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Chong A. Kim
- Division of Urology and Genetics Unit of the Children's Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rachel S. Honjo
- Division of Urology and Genetics Unit of the Children's Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flavio E. Trigo-Rocha
- Division of Urology and Genetics Unit of the Children's Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Homero Bruschini
- Division of Urology and Genetics Unit of the Children's Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Miguel Srougi
- Division of Urology and Genetics Unit of the Children's Institute, University of São Paulo School of Medicine, São Paulo, Brazil
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de Bessa J, Marques C, Caires L, Netto JM, Tiraboschi R, Paschoalin V, Chammas MC, Denes F. 465 DIAGNOSTIC ACCURACY OF HYDRONEPHROSIS GRADE COMBINED WIT URETERAL JETS STUDY EVALUATING OBSTRUCTIVE HYDRONEPHROSIS IN OLDER CHILDREN. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Domingos ALA, Tucci S, Garcia SB, de Bessa J, Cologna AJ, Martins ACP. Use of a latex biomembrane for bladder augmentation in a rabbit model: biocompatibility, clinical and histological outcomes. Int Braz J Urol 2010; 35:217-24; author reply 225-6. [PMID: 19409126 DOI: 10.1590/s1677-55382009000200012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate histological features and biocompatibility of a latex biomembrane for bladder augmentation using a rabbit model. MATERIAL AND METHODS After a partial cystectomy, a patch of a non-vulcanized latex biomembrane (2x4 cm) was sewn to the bladder with 5/0 monofilament polydioxanone sulfate in a watertight manner. Groups of 5 animals were sacrificed at 15, 45 and 90 days after surgery and the bladder was removed. The 5-mum preparations obtained from grafted area and normal bladder were stained with hematoxylin-eosin. Immunohistochemical staining was performed with a primary antibody against alpha-actin to assess muscle regeneration. RESULTS No death, urinary leakage or graft extrusion occurred in any group. All bladders showed a spherical shape. Macroscopically, after 90 days, the latex biomembrane was not identifiable and the patch was indistinguishable from normal bladder. A bladder stone was found in one animal (6.6%). On the 90th day, histology revealed continuity of transitional epithelium of host bladder tissue on the patch area. At this time, the muscle layers were well organized in a similar fashion to native bladder muscle layers. The inflammatory process was higher on grafted areas when compared to controls: 15 days--p < 0.0001, 45 days--p < 0.001, and 90 days--p < 0.01. The anti alpha-actin immunoexpression peaked at 45 days, when the graft was observed covered by muscle cells. CONCLUSION The latex biomembrane is biocompatible and can be used in models for bladder augmentation in rabbits. It promotes epithelium and muscle regeneration without urinary leakage.
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Affiliation(s)
- Andre L A Domingos
- Department of Surgery, Division of Urology, Ribeirao Preto Medical School, University of Sao Paulo, USP, Ribeirao Preto, SP, Brazil.
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Denes FT, Tavares A, Monteiro EDS, de Bessa J, Giron AM, Queiroz Filho FA, Srougi M. Laparoscopic renal surgery in infants and children: is it a feasible and safe procedure for all pediatric age groups? Int Braz J Urol 2008; 34:739-46; discussion 746-8. [PMID: 19111079 DOI: 10.1590/s1677-55382008000600009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2008] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Although laparoscopy is considered the mainstay for most renal procedures in adults, its role in the pediatric population is still controversial, especially for smaller children. We reviewed our experience in pediatric renal laparoscopic surgery in three pediatric age groups in an attempt to identify if age has an impact on feasibility and surgical outcomes. MATERIALS AND METHODS From November 1995 to May 2006, 144 pediatric laparoscopic renal procedures were performed at our institution. The charts of these patients were reviewed for demographic data, urologic pathology and surgical procedure, as well as perioperative complications and post-operative outcomes. The findings were stratified into 3 groups, according to patient age (A: < 1 year, B: 1 to 5 years and C: 6-18 years). RESULTS Median age of the patients was 4.2 years (42 days - 18 years). We performed 54 nephrectomies, 33 nephroureterectomies, 19 upper pole nephrectomies, 11 radical nephrectomies, 22 pyeloplasties and 4 miscellaneous procedures. The 3 age groups were comparable in terms of the procedures performed. Conversion rates were 0%, 1.4% and 1.9% for groups A, B and C, respectively (p = 0.72). Incidence of perioperative complications was 5%, 8.2% and 7.8% for age groups A to C, respectively (p = 0.88). CONCLUSIONS Most renal procedures can be performed safely by laparoscopy in the pediatric population, with excellent aesthetic and functional outcomes. The morbidity related to the procedure was minimal irrespective of the age group.
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Affiliation(s)
- Francisco T Denes
- Uropediatric Unit, Division of Urology University of Sao Paulo Medical School, Sao Paulo, Brazil
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