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Mendes G, Teixeira B, Madanelo M, Rocha A, Mesquita S, Vital J, Monteiro M, Fraga A, Louro N. Semen parameters in testicular tumor patients before orchiectomy: What is the impact of testicular tumor stage and histology? Arch Ital Urol Androl 2024; 96:12238. [PMID: 38389451 DOI: 10.4081/aiua.2024.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE To evaluate the influence of testicular cancer histology and stage on sperm parameters in cryopreserved samples collected prior to orchiectomy. MATERIALS AND METHODS We conducted a retrospective analysis of tumor histology, stage and sperm parameters of patients who underwent pre-orchiectomy sperm cryopreservation for testicular cancer between March 2010 and March 2023. The World Health Organization (WHO) 2010 sperm reference values were used to identify patients with subnormal semen parameters and to further categorize patients by sperm alteration. Localized disease was classified as Stage I, while metastatic disease encompassed Stages II and III. Continuous variables were compared using t-test or Mann Whitney U test, and categorical variables using Chi-square and Fishers exact test. RESULTS A total of 64 patients was identified, 48 (75%) classified as stage I and 16 (25%) classified as stage II/III. No difference was found in semen parameters between patients with seminoma and patients with non-seminoma germ cell tumor (NSGCT). Patients with stage II/III disease had significantly lower percentages of progressive motility (36% vs 53%, p=0.021) and total motility (60% vs 69%, p=0.015) than stage I patients. When categorizing by sperm alterations according to WHO 2010 reference values, patients with stage II/III disease had significantly higher proportions of asthenozoospermia (38% vs 15%, p=0.048) and teratozoospermia (63% vs 31%, p=0.027) than stage I patients. Elevated tumor markers were not associated with sperm abnormalities. CONCLUSIONS Patients with metastatic testicular cancer present with worse sperm quality than patients with localized disease. Sperm cryopreservation should be offered to all patients with testicular cancer, and especially emphasized in patients with metastatic disease.
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Affiliation(s)
- Gonçalo Mendes
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Bernardo Teixeira
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Mariana Madanelo
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Alexandra Rocha
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Sofia Mesquita
- Department of Urology, Santo António University Hospital Center, Porto.
| | - João Vital
- Department of Urology, Hospital of Funchal.
| | - Miguel Monteiro
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Avelino Fraga
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Nuno Louro
- Department of Urology, Santo António University Hospital Center, Porto.
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Mendes G, Madanelo M, Vila F, Versos R, Teixeira BL, Rocha MA, Mesquita S, Marques-Monteiro M, Príncipe P, Ramires R, Lindoro J, Fraga A, Silva-Ramos M. Transperitoneal vs. Retroperitoneal Approach in Laparoscopic Partial Nephrectomy for Posterior Renal Tumors: A Retrospective, Multi-Center, Comparative Study. J Clin Med 2024; 13:701. [PMID: 38337397 PMCID: PMC10856370 DOI: 10.3390/jcm13030701] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Purpose: The aim of our study is to compare the perioperative, functional, and oncological outcomes of laparoscopic transperitoneal partial nephrectomy (LTPN) and laparoscopic retroperitoneal partial nephrectomy (LRPN) for posterior cT1 renal tumors. Methods: We retrospectively collected data on all patients who consecutively underwent LTPN and LRPN for posterior cT1 renal tumors in three different centers from January 2015 to January 2023. Patients with a single, unilateral, cT1 renal mass, located in the posterior renal surface were included. Patients' data regarding perioperative, functional, and oncological outcomes were collected from medical records and statistically analyzed and compared. Results: A total of 128 patients was obtained, with 53 patients in the LPTN group and 75 patients in the LRPN group. Baseline characteristics were similar. Warm ischemia time (WIT) (18.8 vs. 22.6 min, p = 0.002) and immediate postoperative eGFR drop (-6.1 vs. -13.0 mL/min/1.73 m2, p = 0.047) were significantly lower in the LPTN group. Estimated blood loss (EBL) (100 vs. 150 mL, p = 0.043) was significantly lower in the LRPN group. All other perioperative and functional outcomes and complications were similar between the groups. The positive surgical margin (PSM) rate was lower in the LRPN group, although without statistical significance (7.2% vs. 13.5%, p = 0.258). Surgical success defined by Trifecta (WIT ≤ 25 min, no PSM, and no major postoperative complication) was similar between both approaches. Conclusions: LTPN has significantly shorter WIT and a significantly smaller drop in immediate eGFR when compared to LRPN for posterior renal tumors. On the other hand, LRPN has significantly less EBL than LTPN. LRPN demonstrated fewer PSMs than LTPN, albeit without statistical significance. In terms of overall surgical success, as defined by Trifecta, both approaches achieved similar results.
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Affiliation(s)
- Gonçalo Mendes
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Mariana Madanelo
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Fernando Vila
- Urology Department, Centro Hospitalar Tâmega e Sousa, 4564-007 Penafiel, Portugal; (F.V.); (J.L.)
| | - Rui Versos
- Urology Department, Hospital da Senhora da Oliveira—Guimarães, 4835-044 Guimarães, Portugal; (R.V.); (R.R.)
| | - Bernardo Lobão Teixeira
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Maria Alexandra Rocha
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Sofia Mesquita
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Miguel Marques-Monteiro
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Paulo Príncipe
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Ricardo Ramires
- Urology Department, Hospital da Senhora da Oliveira—Guimarães, 4835-044 Guimarães, Portugal; (R.V.); (R.R.)
| | - Joaquim Lindoro
- Urology Department, Centro Hospitalar Tâmega e Sousa, 4564-007 Penafiel, Portugal; (F.V.); (J.L.)
| | - Avelino Fraga
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Miguel Silva-Ramos
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
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Rocha MA, Mendes G, Castro LF, Mesquita S, Teixeira BL, Madanelo M, Vital JA, Marques-Monteiro M, Vinagre N, Oliveira B, Magalhães M, Príncipe P, Ferreira H, Silva-Ramos M. Outcomes of Urinary Tract Endometriosis-Laparoscopic Treatment: A 10-Year Retrospective Study. J Clin Med 2023; 12:6996. [PMID: 38002610 PMCID: PMC10672564 DOI: 10.3390/jcm12226996] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Urinary tract endometriosis (UTE), a rare manifestation, encompasses bladder and ureteral involvement. Surgical intervention is commonly recommended for UTE, though the optimal surgical approach remains a subject of debate. This study aims to report our centre's experience with UTE. METHODS We conducted a retrospective cohort study of 55 patients who underwent surgical treatment for UTE at a single tertiary centre over a 10-year period (2012-2022). Patient data, including demographics, symptoms, intraoperative findings, and complications, were collected from medical records. Data were statistically analysed, and correlations were explored. RESULTS The study population had a mean age of 37.11 years, with dysmenorrhea (89.1%) being the most common symptom. Bladder endometriosis was present in 27 cases, ureteral endometriosis in 25, and mixed-location in 3. Laparoscopy was the primary surgical approach, with multidisciplinary teams involving urologists. There were six patients with postoperative complications, and there were six (10.9%) recurrences of endometriosis. A positive correlation was found between age and recurrence, but no significant predictors of recurrence were identified in our analysis. CONCLUSIONS Laparoscopic treatment of urinary endometriosis is safe and effective. Multidisciplinary collaboration plays a pivotal role in addressing this challenging condition.
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Affiliation(s)
- Maria Alexandra Rocha
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Gonçalo Mendes
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Luis Ferreira Castro
- Gynecology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (L.F.C.); (H.F.)
| | - Sofia Mesquita
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Bernardo Lobão Teixeira
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Mariana Madanelo
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - João Aragão Vital
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Miguel Marques-Monteiro
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Nuno Vinagre
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Beatriz Oliveira
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Martinha Magalhães
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Paulo Príncipe
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
| | - Hélder Ferreira
- Gynecology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (L.F.C.); (H.F.)
| | - Miguel Silva-Ramos
- Urology Department, Centro Hospitalar e Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (S.M.); (B.L.T.); (M.M.); (J.A.V.); (M.M.-M.); (N.V.); (B.O.); (P.P.); (M.S.-R.)
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Marques-Monteiro M, Teixeira B, Mendes G, Rocha A, Madanelo M, Mesquita S, Vital J, Vinagre N, Magalhães M, Oliveira B, Carneiro D, Soares J, Cabral J, Teves F, Fraga A. Extraperitoneal robot-assisted radical prostatectomy with the Hugo™ RAS system: initial experience of a tertiary center with a high background in extraperitoneal laparoscopy surgery. World J Urol 2023; 41:2671-2677. [PMID: 37668717 DOI: 10.1007/s00345-023-04571-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/06/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE The Hugo™ RAS system is a novel robotic platform with innovative features. However, there are currently no available data on extraperitoneal robot-assisted radical prostatectomy (RARP) performed using this system. The objective of this study is to describe the surgical setup and assess the safety and feasibility of the extraperitoneal approach in robotic radical prostatectomy with the Hugo™ RAS system. METHODS Sixteen consecutive patients diagnosed with localized prostate cancer underwent extraperitoneal RARP ± lymph node dissection at our institution, between March and May 2023. All RARP procedures were performed extraperitoneal with a modular four-arm configuration. The focus was to describe the operative room setup, trocar placement, tilt and docking angles and evaluate the safety and feasibility of this approach with this robotic platform. Secondary outcomes recorded included, total operative time, console time, estimated bleeding, intra- and postoperative complications, and length of stay after surgery. A descriptive analysis was conducted. RESULTS We report on the first sixteen cases of extraperitoneal robot-assisted radical prostatectomy performed with the new Hugo™ RAS system. All procedures were completed, without the need for conversion or placement of additional ports. No intraoperative complications or major technical failures that would prevent the completion of surgery were recorded. The median operative time was 211 min (IQR 180-277), and the median console time was 152 min (IQR 119-196). The mean docking time was 4.6 min (IQR 4.1-5.2). The median estimated blood loss and the median time to remove the vesical catheter were 200 mL (IQR 150-400) and 8 days (IQR 7-8), respectively. The median length of stay was 2 days (IQR 2-2). Only one minor complication was registered in the first 30 days. CONCLUSION This study provides evidence of the safety and feasibility of the extraperitoneal approach in RARP with the Hugo™ RAS system. The description of the surgical setup in terms of trocar placement, arm-cart disposition, tilt and docking angles offers valuable information for surgeons interested in adopting this surgical approach with the Hugo™ RAS platform.
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Affiliation(s)
| | - Bernardo Teixeira
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Gonçalo Mendes
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Alexandra Rocha
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Mariana Madanelo
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Sofia Mesquita
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - João Vital
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Nuno Vinagre
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Martinha Magalhães
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Beatriz Oliveira
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Diogo Carneiro
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - José Soares
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - João Cabral
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Frederico Teves
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Avelino Fraga
- Urology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
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Correia J, Madanelo M, Silva-Ramos M. Renal Artery Thrombosis After Laparoscopic Living-Donor Nephrectomy: A Case Report. Transplant Proc 2023; 55:1903-1905. [PMID: 37422375 DOI: 10.1016/j.transproceed.2023.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 07/10/2023]
Abstract
Renal transplantation is the most successful treatment for end-stage renal disease, and the number of living-donor nephrectomies has been rising over the years due to the advantages it offers over deceased donors. Although this surgery is considered safe, it can be associated with complications amplified by the fact that it is performed on a healthy individual. Renal artery thrombosis is a rare disease that needs prompt diagnosis and treatment to avoid renal function deterioration, which becomes even more important in cases of solitary kidneys. We report the first case of renal artery thrombosis after laparoscopic living-donor nephrectomy treated with catheter-directed thrombolysis.
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Affiliation(s)
- Jorge Correia
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Mariana Madanelo
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel Silva-Ramos
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Lecoanet P, Madanelo M, Tricard T, Mauger de Varennes A, Haudebert C, Richard C, Hascoet J, Bentellis I, Tibi B, Saussine C, Hubert J, Peyronnet B. Robot-assisted vesicovaginal fistula repair: comparison of the extravesical and transvesical techniques. Int Urogynecol J 2023; 34:2479-2485. [PMID: 37204473 DOI: 10.1007/s00192-023-05565-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/16/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES Almost two decades after the description of robotic vesicovaginal fistula repair (R-VVF), the literature remains limited. The aims of this study are to report the outcomes of R-VVF and to compare the transvesical versus extravesical techniques. METHODS We performed an observational, retrospective, multicenter study, including all patients who underwent R-VVF from March 2017 to September 2021 at four academic institutions. All abdominal VVF repair over the study period were performed using a robotic approach. The success of R-VVF was defined as the absence of clinical recurrence. The outcomes of the extravesical versus transvesical techniques were compared. RESULTS Twenty-two patients were included. The median age was 43 years old (IQR 38-50). Fistulas were supratrigonal and trigonal in 18 and 4 cases respectively. Five patients had undergone previous attempts of fistula repair (22.7%). The fistulous tract was systematically excised, and an interposition flap was used in all but two cases (90.9%). The transvesical and extravesical techniques were used in 13 and 9 cases respectively. There were four postoperative complications, three minor and one major. None of the patients had vesicovaginal fistula recurrence after a median follow-up of 15 months. CONCLUSIONS The present series, one of the largest R-VVF reported to date, is consistent with the few series already published with a 100% cure rate. Systematic excision of the fistulous tract and the high rate of flap interposition may explain the high success rate. The transvesical and extravesical approaches yielded similar outcomes.
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Affiliation(s)
| | - Mariana Madanelo
- Department of Urology, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
| | - Thibault Tricard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | | | | | - Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | | | | | - Branwell Tibi
- Department of Urology, University of Nice, Nice, France
| | | | - Jacques Hubert
- Department of Urology, University of Nancy, Nancy, France
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Mesquita S, Teixeira B, Mendes G, Rocha M, Madanelo M, Fraga A, Cavadas V. Renal pelvis urine and stone cultures in patients undergoing percutaneous nephrolithotomy and endoscopic combined intrarenal surgery: Are they clinically relevant? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00838-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Teixeira BL, Cabral J, Mendes G, Madanelo M, Rocha MA, Mesquita S, Correia J, Tavares C, Marques-Pinto A, Fraga A. How the COVID-19 pandemic changed urology residency - a nationwide survey from the Portuguese resident's perspective. Cent European J Urol 2021; 74:121-127. [PMID: 33976927 PMCID: PMC8097653 DOI: 10.5173/ceju.2021.0278.r1] [Citation(s) in RCA: 3] [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: 09/29/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction The aim of this article was to evaluate the impact of the COVID-19 pandemic on urology residency. Material and methods A 30 question online survey was sent to all urology residents in Portugal between the 25th of April and the 25th of May 2020. Reduction in different areas of clinical activity during the COVID-19 period were evaluated and their perceived impact on their residency program was quantified. Results Forty-three (54.4%) Portuguese urology residents responded to our inquiry. Eighty-one percent report having supressed their activity by more than 75% in the outpatient clinic; 48.8% in diagnostic procedures; 29.3% in endoscopic surgery; 67.5% in laparoscopic/robotic surgery and 17.5% in major open surgery. There were no differences in clinical activity reduction across residency years. Considering the impact of COVID-19 on urology training programs, 32.6% plan on prolonging residency. During the COVID-19 period, a larger number of residents report having spent more time developing research projects or on continuing medical education, as compared with the pre-COVID-19 period (p = 0.012). Conclusions COVID-19 had a major impact on Urology residency in Portugal, with major short- and long-term consequences. A large proportion of residents are considering prolonging their residency as a result.
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Affiliation(s)
| | - João Cabral
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - Gonçalo Mendes
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - Mariana Madanelo
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | | | - Sofia Mesquita
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - Jorge Correia
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - Catarina Tavares
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - André Marques-Pinto
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - Avelino Fraga
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
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Nunes-Carneiro D, Madanelo M, Silva F, Pestana N, Ribeiro C, Gil-Sousa D, Martins LS, Almeida M, Dias L, Malheiro J, Cavadas V, Castro-Henriques A, Fraga A, Silva-Ramos M. Remaining kidney volume indexed to weight as a strong predictor of estimated glomerular filtration rate at 1 year and mid-term renal function after living-donor nephrectomy - a retrospective observational study. Transpl Int 2020; 33:1262-1273. [PMID: 32608073 DOI: 10.1111/tri.13683] [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: 12/22/2019] [Revised: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 01/10/2023]
Abstract
The donors' estimated glomerular filtration rate (eGFR) after living nephrectomy has been a concern, particularly in donors with smaller kindeys. Therefore, we developed this retrospective observational study in 195 donors to determine the ability remaining kidney volume indexed to weight (RKV/W) to predict eGFR at 1 year through multivariate linear regression and to explore this relationship between annual eGFR change from 1 to 4 years postdonation evaluated by a linear mixed model. Comparing RKV/W tertiles (T1, T2, T3), RKV/W was a good predictor of 1-year eGFR which was significantly better in T3 donors. Gender, predonation eGFR, and RKV/W were independent predictors of eGFR at 1-year. In a subgroup with predonation eGFR < 90mL/min/1.73 m2 , a significant prediction of eGFR < 60mL/min/1.73 m2 was detected in males with RKV/W ≤ 2.51cm3 /kg. Annual eGFR (ml/min/year) change from 1 to 4 years was + 0.77. RKV/W divided by tertiles (T1-T3) was the only significant predictor: T2 and T3 donors had an annual eGFR improvement opposing to T1. RKV/W was a good predictor of eGFR at 1 year, independently from predonation eGFR. A higher RKV/W was associated with improved eGFR at 1 year. A decline in eGFR on the four years after surgery was only noticeable in donors with RKV/W ≤ 2.13cm3 /kg.
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Affiliation(s)
- Diogo Nunes-Carneiro
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,i3S/INEB, Universidade do Porto, Porto, Portugal
| | - Mariana Madanelo
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Filipa Silva
- Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Nicole Pestana
- Nephrology Department, Hospital Dr, Nelio Mendonça Funchal, Porto, Portugal
| | - Catarina Ribeiro
- Nephrology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Porto, Portugal
| | - Diogo Gil-Sousa
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - La Salete Martins
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Manuela Almeida
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Leonídio Dias
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Jorge Malheiro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Vítor Cavadas
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Antonio Castro-Henriques
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology and Kidney Transplantation Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Avelino Fraga
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,i3S/INEB, Universidade do Porto, Porto, Portugal
| | - Miguel Silva-Ramos
- Urology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Gonçalves Correia J, Madanelo M, Teixeira B, Mendes G, Fraga A, Teves F, Silva-Ramos M. Added value of risk calculators to mpMRI in the diagnosis of prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33764-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Nunes Carneiro D, Madanelo M, Silva F, Pestana N, Ribeiro C, Almeida M, Malheiro J, Cavadas V, Fraga A, Silva Ramos M. Remaining kidney volume is a strong predictor of estimated glomerular filtration rate at 1 year and mid-term renal function after living donor nephrectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Madanelo M, Ferreira C, Nunes-Carneiro D, Pinto A, Rocha MA, Correia J, Teixeira B, Mendes G, Tavares C, Mesquita S, Fraga A. The impact of the coronavirus disease 2019 pandemic on the utilisation of emergency urological services. BJU Int 2020; 126:256-258. [PMID: 32406551 PMCID: PMC7272803 DOI: 10.1111/bju.15109] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the number of patients attending the Urology Emergency Department (ED) of the Centro Hospitalar Universitário do Porto (CHUP), as well as their demographic characteristics, the reasons for admission, the clinical severity under the Manchester triage system (MTS), and the need for emergency surgery or hospitalisation, during the coronavirus disease 2019 (COVID-19) pandemic and the equivalent period in 2019. PATIENTS AND METHODS Data were collected from patients attending the Urology ED of the CHUP over 3 weeks, from 11 March to 1 April 2020, and from the same period in the previous year (from 11 March to 1 April 2019). RESULTS During the pandemic, 46.4% fewer patients visited our urological ED (122 vs 263). There was no significant difference in the mean age or the number of old patients (aged ≥65 years) between the two periods. However, significantly fewer female patients sought emergency urological services during the COVID-19 pandemic period (32.7% vs 14.8%, P < 0.05). No significant differences were noted between different clinical severity groups under the MTS. In 2019, significantly less patients required hospitalisation. The most common reasons for admission, during both periods, were haematuria, renal colic and urinary tract infections. The authors recognise that the study has several limitations, namely, those inherent to its retrospective nature. CONCLUSION COVID-19 significantly influenced people's urological care-seeking behaviour. Understanding the present situation is helpful for predicting future urological needs. Based on the results of this study, we have reason to speculate that people's requirements for urological services might grow explosively in the post-COVID-19 period. There should be further studies about the real state of long-term urological services and the consequences that this pandemic may have in terms of morbimortality not directly related to the severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Mariana Madanelo
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Carlos Ferreira
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Diogo Nunes-Carneiro
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - André Pinto
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Jorge Correia
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Bernardo Teixeira
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Gonçalo Mendes
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Catarina Tavares
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sofia Mesquita
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Avelino Fraga
- Department of Urology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Silva F, Pestana N, Ribeiro CI, Carneiro D, Madanelo M, Tavares J, Pedroso S, Almeida M, Malheiro J, Dias L, Silva Ramos M, Martins LS, Henriques AC. P1715CORRELATION OF DONATED KIDNEY MASS AND GRAFT FUNCTION IN RECIPIENTS OF LIVING DONOR KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Kidney volume has been proven to be a surrogate marker of nephron mass and renal function in living donors. Although many studies correlate the kidney mass with renal donors’ function after donation, few studies have compared the donated kidney mass with estimated glomerular filtration rate (eGFR) in the kidneýs recipients.
The purpose of this study is to examine the relationship between donor kidney volume and post-transplantation graft function by using computerized tomography to obtain renal volumes.
Method
Clinical data off all donor and recipient pairs undergoing live donor kidney transplantation (KT) at our institution between January 2008 and December 2017 (n=195) were reviewed. The volume of the kidney selected for transplant was determined using volume calculating software and correlate to transplant recipient eGFR.
Results
All metrics of donor kidney volume (DKV): DKV alone, ADK adjusted for weight, body mass index (BMI) or body surface area (BSA), correlated significantly with eGFR (all with p<0,001) at 1 year after KT, with DKV/BSA having the highest correlation (r=0,431). Hence, recipients were divided into terciles according their DKV/BSA (cm3/m2): tercile 1 (DKV/BSA between 49,7-77,5, n=64), tercile 2 (78-95,2, n=63) and tercile 3 (95,4-176, n=63). eGFR differences between groups at each time point were all significant (P<0.05), except for the comparison between T1 and T2 at month 6 (figure 1)
Significant risk factors for eGFR<60 ml/min at 1-year were: acute rejection (AR) at 1-year (OR=4.116, P=0.018); calculated PRA>0% (OR=2.075, P=0.039); higher donor age (OR per unit=1.033, P=0.047); and peritoneal dialysis modality (in comparison with preemptive KT: OR=3.232, P=0.013). Higher (T3) DKV/BSA tercile (in comparison with T1: OR=0.306, P=0.004) was protective of this outcome.
Patients that experienced AR at 1-year had significantly lower DKV/BSA, particularly those with acute cellular rejection (ACR).
The median follow-up was 4,8 years (IQR: 3.2-7.5). The censored graft survival by DKV/BSA terciles at 10 years were 59,3% for group 1, 91.3% for group 2 and 91.1% for group 3 (figure 3).
Conclusion
Our study demonstrates that transplantation of donor-recipient pairs with lower DKV/BSA ratio were associated with significantly worse graft function and higher incidence of AR. This data suggests that a larger mass of nephrons remaining adjusted to recipient’s weight seems to predict a better long-term eGFR. This method can be useful in order to identify patients at risk for a low eGFR after KT and, in cases of multiple potential donors, optimize donor selection.
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Affiliation(s)
- Filipa Silva
- Centro Hospitalar e Universitário do Porto, Nephrology and Kidney Transplantation, Porto, Portugal
| | - Nicole Pestana
- Hospital Dr. Nélio Mendonça, Nephrology, Funchal, Portugal
| | | | - Diogo Carneiro
- Centro Hospitalar e Universitário do Porto, Urology, Porto, Portugal
| | - Mariana Madanelo
- Centro Hospitalar e Universitário do Porto, Urology, Porto, Portugal
| | - Joana Tavares
- Centro Hospitalar e Universitário do Porto, Nephrology and Kidney Transplantation, Porto, Portugal
| | - Sofia Pedroso
- Centro Hospitalar e Universitário do Porto, Nephrology and Kidney Transplantation, Porto, Portugal
| | - Manuela Almeida
- Centro Hospitalar e Universitário do Porto, Nephrology and Kidney Transplantation, Porto, Portugal
| | - Jorge Malheiro
- Centro Hospitalar e Universitário do Porto, Nephrology and Kidney Transplantation, Porto, Portugal
| | - Leonídio Dias
- Centro Hospitalar e Universitário do Porto, Nephrology and Kidney Transplantation, Porto, Portugal
| | | | - La Salete Martins
- Centro Hospitalar e Universitário do Porto, Nephrology and Kidney Transplantation, Porto, Portugal
| | - António Castro Henriques
- Centro Hospitalar e Universitário do Porto, Nephrology and Kidney Transplantation, Porto, Portugal
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Madanelo M, Ferreira C, Rocha M, Nunes-Carneiro D, Correia J, Teixeira B, Mendes G, Tavares C, Pinto A, Mesquita S, Fraga A. RETIRADO: El impacto de la pandemia de COVID-19 en la utilización de los servicios urológicos de urgencias. Actas Urol Esp 2020. [PMCID: PMC7211695 DOI: 10.1016/j.acuro.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
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