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Faria EF, Maciel CVDM, Melo PA, Tobias-Machado M, Dias R, Dos Reis RB, Costa-Gualberto RJ. Mesentery-Sparing Technique: a New Intracorporeal Approach for Urinary Diversion in Robot-Assisted Radical Cystectomy. Int Braz J Urol 2024; 50:489-499. [PMID: 38701184 DOI: 10.1590/s1677-5538.ibju.2024.0153] [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: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative technique that preserves the complete mesenteric vascularization during the isolation of the intestinal segment used in ICUD, including distal vessels. This approach aims to minimize the risk of ischemia in both the ileal anastomosis and the isolated loop at the diversion site. METHODS This cohort study included 31 patients, both male and female, who underwent RARC with ICUD from February 2018 to November 2023, performed by a single surgeon. Intraoperative and postoperative complications data were retrieved for analysis, employing our proposed mesentery-sparing technique in all cases. The primary endpoint was the incidence of intraoperative and postoperative complications directly attributable to the mesentery-sparing approach in ICUD. Secondary endpoints included other postoperative variables not directly related to mesentery preservation, such as the incidence of postoperative ileus requiring parenteral nutrition and the duration of hospitalization. RESULTS None of the patients experienced intraoperative or postoperative complications directly related to mesentery-sparing, such as intestinal fistulae or internal hernias. The median duration of hospitalization was 6 days, and postoperative ileus necessitating total parenteral nutrition occurred in 19% of the patients. Minor complications (Clavien-Dindo grades I-II) accounted for 27.6% of the cases and major complications (grades III-V) accounted for 20.6%. CONCLUSION The mesentery-sparing technique outlined herein offers an alternative method for preserving the vascularization of intestinal segments and reducing the risk of intestinal complications in ICUD during RARC.
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Affiliation(s)
- Eliney Ferreira Faria
- Departamento de Urologia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade Ciências Médicas de Minas Gerais - FCM-MG, Belo Horizonte, MG, Brasil
| | | | - Pablo Almeida Melo
- Departamento de Urologia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
| | - Marcos Tobias-Machado
- Departamento de Uro-Oncologia, Instituto do Câncer Dr. Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | - Roberto Dias
- Departamento de Cirurgia e Urologia, Hospital do Câncer de Barretos, Barretos, SP, Brasil
| | - Rodolfo Borges Dos Reis
- Divisão de Urologia, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Rodrigo José Costa-Gualberto
- Departamento de Urologia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade Ciências Médicas de Minas Gerais - FCM-MG, Belo Horizonte, MG, Brasil
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Rose KM, Pham R, Zacharias NM, Ionescu F, Paravathaneni M, Marchetti KA, Sanchez D, Mustasam A, Sandstrom R, Vikram R, Dhillon J, Rao P, Schneider A, Pagliaro L, Alifrangis C, Albersen M, Roussel E, Master VA, Nazha B, Hernandez C, Moses KA, Protzel C, Montgomery J, Angel M, Tobias-Machado M, Spiess PE, Pettaway CA, Chahoud J. Neoadjuvant Platinum-Based chemotherapy and lymphadenectomy for penile cancer: an international, Multi-Institutional, Real-World study. J Natl Cancer Inst 2024:djae034. [PMID: 38366627 DOI: 10.1093/jnci/djae034] [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] [Received: 09/29/2023] [Revised: 12/08/2023] [Accepted: 01/10/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION This study investigated the efficacy and safety of neoadjuvant chemotherapy (NAC) for locally advance penile squamous cell carcinoma (PSCC), for which current evidence is lacking. METHODS Included patients had locally advanced PSCC with clinical lymph node metastasis treated with at least one dose of NAC prior to planned consolidative lymphadenectomy. Objective response rates (ORR) were assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. The primary and secondary outcomes were overall survival and progression-free survival, estimated by the Kaplan-Meier method. Treatment-related adverse events (trAEs) were graded per the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS 209 patients received NAC for locally advanced and clinically node-positive PSCC.The study population consisted of 7% of patients with stage II disease, 48% with stage III, and 45% with stage IV. Grade 2 TrAEs occurred in 35 (17%) patients, and no treatment related mortality was observed. 201 (97%) completed planned consolidative lymphadenectomy. During follow up, 106 (52.7%) patients expired, with a median OS of 37.0 months (95% CI 23.8-50.1), and median PFS of 26.0 months (95% CI 11.7-40.2). ORR was 57.2%, with 87 (43.2%) having partial response and 28 (13.9%) having a complete response. Patients with objective response to NAC had a longer median OS (73.0 vs 17.0 months, p < .01) compared to those who did not. The lymph-node pathologic complete response rate (ypN0) was 24.8% in the cohort. CONCLUSION NAC with lymphadenectomy for locally advanced PSCC is well tolerated and active to reduce the disease burden and improve long term survival outcomes.
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Affiliation(s)
- Kyle M Rose
- Ochsner Medical Center, New Orleans, LA, United States
| | - Rachel Pham
- University of Texas Health Science Center Houston, Houston, TX, United States
| | - Niki M Zacharias
- University of Texas M.D. Anderson Cancer Center, Houston TX, United States
| | - Filip Ionescu
- H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | | | | | - Darren Sanchez
- University of Texas Health Science Center Houston, Houston, TX, United States
- University of Texas M.D. Anderson Cancer Center, Houston TX, United States
| | - Arfa Mustasam
- H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | | | - Raghu Vikram
- University of Texas M.D. Anderson Cancer Center, Houston TX, United States
| | | | - Priya Rao
- University of Texas M.D. Anderson Cancer Center, Houston TX, United States
| | - Amy Schneider
- H. Lee Moffitt Cancer Center, Tampa, FL, United States
| | | | | | | | | | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Bassel Nazha
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Cindy Hernandez
- Vanderbilt University Medical Center, Nashville TN, United States
| | - Kelvin A Moses
- Vanderbilt University Medical Center, Nashville TN, United States
| | | | | | - Martin Angel
- Instituto Alexander Fleming, Buenos Aires, Argentina
- Instituto Misionero del Cancer, Posadas, Misiones, Argentina
| | | | | | - Curtis A Pettaway
- University of Texas M.D. Anderson Cancer Center, Houston TX, United States
| | - Jad Chahoud
- H. Lee Moffitt Cancer Center, Tampa, FL, United States
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Tobias-Machado M, Ornellas AA, Hidaka AK, Medina LG, Mattos PAL, Besio RS, Abreu D, Castro PR, Nishimoto RH, Astigueta J, Dourado A, Machado RD, Magnabosco WJ, Corona-Montes V, Villoldo GM, Zampolli HC, Taha A, Auad PR, Faria EF, Arantes PBO, Tavares A, Nascimento FSMS, Brazão ES, Rocha MM, Costa WH, Panico V, Reis LO, Almeida-Carrera RJ, Silva RC, Zequi SC, Calixto JRR, Sotelo R. Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer. Int Braz J Urol 2023; 49:580-589. [PMID: 37390124 PMCID: PMC10482462 DOI: 10.1590/s1677-5538.ibju.2023.0065] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). MATERIALS AND METHODS Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. RESULTS From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. CONCLUSION VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.
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Affiliation(s)
- Marcos Tobias-Machado
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
- Centro Universitário Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | | | - Alexandre K Hidaka
- Centro Universitário Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | - Luis G Medina
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pablo A L Mattos
- Associação Piauiense de Combate ao Câncer - Hospital São Marcos, Teresina, PI, Brasil
| | | | | | | | | | - Juan Astigueta
- Universidad Privada Antenor Orrego, Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo, Perú
| | - Aurus Dourado
- Associação Piauiense de Combate ao Câncer - Hospital São Marcos, Teresina, PI, Brasil
| | | | | | | | | | | | - Anis Taha
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | - Pericles R Auad
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | | | | | | | | | | | | | - Walter H Costa
- AC Camargo Cancer Center, São Paulo, SP, Brasil
- National Institute for Science and Technology in Ocogenomic and Therapeutic Innovation INCIT/INOTE AC Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Leonardo O Reis
- UroScience, Escola de Ciências Médicas, Universidade de Campinas - UNICAMP, Campinas, SP, Brasil
- Pontifícia Universidade Católica de Campinas - PUC, Campinas, SP, Brasil
| | | | - Rafael C Silva
- Universidade Federal do Maranhão - UFMA, Maranhão, MA, Brasil
| | - Stênio C Zequi
- AC Camargo Cancer Center, São Paulo, SP, Brasil
- National Institute for Science and Technology in Ocogenomic and Therapeutic Innovation INCIT/INOTE AC Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Rene Sotelo
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Faria EF, Rosim RP, de Matos Nogueira E, Tobias-Machado M. Cost-Effectiveness Analysis of Robotic-Assisted Radical Prostatectomy for Localized Prostate Cancer From the Brazilian Public System Perspective. Value Health Reg Issues 2022; 29:60-65. [PMID: 34801887 DOI: 10.1016/j.vhri.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/06/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Radical prostatectomy (RP) is the gold standard for the surgical treatment of localized prostate cancer, presenting better results than radiotherapy especially for high-risk patients. Although it has clinical and technical benefits compared with open and laparoscopic techniques, the robotic-assisted RP is not publicly funded in Brazil. The objective of this study was to calculate the cost-effectiveness of the robotic-assisted RP from the Brazilian public system perspective. METHODS A state transition model was built to simulate the life of a patient undergoing RP. A total of 3 arms were compared: robotic-assisted, laparoscopic, and open surgeries. The assumed time horizon was 20 years; discounts were applied to both costs and health outcomes. Events and transition probabilities were obtained in the literature, and costs were obtained in official government databases. The results were reported as incremental cost-utility ratios. RESULTS Robotic-assisted surgery was found to be costlier but more effective than both open and laparoscopic techniques, resulting in Brazilian reals 4518 per quality-adjusted life-year and Brazilian reals 3631 per quality-adjusted life-year incremental cost-effectiveness ratios, respectively. CONCLUSIONS This study gives relevant inputs for decision making regarding the inclusion of robotic-assisted RP in the Brazilian public formularies. The study demonstrates that the technology is cost-effective even when considering willingness-to-pay thresholds lower than the traditionally used ones.
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Affiliation(s)
| | | | | | - Marcos Tobias-Machado
- ICAVC - Cancer Institute Dr. Arnaldo, São Paulo, Brazil; Department of Urology, ABC Medical School, São Paulo, Brazil
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Peixoto GA, Korkes F, Pazeto CL, De Castro MG, Lima TFN, Wroclawski ML, Christofe NM, Tobias-Machado M, Santiago LHS, Glina S. The influence of testosterone suppression on HER2 immunoexpression in prostatic neoplastic tissue. Mol Clin Oncol 2021; 15:185. [PMID: 34277004 PMCID: PMC8278412 DOI: 10.3892/mco.2021.2347] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/17/2021] [Indexed: 12/04/2022] Open
Abstract
During initial risk assessments, the metastatic potential of prostate cancer (PCa) may not be fully considered. The tumor's multicentric origin, which is associated with genetic mutations, may explain existing treatment limitations. Investigating human epidermal growth factor receptor 2 (HER2) expression in patients with different stages of PCa may therefore increase understanding of the mechanisms associated with the development of castration resistance. The present study examined the association between HER2 expression and the histologic features of PCa subjected to radical prostatectomy (RP) and evaluated the role of testosterone suppression in HER2 expression. In group 1, specimens from individuals who underwent RP without prior neoadjuvant androgen deprivation therapy (ADT) were included (n=42). In group 2 (PCa with ADT), specimens from individuals who underwent RP and received neoadjuvant cyproterone acetate during distinct periods (200 mg daily for 1-24 months) were included (n=150; cohort derived from a previous study). Immunohistochemical expression of HER2 was associated with prognostic factors such as perineural invasion, extra-prostatic disease, T stage, serum prostate-specific antigen (PSA), angiolymphatic invasion and surgical margins. Univariate regression analysis indicated that perineural invasion, PSA, International Society of Urological Pathology, angiolymphatic invasion, margin, T stage and neoadjuvant ADT was associated with HER2 expression. Ordinal regression analysis indicated a significant effect of neoadjuvant ADT alone on HER2 expression (P<0.001). In addition, regression analysis indicated a significant effect of neoadjuvant ADT alone on HER2 expression (odd ratio=0.01; 95% CI, 0.00, 0.02; P<0.001). HER2 was expressed in PCa samples but was not associated with known prognostic factors. The use of short-acting ADT and the consequent blockage of testosterone effect may suppress the expression of HER2 in PCa cells.
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Affiliation(s)
- Guilherme Andrade Peixoto
- Department of Urology, Centro Universitário FMABC, Santo André, São Paulo 09060-870, Brazil.,Department of Urology, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Fernando Korkes
- Department of Urology, Centro Universitário FMABC, Santo André, São Paulo 09060-870, Brazil.,Department of Urology, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Cristiano Linck Pazeto
- Department of Urology, Centro Universitário FMABC, Santo André, São Paulo 09060-870, Brazil.,Department of Urology, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | | | | | - Marcelo Langer Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil.,Department of Urology, Beneficência Portuguesa de São Paulo, São Paulo 01323-001, Brazil
| | - Nicolle Martin Christofe
- Department of Urology, Centro Universitário FMABC, Santo André, São Paulo 09060-870, Brazil.,Department of Urology, Faculty of Ciências Médicas da Santa Casa de São Paulo, São Paulo 01238-010, Brazil
| | - Marcos Tobias-Machado
- Department of Urology, Centro Universitário FMABC, Santo André, São Paulo 09060-870, Brazil
| | | | - Sidney Glina
- Department of Urology, Centro Universitário FMABC, Santo André, São Paulo 09060-870, Brazil.,Department of Urology, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
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Nunes-Silva I, Hidaka AK, Monti CR, Tobias-Machado M, Zampolli HC. Salvage Retzius sparing robotic assisted radical prostatectomy: the first brazilian experience. Int Braz J Urol 2021; 47:1279-1280. [PMID: 34156193 PMCID: PMC8486463 DOI: 10.1590/s1677-5538.ibju.2021.0260] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Salvage Radical Prostatectomy after radiation therapy is challenging and associated with high rates of serious complications (1, 2). The novel Retzius-Sparing RARP (RS-RARP) approach has shown excellent continence outcomes (3, 4). Purpose: To describe step-by-step our Salvage Retzius-Sparing RARP (sRS-RARP) operative technique and report feasibility, safety and the preliminary oncological and continence outcomes in the post-radiation scenario. Materials and Methods: Twelve males presenting local prostate cancer recurrence after radiotherapy that underwent sRS-RARP were included. All patients performed preoperative multiparametric MRI and PSMA-PET. Surgical technique: 7cm peritoneum opening at Douglas pouch, Recto-prostatic space development, Seminal vesicles and vas deferens isolation and section, Extra-fascial dissection through peri-prostatic fat, Neurovascular bundle control, Bladder neck total preservation and opening, Anterior dissection at Santorini plexus plane, Apex dissection with urethra preservation and section, Prostate release, Vesicouretral modified Van Velthoveen anastomosis, Rocco Stitch, Oncological and continence outcomes reported with minimum 1-year follow-up. Results: Ten patients had previously received external beam radiation (EBR) whereas two received previous brachytherapy plus EBR. At 1, 3 and 12 months after surgery, 25%, 75% and 91.6% of the men used one safety pad or less, respectively. No major complications or blood transfusions were reported. Final pathology reported pT2b 41.6%, pT2c 33.3% and pT3a 25%, positive surgical margins 25%, positive lymph nodes were not found, biochemical recurrence 16.6%. Conclusion: Salvage Retzius-Sparing Robotic Assisted Radical Prostatectomy approach appears to be technically feasible and oncologically safe with potential to provide better continence outcomes.
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Affiliation(s)
- Igor Nunes-Silva
- Instituto do Câncer Dr. Arnaldo Vieira de Carvalho - IAVC, São Paulo, SP, Brasil.,IN Cancer Center, São Paulo, SP, Brasil.,Instituto de Radium Oncology, Campinas, SP, Brasil.,Clinica Onco Hematos, Aracaju, SE, Brasil
| | - Alexandre Kyoshi Hidaka
- Instituto do Câncer Dr. Arnaldo Vieira de Carvalho - IAVC, São Paulo, SP, Brasil.,Divisão de Urologia, Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | - Carlos Roberto Monti
- Instituto de Radium Oncology, Campinas, SP, Brasil.,Divisão de Urologia, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas - PUC-Campinas, Campinas, SP, Brasil
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7
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Fonseca RB, Correia AO, Vieira RS, Dos Santos JEF, Alves-Neto HR, da Silva Vieira AF, Belém DRF, Tobias-Machado M, Vidal CHF, Waisberg J. Comparative study between minimally invasive supraorbital craniotomy and pterional craniotomy for treating anterior circulation cerebral aneurysms in a low-resource setting. Sci Rep 2021; 11:5555. [PMID: 33692472 PMCID: PMC7946868 DOI: 10.1038/s41598-021-85115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/22/2021] [Indexed: 12/02/2022] Open
Abstract
The challenges encountered in performing minimally invasive approaches, such as supraorbital minicraniotomy (SOMC), in services without adequate equipment are rarely reported in the literature. This study analyzes the viability of SOMC in the treatment of cerebral aneurysms, using exactly the same resources as pterional craniotomy (PC). The results of these two techniques are compared. 35 patients underwent SOMC, compared to 50 patients underwent CP (100 aneurysms in total), using the same microsurgical instruments. The following variables were compared: operative time, angiographic cure, length of intensive care unit stay during the post-operative period, surgical complications, length of hospital stay after surgery until hospital discharge, intraoperative aneurysm rupture, aesthetic satisfaction with the scar, and neurological status at discharge. SOMC had a significantly shorter operative time in relation to PC (213.9 ± 11.09 min and 268.6 ± 15.44 min, respectively) (p = 0.0081).With respect to the cosmetic parameters assessed by the Visual Analog Scale, the average for SOMC was 94.12 ± 1.92 points, and the average for PC was 83.57 ± 4.75 points (p = 0.036). SOMC was as effective as PC in relation to successful aneurysm clipping (p = 0.77). The SOMC technique did not show advantages over PC in any other variable. Even in a general neurosurgery service lacking a specific structure for minimally invasive surgeries, SOMC was feasible and effective for treating intracranial aneurysms, using the same set of microsurgical instruments used for PC, obtaining better results in operating time and cosmetic satisfaction.
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Affiliation(s)
- Ricardo Brandão Fonseca
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil.
| | - Alyne Oliveira Correia
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Raysa Siqueira Vieira
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - José Erivaldo Fonseca Dos Santos
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Heverty Rocha Alves-Neto
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Anajara Ferraz da Silva Vieira
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Diego Ramon Ferreira Belém
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | | | | | - Jaques Waisberg
- Department of Surgery, ABC Medical School, Santo André, São Paulo, Brazil
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Abstract
Introduction and Objective: Annually, more than one hundred thousand new stomas are created in the United States and near 30-50% of those will develop parastomal hernia ( 1 ). Occasionally parastomal hernias may result in life threatening complications such as bowel obstruction or strangulation requiring urgent surgical intervention ( 2 ). The minimally invasive surgery for these hernias are preferred, specially when the primary case was either laparoscopic or robot-assisted. Our objective is to demonstrate a step-by-step robotic approach with and without mesh placement and their outcomes in two different scenarios: elective and emergency. Materials and Methods: We present two cases, a 56-year-old male with three years prior robot-assisted radical cystectomy with ileal conduit and a 82-year-old male with five year post operation of laparoscopic radical cystectomy with bilateral ureterostomies. Both of them had parastomal hernia, the first case was an urgency due to bowel obstruction while the second case was an elective procedure. Using three portals, we choose the primary repair for the first case and placement of a biological mesh within the keyhole technique ( 3 ) for the second one. Results: In the first case we had an operative time of 110min, total blood loss of 40cc and for the second case an operative time of 140min with total blood loss of 20cc. Both patients were discharged within 24h and had a follow-up of 2 years with no recurrence. Conclusions: The capability for complex sutures and dissection of intracorporeal structures makes the robotic platform a powerful ally ( 4 ) and we believe in its superiority over conventional laparoscopy. Although further studies are required, our initial series suggests that the robotic parastomal hernia repair is feasible and reproducible, with or without mesh placement and could be demonstrated its use for either elective or emergency situations.
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Affiliation(s)
- Marcos Tobias-Machado
- Faculdade de Medicina do ABC-FMABCSanto AndréSPBrasilFaculdade de Medicina do ABC-FMABC, Santo André, SP, Brasil
- Instituto do Câncer Dr. Arnaldo Vieira de CarvalhoSão PauloSPBrasilInstituto do Câncer Dr. Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
- Rede D'or São LuizSão PauloSPBrasilServiço de Urologia, Rede D'or São Luiz, São Paulo, SP, Brasil
| | - Daniel Coser Gomes
- Hospital Municipal Dr. José de Carvalho FlorenceSão José dos CamposSPBrasilServiço de Urologia, Hospital Municipal Dr. José de Carvalho Florence, São José dos Campos, SP, Brasil
| | - Eliney Ferreira Faria
- Hospital do Câncer de BarretosBarretosSPBrasilServiço de Urologia, Hospital do Câncer de Barretos, Barretos, SP, Brasil
| | - Hamilton de Campos Zampolli
- Instituto do Câncer Dr. Arnaldo Vieira de CarvalhoSão PauloSPBrasilInstituto do Câncer Dr. Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilServiço de Urologia, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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9
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Abstract
Penile squamous cell carcinoma (PSCC) is a rare cancer with orphan disease designation and a prevalence of 0.1-1 per 100,000 men in high-income countries, but it constitutes up to 10% of malignancies in men in some African, Asian and South American regions. Risk factors for PSCC include the absence of childhood circumcision, phimosis, chronic inflammation, poor penile hygiene, smoking, immunosuppression and infection with human papillomavirus (HPV). Several different subtypes of HPV-related and non-HPV-related penile cancers have been described, which also have different prognostic profiles. Localized disease can be effectively managed by topical therapy, surgery or radiotherapy. As PSCC is characterized by early lymphatic spread and imaging is inadequate for the detection of micrometastatic disease, correct and upfront surgical staging of the inguinal lymph nodes is crucial in disease management. Advanced stages of disease require multimodal management. Optimal sequencing of treatments and patient selection are still being investigated. Cisplatin-based chemotherapy regimens are the mainstay of systemic therapy for advanced PSCC, but they have poor and non-durable responses and high rates of toxic effects, indicating a need for the development of more effective and less toxic therapeutic options. Localized and advanced penile cancers and their treatment have profound physical and psychosexual effects on the quality of life of patients and survivors by altering sexual and urinary function and causing lymphoedema.
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Affiliation(s)
- Anita Thomas
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Andrea Necchi
- Genitourinary Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Asif Muneer
- Department of Urology, University College London Hospitals, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Marcos Tobias-Machado
- Section of Urologic Oncology, Department of Urology, ABC Medical School, Instituto do Cancer Vieira de Carvalho, São Paulo, Brazil
| | - Anna Thi Huyen Tran
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium. .,Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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10
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Faria EF, Maciel CVM, Berger A, Mitre A, Dauster B, Freitas CH, Fraga C, Chade D, Dall'Oglio M, Carvalho F, Campos F, Carvalhal GF, Lemos GC, Guimarães G, Zampolli H, Alves JR, Manzano JP, Fortes MA, Rocha MFH, Rubinstein M, Luz M, Romanelli P, Coelho R, Rocha R, Machado RD, Dos Reis RB, Zequi S, Guida R, Muglia V, Tobias-Machado M. Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus. J Robot Surg 2021; 15:829-839. [PMID: 33426578 DOI: 10.1007/s11701-020-01186-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts' panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.
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Affiliation(s)
| | | | - André Berger
- Hospital Moinhos de Vento, Porto Alegre , RS, Brazil
| | - Anuar Mitre
- University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Daher Chade
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
| | | | | | - Franz Campos
- Instituto Nacional do Cancer, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | | | - Murilo Luz
- Hospital Albert Einstein, São Paulo, SP, Brazil
| | | | - Rafael Coelho
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
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11
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Alcántara-Quispe C, Faria EF, Santos AC, Magnabosco WJ, Fantin J, Tobias-Machado M, Machado RD. Vaginal sparing in laparoscopic radical cystectomy for females: feasibility and technical notes. Int Braz J Urol 2020; 46:1109-1110. [PMID: 32822145 PMCID: PMC7527095 DOI: 10.1590/s1677-5538.ibju.2019.0021] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 11/06/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | - João Fantin
- Hospital de Cancer de Barretos - Urologia Barretos, Barretos, SP, Brasil
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12
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Cunha FLD, Arcoverde FVL, Andres MP, Gomes DC, Bautzer CRD, Abrao MS, Tobias-Machado M. Laparoscopic Treatment of Ureteral Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2020; 28:779-787. [PMID: 33253957 DOI: 10.1016/j.jmig.2020.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To review the literature for the preoperative clinical characteristics, surgical findings, and outcomes of patients who underwent laparoscopic surgical treatment of ureteral endometriosis (UE). DATA SOURCES A systematic search was performed in the PubMed and Scopus databases. METHODS OF STUDY SELECTION Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies in English language that assessed UE treated surgically by laparoscopy published between 2008 and 2020 were selected. TABULATION, INTEGRATION, AND RESULTS In an initial search, 1313 articles were identified, 193 in PubMed and 1120 in Scopus databases. A total of 1291 articles that did not meet eligibility criteria were excluded. The remaining 22 studies were included in the final qualitative analysis, with a total of 1337 patients. Data on preoperative patient's characteristics, preoperative imaging examinations, intraoperative findings, and postoperative complications were abstracted by 1 author. The descriptive nature of included studies prevented the performance of meta-analysis. Preoperative symptoms included dysmenorrhea (76.3%), pelvic pain (59.6%), dyspareunia (46.2%), lower urinary tract symptoms (21.3%), and ureteral obstructive symptoms (9.9%). Intraoperative findings showed that UE lesions were left-sided in 55% of the cases, right-sided in 28.9% of the cases, and bilateral in 8.7% of the cases. Ureterolysis alone or before another technique was performed in 69.1% of the cases, ureteral resection followed by ureteroureteral anastomosis in 6%, ureteroneocystostomy after ureteral resection in 21%, and nephrectomy in 0.45% of the patients. Double-J ureteral stent placement was reported in 33.3% of the cases. Concomitant resection of the bladder owing to endometriosis involvement was performed in 15.5% of the cases. The prevalence of ureteral injury was 3.1%. Postoperative complications included ureteral fistula (2.8%), ureteral stenosis (24.2%), persistence/recurrence of UE (3.8%), and reoperation for fistula and/or stricture treatment (3.9%). CONCLUSION UE is associated with common endometriosis pain symptoms and a low rate of lower urinary tract symptoms. The standard surgical technique for UE treatment is not yet a consensus; however, the laparoscopic approach with previous ureterolysis, leaving ureteral resection only for refractory cases, seems to be a safe and effective treatment, with improvement of symptoms and few intraoperative and postoperative complications.
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Affiliation(s)
| | | | - Marina Paula Andres
- Gynecologic Division, Departamento de Obstetrícia e Ginecologia. Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (Drs. Andres and Abrao); Gynecologic Division, Beneficência Portuguesa de São Paulo (Drs. Andres and Abrao)
| | - Daniel Coser Gomes
- Urology Division, Hospital Municipal Dr. José de Carvalho Florence, São José dos Campos (Dr. Gomes)
| | - Carlos Ricardo Doi Bautzer
- Urology Division, Hospital Sirio Libanês (Dr. Bautzer); Urology Division, ABC Medical School, Santo André (Drs. Bautzer and Tobias-Machado)
| | - Mauricio Simoes Abrao
- Gynecologic Division, Departamento de Obstetrícia e Ginecologia. Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (Drs. Andres and Abrao); Gynecologic Division, Beneficência Portuguesa de São Paulo (Drs. Andres and Abrao).
| | - Marcos Tobias-Machado
- Instituto do Câncer, Dr. Arnaldo Vieira de Carvalho (Drs. da Cunha and Tobias-Machado); Urology Division, ABC Medical School, Santo André (Drs. Bautzer and Tobias-Machado); Hospital São Luiz Morumbi, Rede D´Or (Dr. Tobias-Machado), São Paulo
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13
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Fantin JPP, Furst MCB, Tobias-Machado M, Muller RL, Machado RD, Santos AC, Magnabosco WJ, Alcantara-Quispe C, Faria EF. Role of salvage lymph node dissection in patients previously treated for prostate cancer: systematic review. Int Braz J Urol 2020; 47:484-494. [PMID: 33146973 PMCID: PMC7993961 DOI: 10.1590/s1677-5538.ibju.2020.0051] [Citation(s) in RCA: 4] [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: 01/24/2020] [Accepted: 05/09/2020] [Indexed: 12/03/2022] Open
Abstract
Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.
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14
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Taha A, Genes WEP, Zampolli HDC, Faria EF, Tobias-Machado M. Preliminary Results of Minimally Invasive Gracilis Muscle Transposition for Rectourethral Fistula Surgery. Surg Innov 2020; 28:511-512. [PMID: 32909930 DOI: 10.1177/1553350620959932] [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]
Affiliation(s)
- Anis Taha
- Faculdade de Medicina da Fundação do ABC, Santo André, Brazil.,Instituto de Câncer Dr Arnaldo Vieira de Carvalho, San Paulo, Brazil
| | - William E P Genes
- Urooncology and minimally invasive surgery, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | | | - Marcos Tobias-Machado
- Instituto de Câncer Dr Arnaldo Vieira de Carvalho, San Paulo, Brazil.,ABC Medical School, Santo André, Brazil
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15
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Tobias-Machado M, Genes WEP, Taha A, Lorenzetti FC, Quadros F, Zampolli HC, Pacheco LVE. Videoendoscopic gracilis muscle flap (VEGMF): A new minimally invasive technique for rectovesical fistula closure. Int Braz J Urol 2020; 46:1107-1108. [PMID: 32822144 PMCID: PMC7527081 DOI: 10.1590/s1677-5538.ibju.2019.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/20/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Anis Taha
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | | | - Felipe Quadros
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
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16
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Garza-Gangemi AM, Castillejos-Molina RA, Gueglio G, Tobia Gonzalez IP, Jurado AM, Meza-Montoya L, Scorticati CH, Henriques-da-Costa W, Yandian J, Ubillos L, Glina S, Tobias-Machado M, Rodríguez-Faba O, Ameri C, Nolazco A, Martinez P, Franco-Carvalhal G, Bengio RG, Cristian Arribillaga L, Langenhin R, Muguruza D, Campos-Salcedo JG, Bravo-Castro EI, Mingote PA, Ginestar N, Autran-Gomez AM, Langenhin R, Puente R, Decia R, Cardoso-Guimarães G, Langenhin R, Palou-Redorta J, Abreu-Clavijo D, de-Cassio-Zequi S, Rodriguez-Covarrubias FT. Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group. Rev Invest Clin 2020; 72. [PMID: 33057321 DOI: 10.24875/ric.20000018] [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] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. OBJECTIVE The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. METHODS This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (less than 75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. RESULTS There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p less than 0.01) and higher ASA score (ASA > 2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p less than 0.01), EBL ≥ 500 cc (OR 3.34, p less than 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. CONCLUSIONS Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities.
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Affiliation(s)
- Adrián M Garza-Gangemi
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gustavo Franco-Carvalhal
- School of Medicine,Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | | | - Raúl Langenhin
- Corporación Médica de Paysandú (COMEPA),Paysandu,Uruguay
| | - Diego Muguruza
- Corporación Médica de Paysandú (COMEPA),Paysandu,Uruguay
| | | | | | | | | | | | - Raúl Langenhin
- Corporación Médica de Paysandú (COMEPA),Paysandu,Uruguay
| | | | | | | | - Raúl Langenhin
- Corporación Médica de Paysandú (COMEPA),Paysandu,Uruguay
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17
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Elbalka SS, Taha A, Srinivas C, Hegazy MA, Kotb SZ, Elnahas W, Farouk O, Metwally IH, Elzahaby IA, Abdelwahab K, Fathi A, Tobias-Machado M, Nayak SP. Short-Term Surgical Outcomes of Standard and Lateral Video Endoscopic Inguinal Lymphadenectomy: A Multinational Retrospective Study. J Laparoendosc Adv Surg Tech A 2020; 30:373-377. [DOI: 10.1089/lap.2019.0733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Anis Taha
- Faculdade de Medicina do ABC, Santo Andre, Brazil
| | | | | | - Sherif Z. Kotb
- Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Waleed Elnahas
- Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Omar Farouk
- Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | | | | | | | - Adel Fathi
- Oncology Center Mansoura University (OCMU), Mansoura, Egypt
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18
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Laranja WW, Pereira TA, Guimarães PVB, Tobias-Machado M, Leandro-Merhi VA, de Aquino JLB, Reis LO. Do rapid emotional thermometers correlate with multidimensional validated structured questionnaires in low-risk prostate cancer? Int Urol Nephrol 2020; 52:1073-1078. [PMID: 32056135 DOI: 10.1007/s11255-020-02399-w] [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: 12/11/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To promptly identify mental suffering in low-risk prostate cancer (LRPC) patients, vulnerable to over- and undertreatment, we evaluated the correlation of rapid emotional thermometers (ET) with multidimensional validated structured questionnaires. METHODS At diagnosis, consecutive LRPC patients underwent five ET domains: emotional suffering, anxiety, depression (DT), revolt and need for help and multidimensional questionnaires: beck anxiety inventory (BAI), beck depression inventory (BDI), beck hopelessness scale, SF36 (physical functioning PF, role limitations due to physical health RP, bodily pain BP, general health perceptions GH, vitality VT, social functioning SF, role limitations due to emotional problems RE and general mental health MH), international index of erectile function and international prostate symptom score (IPSS). RESULTS Among 30 included patients, mean age 67.4 y (52-74), 20 days after the diagnosis (15-30), mean time to obtain ET 27 s (15-57) and all questionnaires 36.7 min (31-49), ETs showed moderate/strong Spearman correlation among themselves. DT domain displayed the best correlation to most of the multidimensional validated structured questionnaires: moderate to BDI, SF-36 (PF, GH, VT, SF, RE, MH) and IPSS and strong to BAI. CONCLUSION DT revealed the best correlation to validated structured questionnaires of diverse dimensions with clear potential for quick screening of patients with psychological suffering and in need of further evaluation and support.
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Affiliation(s)
- Walker Wendell Laranja
- UroScience, University of Campinas and Pontifical Catholic University of Campinas, Campinas, SP, Brazil
| | - Thairo Alves Pereira
- UroScience, University of Campinas and Pontifical Catholic University of Campinas, Campinas, SP, Brazil
| | | | - Marcos Tobias-Machado
- UroScience, University of Campinas and Pontifical Catholic University of Campinas, Campinas, SP, Brazil
| | | | - José Luis Braga de Aquino
- UroScience, University of Campinas and Pontifical Catholic University of Campinas, Campinas, SP, Brazil
| | - Leonardo Oliveira Reis
- UroScience, University of Campinas and Pontifical Catholic University of Campinas, Campinas, SP, Brazil.
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19
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Tobias-Machado M, Pazeto CL, Borges RC. Robot-assisted transvesical partial cystectomy for leiomyoma of bladder trigone. Int Braz J Urol 2020; 46:300. [PMID: 32022531 PMCID: PMC7025855 DOI: 10.1590/s1677-5538.ibju.2018.0801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 07/02/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Marcos Tobias-Machado
- Disciplina de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil.,Departamento de Urologia, Instituto do Câncer Dr. Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil.,Serviço de Urologia, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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20
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Tobias-Machado M, Genes WEP, Pazeto CL, Faria EF, Zampolli HC. Robotic-assisted surgical removal of retroperitoneal schwannoma by transmesocolic access. Int Braz J Urol 2020; 46:143-144. [PMID: 31851478 PMCID: PMC6968896 DOI: 10.1590/s1677-5538.ibju.2018.0624] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Schwannoma are usually benign tumors, most of the cases are asymptomatic, and others may present symptoms by compression. In the literature robotic surgery were described in 8 cases. We emphasize that robotic surgery improves visualization and enable the performance of this procedure. Objectives: Describe and evaluate the results and benefits of resection of a retroperitoneal tumor by means of robotic surgery by transmesocolic access. Materials and methods: We present a case of a 34 year old patient, with low back pain, who were diagnosed with a retroperitoneal tumor in which an incisional biopsy by laparoscopy was previously performed with the diagnosis of schwannoma, measuring 4.1cm x 3 cm next to the left renal hilum and near to abdominal aorta. Robotic surgery was performed. It was possible to localize the vena cava, aorta and left renal hilum and consequently it was possible to preserve the adjacent structures. The resection of the tumor was carried out carefully allowing complete tumor resection. Results: The total of procedure time was 230 minutes, blood loss was 60ml, 1 day of hospital stay without complications. The histopathological findings confirmed benign Schwannoma. Conclusion: The maximization of robotic surgery images offers dexterity and dissection capacity, required for the complex dissection of masses in the retroperitoneum. It is safe and effective for removing benign retroperitoneal schwannomas when performed by experienced surgeons. This transmesocolic robotic assisted surgical approach could be an option in selected cases.
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21
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Tobias-Machado M, Pazeto CL, Faria EF, Dauster B, Genes WEP, Nishimoto RH. Robot-assisted Simple Prostatectomy with Tunnel-Shaped Trigonization (RASP-TST) - A Novel Technique. Int Braz J Urol 2019; 45:858. [PMID: 30785701 PMCID: PMC6837598 DOI: 10.1590/s1677-5538.ibju.2018.0611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 12/04/2018] [Indexed: 12/03/2022] Open
Abstract
To describe a technical modification for robotic-assisted simple prostatectomy (RASP) using three-steps reconstruc¬tive technique to achieve a 360 trigonization of the bladder mucosa. Through five-trocars transperitoneal access, we perform a longitudinal incision of the bladder wall and prostate capsule. Our technique of RASP is very similar to the standard operative technique described during laparoscopic and robotic removal of adenoma, however, for reconstruction, we propose the Tunnel-Shaped Trigonization (TST). The first step is the advancement of a bladder mucosa flap until the posterior part of the prostatic urethra. The second step, a running suture between the advanced mucosa and the prostatic capsule is done bilaterally. At this point, the prostate capsule should be totally isolated from the rest of the urinary tract. Finally, the third step is closing both sides of the capsule and bladder mucosa anteriorly identical to a tunnel conformation. Hiding the prostatic capsule optimizes the patient recovery since hematuria is the most related factor for hospital stay length. This pilot-case has shown satisfactory results without the need for continuous bladder irrigation. The prostate volume in the TRUS was 130 cm3 and the preoperative International Prostate Symptom score was 24. He was discharged at second postoperative day and no late complications were detected. In conclusion, the TST-RASP seems to be a safe and feasible modification of the RASP. We hope that the application of the TST can lead us to lower rates of blood loss, transfusion and postoperative complications in comparison to the standard technique.
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Affiliation(s)
| | | | | | - Breno Dauster
- Serviço de Urologia, Hospital São Rafael, Salvador, BA, Brasil
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22
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Lamacchia GB, Korkes F, Baccaglini W, de Mello LGM, Szwarc M, Tobias-Machado M. A large series of extracorporeal shockwave lithotripsy in the very elderly. Ther Adv Urol 2019; 11:1756287219870412. [PMID: 31467593 PMCID: PMC6704411 DOI: 10.1177/1756287219870412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/15/2019] [Indexed: 12/23/2022] Open
Abstract
Background: The incidence of urinary lithiasis has been increasing in recent decades at all ages, including the elderly. In parallel, the world population is aging and there is a paucity of data on treatment of urinary stones in very elderly people. Our main objective was to evaluate the effects of extracorporeal shockwave lithotripsy (ESWL) in patients older than 75 years, and the characteristics of this population. Complications and mortality rates after this procedure in octogenarians were also described. Methods: We retrospectively evaluated very elderly patients who underwent ESWL at our institution from 1998 to 2015, through chart review, telephone interviews, and consultation with the municipal mortality information program. Measured outcomes included demographic and clinical data, ESWL characteristics and complications, interval between ESWL and death, and cause of death. Results: Demographic and treatment characteristics were similar between very elderly and younger patients who underwent ESWL during the same period. No severe complications occurred among older patients. Octogenarians treated in our cohort had a significant life expectancy when ESWL procedures were performed. Even though 38.9% of the patients passed away during the studied period, mortality occurred on average 4.38 years after the ESWL session. Conclusions: In conclusion, ESWL has been used by urologists as a first-line treatment for uncomplicated urinary calculi in very elderly patients. Despite changes associated with aging, and the high prevalence of comorbidities, this procedure seems to be safe and well tolerated in elderly people.
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Affiliation(s)
- Guilherme Braga Lamacchia
- Discipline of Urology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
- Department of Urology, Hospital São Luiz Jabaquara, São Paulo, SP, Brazil
| | - Fernando Korkes
- Discipline of Urology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
- Division of Urology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Willy Baccaglini
- Discipline of Urology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | | | - Marcelo Szwarc
- Discipline of Urology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
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Borges RC, Tobias-Machado M, Gabriotti EN, Dos Santos Figueiredo FW, Bezerra CA, Glina S. Post-radical prostatectomy urinary incontinence: is there any discrepancy between medical reports and patients' perceptions? BMC Urol 2019; 19:32. [PMID: 31060521 PMCID: PMC6501406 DOI: 10.1186/s12894-019-0464-6] [Citation(s) in RCA: 16] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/18/2019] [Indexed: 11/21/2022] Open
Abstract
Background Post-radical prostatectomy urinary incontinence (PPI) negatively affects the quality of life of patients. Accurate identification of the problem by physicians is essential for adequate postoperative management. In this study we sought to access whether there is, for urinary incontinence, any discrepancy between medical reports and the perception of patients. Methods We performed a retrospective analysis of medical records of 337 patients subjected to radical retropubic prostatectomy (RRP) between 2005 and 2010. Sociodemographic variables were collected, as well as continence status over the course of treatment. Next, we contacted patients by phone to determine continence status at present and at time of their last appointment, as well as to apply ICIQ – SF questionnaire. Poisson regression model with robust variance was used to estimate the factors associated with discrepancy, using the stepwise backward strategy. Software used was Stata® (StataCorp, LC) version 11.0. Results There is discrepancy between medical reports and patients’ perceptions in 42.2% of cases. This discrepancy was found in 56% of elderly patients and 52% of men with low schooling, with statistical significance in these groups (p = 0.069 and 0.0001, respectively), whereas in multivariate regression analysis the discrepancy rate was significantly higher in black men (discrepancy rate of 52.6%) with low schooling (p = 0.004 and 0.043, respectively). Conclusion There is discrepancy between medical reports and the perception of black men with low schooling in respect to post-radical prostatectomy urinary incontinence and a need for more thorough investigation of this condition in patients that fit this risk profile.
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Affiliation(s)
- Rafael Castilho Borges
- Department of Urology, Faculdade de Medicina do ABC, No.2000, Avenue Lauro Gomes, Santo André, 09051-040, Brazil.
| | - Marcos Tobias-Machado
- Department of Urology, Faculdade de Medicina do ABC, No.2000, Avenue Lauro Gomes, Santo André, 09051-040, Brazil
| | - Estefânia Nicoleti Gabriotti
- Department of Urology, Faculdade de Medicina do ABC, No.2000, Avenue Lauro Gomes, Santo André, 09051-040, Brazil
| | | | - Carlos Alberto Bezerra
- Department of Urology, Faculdade de Medicina do ABC, No.2000, Avenue Lauro Gomes, Santo André, 09051-040, Brazil
| | - Sidney Glina
- Department of Urology, Faculdade de Medicina do ABC, No.2000, Avenue Lauro Gomes, Santo André, 09051-040, Brazil
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da Silva MNR, Mendes A, Martins JRM, Tobias-Machado M, Pinhal MADS. Prospective Evaluation of Chondroitin Sulfate, Heparan Sulfate and Hyaluronic Acid in Prostate Cancer. Int Braz J Urol 2019; 44:1139-1146. [PMID: 30516927 PMCID: PMC6442162 DOI: 10.1590/s1677-5538.ibju.2017.0569] [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: 10/24/2017] [Accepted: 06/11/2018] [Indexed: 01/08/2023] Open
Abstract
Purpose: The present study evaluates chondroitin sulfate (CS) and heparan sulfate (HS) in the urine and hyaluronic acid (HA) in the plasma of patients with prostate cancer before and after treatment compared to a control group. Materials and Methods: Plasma samples were used for HA dosage and urine for quantification of CS and HS from forty-four cancer patients and fourteen controls. Clinical, laboratory and radiological information were correlated with glycosaminoglycan quantification by statistical analysis. Results: Serum HA was significantly increased in cancer patients (39.68 ± 30.00 ng/ mL) compared to control group (15.04 ± 7.11 ng/mL; p=0.004) and was further increased in high-risk prostate cancer patients when compared to lower risk patients (p = 0.0214). Also, surgically treated individuals had a significant decrease in seric levels of heparan sulfate after surgical treatment, 31.05 ± 21.01 μg/mL (before surgery) and 23.14 ± 11.1 μg/mL (after surgery; p=0.029). There was no difference in the urinary CS and HS between prostate cancer patients and control group. Urinary CS in cancer patients was 27.32 ± 25.99 μg/mg creatinine while in the men unaffected by cancer it was 31.37 ± 28.37 μg/mg creatinine (p=0.4768). Urinary HS was 39.58 ± 32.81 μg/ mg creatinine and 35.29 ± 28.11 μg/mg creatinine, respectively, in cancer patients and control group (p=0.6252). Conclusions: Serum HA may be a useful biomarker for the diagnosis and prognosis of prostate cancer. However, urinary CS and HS did not altered in the present evaluation. Further studies are necessary to confirm these preliminary findings.
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Affiliation(s)
- Matheus Neves Ribeiro da Silva
- Departamento de Bioquímica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil.,Departmento de Urologia Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Aline Mendes
- Departamento de Bioquímica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
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Meneses AD, Mattos PAL, Eulálio WMN, Fé TSDM, Rodrigues RMDM, Tobias-Machado M. Initial experience of video endoscopic inguinal Lymphadenectomy in a center located at northeast brazilian region. Int Braz J Urol 2019; 45:325-331. [PMID: 30676302 PMCID: PMC6541140 DOI: 10.1590/s1677-5538.ibju.2018.0521] [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: 07/30/2018] [Accepted: 11/30/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction: Video endoscopic inguinal lymphadenectomy – VEIL – has emerged as an alternative to reduce post-surgical complications (PSC) in patients with penile cancer submitted to inguinal lymphadenectomy (IL). In some series, these PSC are observed in more than 50% of patients. The objectives of the present study are to describe the initial experience of VEIL in a Hospital in Teresina, PI, Brazil, and to analyze PSC incidence. Material and Methods: Retrospective descriptive study of patients submitted to VEIL from March 2014 to November 2015. Data were collected regarding surgical time, bleeding, complications, lymph node number, conversion, global complications, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. Results: 20 lower limbs of 11 patients were operated. Mean age was 51.4 (24-72) years. Mean surgical time was 85 (60-120) minutes. No patient showed intrasurgical complications, bleeding > 50 mL or conversion. Three surgeries evolved with lower limb edema, 2 with lymphoceles and one patient had cutaneous necrosis and another bulging of surgical wound. Mean time of hospitalization was 4 (2-11) days. A mean of 5.8 (1-12) lymph nodes were dissected in each surgery. Conclusion: VEIL is a safe and easy technique with lower incidence of PSC that can be reproduced in small centers.
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Abstract
Purpose Prostate cancer is one of the most common cancers in men, with higher prevalence in developed countries. Nothing much is known regarding the incidence and mortality of prostate cancer in Brazilian population or among the indigenous groups in Brazil. Therefore, this study aimed to correlate prostate-specific antigen (PSA) level and age in the tribe with Macuxi ethnicity, from the jungles of Amazon (between Brazil and Venezuela). Patients and methods This was an epidemiological cross-sectional study aimed to find the correlation between age and PSA in the 110 Brazilian Indian tribal men of Macuxi ethnicity. Serum PSA levels (total and free PSA [tPSA and fPSA]) were screened and analyzed considering age groups. Results We found that there was a significant correlation between the age and either tPSA (p=0.016) or fPSA (p=0.036). Interestingly, there was no correlation between tPSA and fPSA with any of the age groups, but we found a significant correlation between fPSA and tPSA in only the age groups 60-69 years and 70-80 years (p=0.008). Conclusion In this study, we found a significant correlation between tPSA, fPSA, and the age of patients. However, the age-specific correlation was insignificant. From our current findings, we found that the levels of PSA may be considered as an important determinant in determining this correlation and specificity, even though more work needs to be done to verify this. Although PSA screening is a valuable research tool for male patients, the low specificity of the screening might provide false-positive results leading to overtreatment.
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Affiliation(s)
| | | | - Marcos Tobias-Machado
- Section of Urologic Oncology, Department of Urology, ABC Medical School, Sao Paulo, Brazil
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Carneiro A, Barbosa ÁRG, Takemura LS, Kayano PP, Moran NKS, Chen CK, Wroclawski ML, Lemos GC, da Cunha IW, Obara MT, Tobias-Machado M, Sowalsky AG, Bianco B. The Role of Immunohistochemical Analysis as a Tool for the Diagnosis, Prognostic Evaluation and Treatment of Prostate Cancer: A Systematic Review of the Literature. Front Oncol 2018; 8:377. [PMID: 30280090 PMCID: PMC6153326 DOI: 10.3389/fonc.2018.00377] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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] [Received: 06/20/2018] [Accepted: 08/23/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Prostate cancer (PCa) is a heterogeneous disease that lends itself toward numerous therapeutic options depending on its risk stratification. One of the greatest challenges in PCa urologic practice is to select patients who should be referred for biopsy and, for those patients who are diagnosed with cancer, to differentiate between patients with indolent disease from those with an unfavorable prognosis and, to determine ideal patient management and avoid unnecessary interventions. Accordingly, there is a growing body of literature reporting immunohistochemical studies with the objective of determining a prostate cancer prognosis. Among the most frequent biomarkers studied are Ki-67, p53, PTEN, MYC, and ERG. Based on these findings, we systematically reviewed articles that assessed the role of these main prognostic markers in prostate cancer. Methods: Consistent with PRISMA guidelines, we performed a systematic literature search throughout the Web of Science and PubMed Medline databases. We considered all types of studies evaluating the role of Ki-67, p53, PTEN, MYC, and ERG immunohistochemical analysis in prostate cancer until July 2017. Results: We identified 361 articles, 44 of which were summarized in this review. Diagnostically, no single immunohistochemical marker was able to define a tumor as benign or malignant. Prognostically, Ki-67, p53, and MYC were related to the tumor grade given by Gleason score and to the tumor stage (higher levels related to higher tumor grade). Furthermore, Ki-67 was also related to higher PSA levels, shorter disease-free intervals and shorter tumor-specific survival; the latter was also related to p53. The loss of PTEN protein expression showed a higher association with biochemical recurrence and with a worse prognosis, beyond that predicted by the Gleason score and tumor stage. ERG staining also showed a strong association with biochemical recurrence. Conclusion: There are several studies relating immunohistochemical markers with clinical-laboratorial outcomes in prostate cancer, the most frequent being Ki-67, p53, ERG, PTEN, and MYC. However, none of these markers have been validated by literary consensus to be routinely applied in medical practice.
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Affiliation(s)
- Arie Carneiro
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | - Carolina Ko Chen
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Langer Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Marcos Takeo Obara
- Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Adam G Sowalsky
- Laboratory of Genitourinary Cancer Pathogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Bianca Bianco
- Human Reproduction and Genetics Center, Faculdade de Medicina do ABC, Santo André, Brazil
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Carneiro A, Priante Kayano P, Gomes Barbosa ÁR, Langer Wroclawski M, Ko Chen C, Cavlini GC, Reche GJ, Sanchez-Salas R, Tobias-Machado M, Sowalsky AG, Bianco B. Are localized prostate cancer biomarkers useful in the clinical practice? Tumour Biol 2018; 40:1010428318799255. [PMID: 30204063 PMCID: PMC6602068 DOI: 10.1177/1010428318799255] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer presents itself in a heterogeneous way with both aggressive and indolent forms. Despite the controversy
surrounding its use, prostate-specific antigen screening ultimately leads to a greater number of diagnosed patients. One of the
biggest challenges in clinical practice is to select the right patients for biopsy and, among diagnosed patients, to differentiate
tumors with an indolent course from those with an unfavorable prognosis, in order to determine the best therapeutic decision for
each case, avoiding unnecessary interventions. Currently, several types of biomarkers are available for clinical use in patients
with prostate cancer, which include blood-based (prostate-specific antigen, Prostate Health Index®, 4K score®);
urine sample-based (PCA3, SelectMDx®, ExoDx Prostate IntelliScore®); and biopsy, transurethral resection, or radical
prostatectomy tissue-based (ConfirmMDx®, Oncotype®, Prolaris®, Decipher®). The aim of this review is
to provide an overview of the current state of evidence and to highlight recent advances in the evaluation and diagnosis of
prostate cancer, with emphasis on biomarkers related to diagnosis and to prognostic evaluation of localized prostate cancer.
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Affiliation(s)
- Arie Carneiro
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil.,2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Paulo Priante Kayano
- 2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Álan Roger Gomes Barbosa
- 2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Langer Wroclawski
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil.,2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carolina Ko Chen
- 2 Discipline of Urology, Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Giulio Costa Cavlini
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Guilherme Jose Reche
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil
| | | | - Marcos Tobias-Machado
- 1 Discipline of Urology, Department of Surgery, Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Adam G Sowalsky
- 4 Laboratory of Genitourinary Cancer Pathogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bianca Bianco
- 5 Center for Human Reproduction and Genetics, Department of Collective Health, Faculdade de Medicina do ABC, São Paulo, Brazil
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Cartapatti M, Machado RD, Muller RL, Magnabosco WJ, Santos AC, Chapin BF, Melani A, Talvane A, Tobias-Machado M, Faria EF. Synchronous abdominal tumors: is combined laparoscopic surgery in a single approach a safe option? Int Braz J Urol 2018; 44:483-490. [PMID: 29219275 PMCID: PMC5996783 DOI: 10.1590/s1677-5538.ibju.2017.0429] [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: 07/18/2017] [Accepted: 10/13/2017] [Indexed: 12/28/2022] Open
Abstract
Background and Purpose: Recent advances in cancer treatment have resulted in bet- ter prognosis with impact on patient's survival, allowing an increase in incidence of a second primary neoplasm. The development of minimally invasive surgery has provided similar outcomes in comparison to open surgery with potentially less mor- bidity. Consequently, this technique has been used as a safe option to simultaneously treat synchronous abdominal malignancies during a single operating room visit. The objective of this study is to describe the experience of two tertiary cancer hospitals in Brazil, in the minimally invasive treatment of synchronous abdominal neoplasms and to evaluate its feasibility and peri-operative results. Materials and Methods: We retrospectively reviewed the data from patients who were submitted to combined laparoscopic procedures performed in two tertiary hospitals in Brazil from May 2009 to February 2015. Results: A total of 12 patients (9 males and 3 females) with a mean age of 58.83 years (range: 33 to 76 years) underwent combined laparoscopic surgeries for the treatment of at least one urological disease. The total average duration of surgery was 339.8 minutes (range: 210 to 480 min). The average amount of intraoperative bleeding was 276.6mL (range: 70 to 550mL) and length of hospitalization was 5.08 days (range: 3 to 10 days). Two patients suffered minor complications regarding Clavien system during the immediate postoperative period. Conclusions: Combined laparoscopic surgery for the treatment of synchronous tumors is feasible, viable and safe. In our study, there was a low risk of postoperative morbidity.
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Tobias-Machado M, Pazeto CL, Neves-Neto OC, Nunes-Silva I, Zampolli HDC. A Safe teaching protocol of LRP (laparoscopic radical prostatectomy). Int Braz J Urol 2018; 44:273-279. [PMID: 28853815 PMCID: PMC6050564 DOI: 10.1590/s1677-5538.ibju.2017.0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/08/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The LRP has a steep learning curve to obtain proficiency during which patient safety may be compromised. We present an adapted modular training system which purpose to optimize the learning curve and perform a safe surgery. MATERIALS AND METHODS A retrospective analysis of the LRP safe learning protocol applied during a fellowship program over eight years (2008-2015). The surgery was divided in 12 steps and 5 levels of difficulty. A maximum time interval was stipulated in 240 minutes. After an adaptation, the fellows had 120 minutes to perform all the corresponding modules to its accumulated skill. The participants gradually and safely pass through the steps and difficulty levels. Surgeries performed by fellows were analyzed as a single group and compared to a prior series performed by tutor. RESULTS In eight years, 250 LRP were performed (25 per apprentice) during fellowship program and 150 procedures after completion. The baseline characteristics were comparable. Most cases operated were of intermediate risk. Mean operative time was longer in the fellow group when compared to the tutor (150 min). Mean estimated blood loss were similar among the groups. Functional and oncological outcomes were better in the Tutor´s group. No conversion to open surgery was performed. CONCLUSIONS The LRP safe learning protocol proved to be an effective method to optimize the learning curve and perform safe surgery. However, the tutor's functional and oncological results were better, showing that this is a procedure with a steep learning curve and proficiency demands more than 25 cases.
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Affiliation(s)
| | | | | | - Igor Nunes-Silva
- Instituto do Câncer Arnaldo Vieira de Carvalho - IAVC , São Paulo, SP, Brasil
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Tobias-Machado M, Fonseca F, Fantinato AP, Bendit I, Wroclawski ML, Wroclawski E, del Giglio A. Cytokeratin 19 Expression by Reverse Transcriptase-Polymerase Chain Reaction in the Peripheral Blood of Prostate Cancer Patients. Tumori 2018; 91:248-52. [PMID: 16206649 DOI: 10.1177/030089160509100307] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Sensitive reverse transcriptase-polymerase chain reaction-based techniques for detection of epithelial antigen expression, such as cytokeratin 19, in the peripheral blood mononuclear fraction of prostate cancer patients may allow the detection of tumor progression at A molecular level. Methods We studied cytokeratin 19 expression by reverse transcriptase-polymerase chain reaction in peripheral blood mononuclear cell samples of 10 control men and serially in 44 patients with prostate cancer every three months for 18 months. Results None of the 10 normal control men expressed cytokeratin 19 in their peripheral blood mononuclear fraction. In the patients, cytokeratin 19 positivity at entry was not associated with age, Gleason score, clinical stage, prostate-specific antigen or alkaline phosphatase. Interestingly, having at least one positive cytokeratin 19 result during follow-up correlated significantly with time to prostate-specific antigen progression (P = 0.049), especially in the subgroup of metastatic patients (P = 0.032). Conclusions We conclude that cytokeratin 19 expression by reverse transcriptase-polymerase chain reaction in the peripheral blood mononuclear cell fraction of prostate cancer patients correlates with time to prostate-specific antigen progression. Further studies are needed to confirm these findings.
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Affiliation(s)
- Marcos Tobias-Machado
- Disciplina de Urologia da Faculdade de Medicina da Fundação ABC, FMUSP, S Paulo, Brazil
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Garza-Gangemi AM, Castillejos-Molina RA, Gueglio Saccone MG, Jurado A, Meza Montoya L, Scorticati C, Lopez M, da Costa WH, Yandian J, Ubillos L, Glina S, Tobias-Machado M, Rodríguez Faba O, Ameri CA, Nolazco A, Martinez P, Carvalhal G, Cauduro C, Barrios PM, Bengio R, Arribillaga L, Langenhin R, Muguruza D, Campos Salcedo JG, Bravo Castro EI, Mingote P, Ginastar N, Puente R, Decia R, Cardoso Guimarães G, Palau J, Abreu-Clavijo D, Zequi SDC, Rodríguez-Covarrubias F. MP59-02 CHARACTERISTICS AND PERIOPERATIVE OUTCOMES FOLLOWING SURGICAL TREATMENT FOR RENAL CELL CARCINOMA IN VERY ELDERLY PATIENTS (≥75 YEARS): DATA FROM THE LATIN AMERICAN RENAL CANCER GROUP (LARCG). J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1854] [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: 11/28/2022]
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Rebouças RB, Monteiro RC, Lima JPP, Almeida FPBF, Britto CA, Tobias-Machado M, Passerotti C. The pubovesical complex-sparing technique on laparoscopic radical prostatectomy. Int Braz J Urol 2018; 44:844-845. [PMID: 29493182 PMCID: PMC6092663 DOI: 10.1590/s1677-5538.ibju.2017.0359] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/10/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution. Presentation: A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment. A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed. Results: The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection. Conclusion: The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe. Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes.
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Affiliation(s)
- Rafael Batista Rebouças
- Departamento de Urologia, Hospital da Polícia Militar Edson Ramalho, João Pessoa, PB, Brasil.,Departamento de Urologia, Universidade de João Pessoa - UNIPE, João Pessoa, PB, Brasil.,Departamento de Uro-oncológica, Hospital São Vicente de Paulo, João Pessoa, PB, Brasil
| | - Rodrigo Campos Monteiro
- Departamento de Urologia, Hospital da Polícia Militar Edson Ramalho, João Pessoa, PB, Brasil.,Departamento de Uro-oncológica, Hospital São Vicente de Paulo, João Pessoa, PB, Brasil
| | - João Paulo Pereira Lima
- Departamento de Urologia, Hospital da Polícia Militar Edson Ramalho, João Pessoa, PB, Brasil
| | | | - Cesar Araujo Britto
- Departamento de Urologia, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil
| | | | - Carlo Passerotti
- Centro de Cirurgia Robótica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil.,Departamento de Urologia, Escola de Medicina de São Paulo - Laboratório de Investigação Médica (LIM55), São Paulo, SP, Brasil
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Fantinato AP, Tobias-Machado M, Fonseca F, Pinto JLF, Wroclawski ML, Wroclawski E, Verotti M, Del Giglio A. Her2/neu Expression by Reverse Transcriptase-Polymerase Chain Reaction in the Peripheral Blood of Prostate Cancer Patients. Tumori 2018; 93:467-72. [DOI: 10.1177/030089160709300510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background/Aims Evaluation of Her2/neu expression in the peripheral blood mononuclear cell fraction of prostate cancer patients by RT-PCR may afford an opportunity for the detection of circulating tumor cells and thus serve as a marker of micrometastatic disease. Methods We studied Her2/neu expression by reverse transcriptase-polymerase chain reaction in peripheral blood mononuclear cell fraction samples of 21 controls and serially in 43 patients with prostate cancer. Results None of the 21 controls expressed Her2/neu whereas 23.25% (95% CI, 11.75–38.63) of the patients were positive at entry into the study, and 65.11% (95% CI, 49.07–78.99) of them had at least one positive result during the follow-up period. Her2/neu positivity at study entry did not correlate significantly with PSA level, Gleason score, clinical stage or time to PSA progression. When we analyzed only patients with advanced disease, we observed a trend towards a shorter time to PSA progression in patients with at least one positive Her2/neu result during the follow-up (log-rank test, P = 0.08). Conclusions We conclude that Her2/neu expression in the peripheral blood mononuclear cell fraction of prostate cancer patients is frequent and therefore this assay may potentially be useful to detect the presence of micrometastatic disease in men with prostate cancer and for monitoring patients enrolled in trastuzumab-based therapeutic protocols.
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Affiliation(s)
- Ana Paula Fantinato
- Disciplina de Hematologia e Oncologia da Faculdade de Medicina da Fundação ABC, São Paulo
- Postgraduate student from Disciplina de clínica Médica UNIFESP, São Paulo
| | - Marcos Tobias-Machado
- Disciplina de Urologia da Faculdade de Medicina da Fundação ABC, São Paulo
- Postgraduate student from Disciplina de Hematologia e Hemoterapia da FMUSP, São Paulo, Brazil
| | - Fernando Fonseca
- Disciplina de Urologia da Faculdade de Medicina da Fundação ABC, São Paulo
| | - Jorge Luiz Freire Pinto
- Disciplina de Hematologia e Oncologia da Faculdade de Medicina da Fundação ABC, São Paulo
- Postgraduate student from Disciplina de clínica Médica UNIFESP, São Paulo
| | | | - Eric Wroclawski
- Disciplina de Urologia da Faculdade de Medicina da Fundação ABC, São Paulo
| | - Maurício Verotti
- Disciplina de Urologia da Faculdade de Medicina da Fundação ABC, São Paulo
| | - Auro Del Giglio
- Disciplina de Hematologia e Oncologia da Faculdade de Medicina da Fundação ABC, São Paulo
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Neto AS, Tobias-Machado M, Wroclawski ML, Fonseca FLA, Pompeo ACL, Del Giglio A. Molecular Oncogenesis of Prostate Adenocarcinoma: Role of the Human Epidermal Growth Factor Receptor 2 (HER-2/neu). Tumori 2018; 96:645-9. [DOI: 10.1177/030089161009600501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The potential mechanisms involving the genesis and growth of androgen-independent prostate cancer include super-expression of the androgen receptor (AR), in an attempt to compensate for the low androgenic plasma levels and mutations of this specific receptor, which could determine resistance to anti-androgenic therapy. However, most advanced prostate tumors have no mutations or amplifications of the AR, suggesting a potential role of non-androgenic growth factors, including epidermal growth factor (EGF), transforming growth factor α, insulin-like growth factor (IGF-1) and fibroblast growth factor. More specifically, these factors, and their receptors like EGFR (HER-1) and HER-2/neu, through paracrine and autocrine mechanisms, may contribute to the proliferation and growth of prostate cancer. Free full text available at www.tumorionline.it
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Affiliation(s)
- Ary Serpa Neto
- Urologic Oncology Division, Department of Urology, ABC Medical School (FMABC), Santo André
| | - Marcos Tobias-Machado
- Urologic Oncology Division, Department of Urology, ABC Medical School (FMABC), Santo André
- Research Institute, Albert Einstein Jewish Hospital (IEP-HIAE), São Paulo
| | - Marcelo Langer Wroclawski
- Urologic Oncology Division, Department of Urology, ABC Medical School (FMABC), Santo André
- Research Institute, Albert Einstein Jewish Hospital (IEP-HIAE), São Paulo
| | - Fernando Luiz Affonso Fonseca
- Research Institute, Albert Einstein Jewish Hospital (IEP-HIAE), São Paulo
- Oncology Division, Department of Clinical Oncology and Hematology, ABC Medicine School (FMABC), Santo André, Brazil
| | | | - Auro Del Giglio
- Research Institute, Albert Einstein Jewish Hospital (IEP-HIAE), São Paulo
- Oncology Division, Department of Clinical Oncology and Hematology, ABC Medicine School (FMABC), Santo André, Brazil
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Tourinho-Barbosa RR, Tobias-Machado M, Castro-Alfaro A, Ogaya-Pinies G, Cathelineau X, Sanchez-Salas R. Complications in robotic urological surgeries and how to avoid them: A systematic review. Arab J Urol 2017; 16:285-292. [PMID: 30140463 PMCID: PMC6104661 DOI: 10.1016/j.aju.2017.11.005] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/26/2017] [Accepted: 11/08/2017] [Indexed: 01/16/2023] Open
Abstract
Objectives To review the main complications related to the robot-assisted laparoscopic (RAL) approach in urology and to suggest measures to avoid such issues. Methods A systematic search for articles of the contemporary literature was performed in PubMed database for complications in RAL urological procedures focused on positioning, access, and operative technique considerations. Each complication topic is followed by recommendations about how to avoid it. Results In all, 40 of 253 articles were included in this analysis. Several complications in RAL procedures can be avoided if the surgical team follows some key steps. Adequate patient positioning must avoid skin, peripheral nerve, and muscles injuries, and ocular and cognitive complications mainly related to steep Trendelenburg positioning in pelvic procedures. Port-site access and closure should not be neglected during minimally invasive procedures as these complications although rare can be troublesome. Technique-related complications depend on surgeon experience and the early learning curve should be monitored. Conclusions Adequate patient selection, surgical positioning, mentorship training, and avoiding long-lasting procedures are essential to prevent RAL-related complications. The robotic surgical team must be careful and work together to avoid possible complications. This review offers several steps in surgical planning to reach this goal.
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Affiliation(s)
- Rafael Rocha Tourinho-Barbosa
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.,Division of Urology, ABC Medical School, Sao Paulo, Brazil
| | | | - Adalberto Castro-Alfaro
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Gabriel Ogaya-Pinies
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, FL, USA
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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Faria EF, Neves HS, Dauster B, Machado RD, Magnabosco WJ, Muller RL, Santos AC, Tobias-Machado M. Laparoscopic Retroperitoneal Lymph Node Dissection as a Safe Procedure for Postchemotherapy Residual Mass in Testicular Cancer. J Laparoendosc Adv Surg Tech A 2017; 28:168-173. [PMID: 29215949 DOI: 10.1089/lap.2017.0381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To evaluate the feasibility, clinical and perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) in the management of patients with germ cell tumors (GCT) and residual post-chemotherapy mass. METHODS We report our experience of 25 patients treated with L-RPLND between 2008 and 2015. All 25 patients were diagnosed with GCT by primary pathological evaluation of the specimens after orchiectomy. All patients received cisplatin-based chemotherapy. The technique consisted of L-RPLND excision of the residual mass using unilateral template dissection. We assessed perioperative data and histological findings. RESULTS Surgery was successfully completed in 24 (96%) patients, 1 patient required an open surgery due to intense adhesions of the mass to the inferior vena cava. Mean operation time was 213 minutes. Mean blood loss was 260 mL. Postoperative complications were upper limb osteomuscular pain in 2 patients and chylous ascites in 1 patient. Mean postoperative hospital stay was 2 days. The median residual mass diameter was 3.3 cm (range 1.1-6.6 cm). Histopathological findings were necrotic tissue in 9 patients, teratoma in 9 patients, viable tumor in 6 patients, and Castleman disease in 1 patient. The median follow-up was 30 months. Normal antegrade ejaculation was preserved in all patients. CONCLUSIONS Laparoscopic postchemotherapy RPLND is a feasible, safe, and highly oncologically efficient procedure, which has the benefits of minimally invasive surgery.
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Affiliation(s)
- Eliney Ferreira Faria
- 1 Department of Surgical Urologic Oncology, Hospital de Amor de Barretos, Barretos, SP, Brazil
| | - Hugo Silva Neves
- 1 Department of Surgical Urologic Oncology, Hospital de Amor de Barretos, Barretos, SP, Brazil
| | - Breno Dauster
- 2 Department of Urology, Hospital São Rafael, Salvador, BA, Brazil
| | - Roberto Dias Machado
- 1 Department of Surgical Urologic Oncology, Hospital de Amor de Barretos, Barretos, SP, Brazil
| | | | - Roberto Lodeiro Muller
- 3 Department of Surgical Urologic Oncology, Centro de Pesquisas Oncológicas, Florianópolis, SC, Brazil
| | - Alexandre César Santos
- 1 Department of Surgical Urologic Oncology, Hospital de Amor de Barretos, Barretos, SP, Brazil
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Tobias-Machado M, Hidaka AK, Sato LLK, Silva IN, Mattos PAL, Pompeo ACL. Laparoscopic resection of prescral and obturator fossa schwannoma. Int Braz J Urol 2017; 43:566. [PMID: 27649114 PMCID: PMC5462152 DOI: 10.1590/s1677-5538.ibju.2015.0091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 11/06/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Pelvic Schwannoma is an extremely rare event. Laparoscopic approach for radical resection on pelvic region already has been described in the literature. However, with better image quality provided by optic in the laparoscopy we can assure an improvement in this kind of approach for tumor resection. Objective Our goal is to describe and evaluate the results of one laparoscopic resection of presacral and obturator fossa tumor. Materials and Methods We present a case of a 60-year-old man with progressive congestion in the right inferior member and CT scan revealing a mass with miscellaneous content located behind of the right iliac vessels and right obturator nerve. Exploratory transperitoneal laparoscopy was indicated. During laparoscopy it was possible to see the mass between the spermatic cord and external iliac artery. We made the identification and preservation of iliac vessels and obturator nerve. Resection of the tumor was performed carefully, allowing the safe removal of the specimen with complete preservation of the iliac vessels and obturator nerve. Results Mean operative time of 150 minutes. No perioperative complications occurred. Two days of hospital stay. Posterior histopathological exam confirmed that the mass was a Schwannoma. Conclusion The maximization of the image in the laparoscopic surgery offers dexterity and capacity of dissection required for complex mass dissection on pelvic region.
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Affiliation(s)
- Marcos Tobias-Machado
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | | | | | - Igor Nunes Silva
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
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Korkes F, Silveira M, Neves-Neto OC, Brandao LF, Tobias-Machado M, Wolosker N, Nasser F, Maurano A. Nutcracker Syndrome: laparoscopic external stenting of the renal vein (″the shield technique″). Int Braz J Urol 2017; 43:373. [PMID: 27649112 PMCID: PMC5433379 DOI: 10.1590/s1677-5538.ibju.2015.0666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/26/2016] [Indexed: 11/28/2022] Open
Abstract
Nutcracker syndrome refers to the complex of clinical symptoms caused by the compression of the left renal vein (LRV) between the abdominal aorta and the superior mesenteric artery, leading to stenosis of the aortomesenteric portion of the LRV and dilatation of the distal portion. Hematuria, proteinuria, flank pain, varicocele and pelvic congestion may occur, occurring more frequently in young adults. Conservative management, might be the option whenever it is possible. When surgical treatment is required, classically open surgery have been performed, with major surgeries as LRV transposition or bypass techniques. The main caveats regards the fact that these are large and risky surgeries. Endovascular surgery with venous stent placement has gained some space as it is minimally invasive alternative. However, venous stents are associated with a high number of trombotic complications and in many cases requirement of life-long anticoagulants. External stenting of the LRV with this “shield technique” is a minimally invasive alternative, with good medium term results. We herein demonstrate our second experience with the technique of this surgery in a patient with 12 months of follow up and excellent results.
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Affiliation(s)
- Fernando Korkes
- Serviço de Urologia, Hospital Israelita Albert Einstein, SP, Brasil
| | - Marcel Silveira
- Departamento de Urologia, Faculdade de Medicina ABC, SP, Brasil
| | | | | | | | - Nelson Wolosker
- Serviço de Cirurgia Vascular, Hospital Israelita Albert Einstein, SP, Brasil
| | - Felipe Nasser
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, SP, Brasil
| | - Alexandre Maurano
- Departamento de Radiologia, Hospital Israelita Albert Einstein, SP, Brasil
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40
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41
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Carneiro A, Sakuramoto P, Wroclawski ML, Forseto PH, Den Julio A, Bautzer CRD, Lins LMM, Kataguiri A, Yamada FB, Teixeira GK, Tobias-Machado M, Pompeo ACL. Open suprapubic versus retropubic prostatectomy in the treatment of benign prostatic hyperplasia during resident's learning curve: a randomized controlled trial. Int Braz J Urol 2017; 42:284-92. [PMID: 27256183 PMCID: PMC4871389 DOI: 10.1590/s1677-5538.ibju.2014.0517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 05/21/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study compared the suprapubic (SP) versus retropubic (RP) prostatectomy for the treatment of large prostates and evaluated perioperative surgical morbidity and improvement of urinary symptoms. MATERIALS AND METHODS In this single centre, prospective, randomised study, 65 consecutive patients with LUTS and surgical indication with prostate volume greater than 75g underwent open prostatectomy to compare the RP (32 patients) versus SP (33 patients) technique. RESULTS The SP group exhibited a higher incidence of complications (p=0.002). Regarding voiding pattern analysis (IPSS and flowmetry), both were significantly effective compared to pre-treatment baseline. The RP group parameters were significantly better, with higher peak urinary flow (SP: 16.77 versus RP: 23.03mL/s, p=0.008) and a trend of lower IPSS score (SP: 6.67 versus RP 4.14, p=0.06). In a subgroup evaluation of patients with prostate volumes larger than 100g, blood loss was lower in those undergoing SP prostatectomy (p=0.003). Patients with prostates smaller than 100g in the SP group exhibited a higher incidence of low grade late complications (p=0.004). CONCLUSIONS The SP technique was related to a higher incidence of minor complications in the late postoperative period. High volume prostates were associated with increased bleeding when the RP technique was utilized. The RP prostatectomy was associated with higher peak urinary flow and a trend of a lower IPSS Score.
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Affiliation(s)
- Arie Carneiro
- Hospital Israelita Albert Einstein, SP, Brasil.,Departamento de Urologia, Faculdade de Medicina do ABC, São Paulo, Brasil
| | - Paulo Sakuramoto
- Departamento de Urologia, Faculdade de Medicina do ABC, São Paulo, Brasil
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, SP, Brasil.,Departamento de Urologia, Faculdade de Medicina do ABC, São Paulo, Brasil
| | | | | | | | | | - Andre Kataguiri
- Departamento de Urologia, Faculdade de Medicina do ABC, São Paulo, Brasil
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de Lima MM, Tobias-Machado M. Suicide in patients with genitourinary malignancies. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28134462 DOI: 10.1111/ecc.12635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/19/2016] [Revised: 09/20/2016] [Accepted: 11/20/2016] [Indexed: 12/21/2022]
Abstract
Genitourinary cancers are significant causes of morbidity and mortality around the world. The present review summarises the current literature on suicide and its risk factors among patients with genitourinary cancers. The review was based on relevant articles published in MEDLINE, ProQuest, PsycINFO, Science Direct and Scopus databases. Patients with prostate cancer represented the most important risk group for suicide, among patients with urogenital cancers. Other risk factors are male gender, older age, white race, advanced disease, living alone and co-existing psychological comorbidities. Findings from the review call for a greater caregiver awareness on psychosocial morbidity and suicidality among genitourinary cancer patients pre- and post-treatment and their early identification, adoption of risk-reduction strategies and prompt referral for expert mental health care.
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Affiliation(s)
- M M de Lima
- Department of Urology, Coronel Mota Hospital, Roraima, Brazil
| | - M Tobias-Machado
- Section of Urologic Oncology, Department of Urology, ABC Medical School, São Paulo, UK
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43
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Tobias-Machado M, Hidaka AK, Sato LLK, Almeida-Carrera RJ, Faria EF, Zampolli H. One wire tubeless ureteral reimplant: preliminary experience and step-by-step
technique. Medical Express 2017. [DOI: 10.5935/medicalexpress.2017.01.06] [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: 11/20/2022] Open
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Tobias-Machado M, Nunes-Silva I, Hidaka AK, Sato LLK, Almeida R, Colombo JR, Zampolli HDC, Pompeo ACL. Retzus-sparing robotic-assisted laparoscopic radical prostatectomy: a step-by-step technique description of this first brazilian experience. Int Braz J Urol 2016; 42:1250. [PMID: 27649115 PMCID: PMC5117986 DOI: 10.1590/s1677-5538.ibju.2015.0348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/07/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction: Retzus-sparing robotic-assisted radical prostatectomy(RARP) is a newly approach that preserve the Retzus structures and provide better recovery of continence and erectile function. In Brazil, this approach has not yet been previously reported. Objective: Our goal is to describe Step-by-Step the Retzus-sparing RARP surgical technique and report our first Brazilian experience. Methods: We present a case of a 60-year-old white man with low risk prostate cancer. Surgical materials were four arms Da Vinci robotic platform system, six transperitoneal portals, two prolene wires and Polymer Clips. This surgical technique was step-by-step described according to Galfano et al. One additional step was added as a modification of Galfano et al. Primary technique description: The closure of the Denovellier fascia. Results: We have operated one patient with this technique. The operative time was 180minutes, console time was135 min, the blood loss was 150ml, none perioperative or postoperative complications was found, hospital stay of 01 day. The anatomopathological classification revealed a pT2aN0M0 specimen with free surgical margins. The patient achieved continence immediately after bladder stent retrieval. Full erection reported after 30 days of surgery. Conclusion: Retzus-sparing RARP approach is feasible and reproducible. However, further comparative studies are necessary to demonstrate potential benefits in continence and sexual outcomes over the standard approaches.
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Affiliation(s)
| | - Igor Nunes-Silva
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
| | | | | | - Roberto Almeida
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
| | - Jose Roberto Colombo
- Departamento de Uro-Oncologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil.,Departamento de Urologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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de Almeida EFP, Abdalla TE, Arrym TP, de Oliveira Delgado P, Wroclawski ML, da Costa Aguiar Alves B, de S Gehrke F, Azzalis LA, Alves S, Tobias-Machado M, de Lima Pompeo AC, Fonseca FLA. Plasma and urine DNA levels are related to microscopic hematuria in patients with bladder urothelial carcinoma. Clin Biochem 2016; 49:1274-1277. [PMID: 27599849 DOI: 10.1016/j.clinbiochem.2016.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/26/2016] [Revised: 07/11/2016] [Accepted: 08/30/2016] [Indexed: 11/16/2022]
Abstract
a) Objective: An increase in cell-free DNA was observed in the plasma of many cancer patients. This major biomarker can be used to differentiate patients with malignant neoplasms from those with benign neoplasms or healthy patients. Depending on the characteristic of the tumor, there are qualitative variations in the circulating cell-free DNA. Today, studies on the concentration of fragments of circulating cell-free DNA and their respective sizes in patients with bladder cancer are not plentiful in the literature. A 100% effective plasma tumor marker, which would help in the diagnosis and follow-up of bladder cancer, is yet to be developed; therefore, cell-free DNA levels in the plasma may represent a valuable biomarker for the diagnosis, prognosis and follow-up of patients with this type of tumor. b) Design and methods: In this study we analyze the kinetics of plasma and urine DNA concentrations in patients with bladder cancer, relating them to the other clinical laboratory variables. c) Results: Patients with hematuria showed a positive correlation with urine DNA. d) Conclusion: An increase in plasma and urine DNA was unprecedentedly reported over time, a fact that may come in handy in the prognosis of patients. Furthermore, microscopic haematuria is correlated with plasma and urinary DNA levels.
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Affiliation(s)
| | - Tomás Elias Abdalla
- Disciplina de Urologia, Faculade de Medicina do ABC, Santo André, SP, Brazil
| | | | | | | | | | - Flávia de S Gehrke
- Laboratório de Análises Clínicas da Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | | | - Sarah Alves
- Universidade Federal de São Paulo, Diadema, SP, Brazil
| | | | | | - Fernando Luiz Affonso Fonseca
- Laboratório de Análises Clínicas da Faculdade de Medicina do ABC, Santo André, SP, Brazil; Universidade Federal de São Paulo, Diadema, SP, Brazil.
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Tobias-Machado M, Hidaka AK, Nunes-Silva I, Chagas CA, Leal LC, Pompeo ACL. Laparoscopic - assisted transpyelic rigid nephroscopy - simple alternative when flexible ureteroscopy is not available. Int Braz J Urol 2016; 42:853-4. [PMID: 27564304 PMCID: PMC5006789 DOI: 10.1590/s1677-5538.ibju.2014.0588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 10/28/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In special situations such as malrotated or ectopic kidneys and UPJ stenosis treatment of renal lithiasis can be challenging. In these rare cases laparoscopy can be indicated. OBJECTIVE Describe the Laparoscopic-assisted rigid nephroscopy performed via transpyelic approach and report the feasibility. PATIENTS AND METHODS We present two cases of caliceal lithiasis. The first is a patient that ESWL and previous percutaneous lithotripsy have failed, with pelvic kidney where laparoscopic dissection of renal pelvis was carried out followed by nephroscopy utilizing the 30 Fr rigid nephroscope to remove the calculus. Ideal angle between the major axis of renal pelvis and the rigid nephroscope to allow success with this technique was 60-90 grades. In the second case, the kidney had a dilated infundibulum. RESULTS The operative time was 180 minutes for both procedures. No significant blood loss or perioperative complications occurred. The bladder catheter was removed in the postoperative day 1 and Penrose drain on day 2 when patients were discharged. The convalescence was completed after 3 weeks. Patients were stone free without symptons in one year of follow-up. CONCLUSIONS Laparoscopic-assisted rigid nephroscopy performed via tranpyelic approach can be done safely with proper patient selection and adherence to standard laparoscopic surgical principles. This approach is an alternative in cases where flexible endoscope is not available and when standard procedure is unlikely to produce a stone-free status.
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Affiliation(s)
- Marcos Tobias-Machado
- Departamento de Urologia, Faculdade de Medicina do ABC - FMABC - Santo André, São Paulo, Brasil
| | | | - Igor Nunes-Silva
- Departamento de Urologia, Faculdade de Medicina do ABC - FMABC - Santo André, São Paulo, Brasil
| | | | - Leandro Correa Leal
- Departamento de Urologia do Meridional Hospital - Cariacica, Espírito Santo, Brasil
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Tobias-Machado M, Mitre AI, Rubinstein M, Costa EFD, Hidaka AK. Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist? Int Braz J Urol 2016; 42:83-9. [PMID: 27136471 PMCID: PMC4811230 DOI: 10.1590/s1677-5538.ibju.2014.0485] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 03/19/2015] [Indexed: 12/03/2022] Open
Abstract
Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP.
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Affiliation(s)
| | - Anuar Ibrahim Mitre
- Divisão de Urologia, Jundiaí Faculdade de Medicina de Jundiaí, SP, Brasil.,Hospital Sírio-Libanês, SP, Brasil
| | - Mauricio Rubinstein
- Divisão de Urologia, Seção de Cirurgia Minimamente Invasiva do Hospital Universitário Gaffrée e Guinle (UNIRIO), Rio de Janeiro, Brasil
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48
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Tobias-Machado M, Said DF, Mitre AI, Pompeo A, Pompeo ACL. Comparison beetwen open and laparoscopic radical cistectomy in a Latin American reference center: perioperative and oncological results. Int Braz J Urol 2016; 41:635-41. [PMID: 26401854 PMCID: PMC4756990 DOI: 10.1590/s1677-5538.ibju.2014.0168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 12/01/2014] [Indexed: 11/22/2022] Open
Abstract
Objectives: To evaluate the differences of peri-operatory and oncological outcomes between Laparoscopic Radical Cystectomy and Open Radical Cystectomy in our center. Materials and Methods: Overall, 50 patients were included in this non randomized match-pair analysis: 25 patients who had undergone Laparoscopic Radical Cystectomy for invasive bladder cancer (Group-1) and 25 patients with similar characteristics who had undergone Open Radical Cystectomy (Group-2). The patients were operated from January 2005 to December 2012 in a single Institution. Results: Mean operative time for groups 1 and 2 were 350 and 280 minutes (p=0.03) respectively. Mean blood loss was 330 mL for group 1 and 580 mL for group 2 (p=0.04). Intraoperative transfusion rate was 0% and 36% for groups 1 and 2 respectively (p=0.005). Perioperative complication rate was similar between groups. Mean time to oral intake was 2 days for group 1 and 3 days for group 2 (p=0.08). Median hospital stay was 7 days for group 1 and 13 for group 2 (p=0.04). There were no differences in positive surgical margins and overall survival, between groups. Conclusions: In a reference center with pelvic laparoscopic expertise, Laparoscopic Radical Cystectomy may be considered a safe procedure with similar complication rate of Open Radical Cystectomy. Laparoscopic Radical Cystectomy is more time consuming, with reduced bleeding and transfusion rate. Hospital stay seems to be shorter. Oncologically no difference was observed in our mid-term follow-up.
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Affiliation(s)
- Marcos Tobias-Machado
- Departmento de Urologia, Seção de Urologia Oncológica da Faculdade de Medicina do ABC, Santo André, Brasil
| | - Danniel Frade Said
- Departmento de Urologia, Seção de Urologia Oncológica da Faculdade de Medicina do ABC, Santo André, Brasil
| | - Anuar Ibrahim Mitre
- Departamento de Urologia - Faculdade de Medicina da Universidade de São Paulo, Brasil
| | - Alexandre Pompeo
- Departmento de Urologia, Seção de Urologia Oncológica da Faculdade de Medicina do ABC, Santo André, Brasil
| | - Antonio Carlos Lima Pompeo
- Departmento de Urologia, Seção de Urologia Oncológica da Faculdade de Medicina do ABC, Santo André, Brasil
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Tobias-Machado M, Mattos PAL, Reis LO, Juliano CAB, Pompeo ACL. Transanal Minimally Invasive Surgery (TAMIS) to Treat Vesicorectal Fistula: A New Approach. Int Braz J Urol 2015; 41:1020-6. [PMID: 26689530 PMCID: PMC4756981 DOI: 10.1590/s1677-5538.ibju.2014.0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 06/08/2014] [Indexed: 11/22/2022] Open
Abstract
Purpose: Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence. Despite many options, there is not an unanimous accepted approach. This article aimed to report a new minimally invasive approach as an option to reconstructive surgery. Materials and Methods: We report on Transanal Minimally Invasive Surgery (TAMIS) with miniLap devices for instrumentation in a 65 year old patient presenting with vesicorectal fistula after radical prostatectomy. We used Alexis® device for transanal access and 3, 5 and 11 mm triangulated ports for the procedure. The surgical steps were as follows: cystoscopy and implant of guide wire through fistula; patient at jack-knife position; transanal access; Identification of the fistula; dissection; vesical wall closure; injection of fibrin glue in defect; rectal wall closure. Results: The operative time was 240 minutes, with 120 minutes for reconstruction. No perioperative complications or conversion were observed. Hospital stay was two days and catheters were removed at four weeks. No recurrence was observed. Conclusions: This approach has low morbidity and is feasible. The main difficulties consisted in maintaining luminal dilation, instrumental manipulation and suturing.
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Affiliation(s)
- Marcos Tobias-Machado
- Programa de Cirurgia Urológica Minimamente Invasiva, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil.,Seção de Uro-oncologia, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | - Pablo Aloisio Lima Mattos
- Programa de Cirurgia Urológica Minimamente Invasiva, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil.,Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | - Leonardo Oliveira Reis
- Divisão de Urologia da Faculdade de Ciências Médicas da Universidade de Campinas, UNICAMP, Campinas, Brasil.,Faculdade de Medicina - Divisão de Urologia do Centro de Ciências da Vida, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Brasil
| | - César Augusto Braz Juliano
- Programa de Cirurgia Urológica Minimamente Invasiva, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil.,Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
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Tobias-Machado M, Nunes-Silva I, Silveira MA, Castro Neves O, Kyoshi Hidaka A, Lima Pompeo AC. PD3-04 LESS POSTERIOR RETROPERITONEOSCOPIC ADRENALECTOMY: STEP-BY-STEP TECHNIQUE DESCRIPTION AND COMPARISON WITH 3-PORTS LATERAL RETROPERITONEAL APPROACH. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.291] [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: 10/23/2022]
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