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1.
Int. braz. j. urol ; 48(1): 122-130, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356274

ABSTRACT

ABSTRACT Purpose: To analyze the association between obesity and urinary incontinence rate in men submitted to robot-assisted radical prostatectomy (RARP) in a high-volume cancer center. Materials and Methods: We reported 1.077 men who underwent RARP as the primary treatment for localized prostate cancer from 2013 to 2017. Patients were classified as non-obese (normal BMI or overweight) or obese men (BMI ≥30kg/m2). They were grouped according to the age, PSA level, D'Amico risk group, Gleason score, ASA classification, pathological stage, prostate volume, salvage/adjuvant radiotherapy, perioperative complications, and follow-up time. Urinary continence was defined as the use of no pads. For the analysis of long-term urinary continence recovery, we conducted a 1:1 propensity-score matching to control confounders. Results: Among the obese patients, mean BMI was 32.8kg/m2, ranging 30 - 45.7kg/m2. Only 2% was morbidly obese. Obese presented more comorbidities and larger prostates. Median follow-up time was 15 months for the obese. Complications classified as Clavien ≥3 were reported in 5.6% of the obese and in 4.4% of the non-obese men (p=0.423). Median time for continence recovery was 4 months in both groups. In this analysis, HR was 0.989 for urinary continence recovery in obese (95%CI=0.789 - 1.240; p=0.927). Conclusions: Obese can safely undergo RARP with similar continence outcomes comparing to the non-obese men when performed by surgeons with a standardized operative technique. Future studies should perform a subgroup analysis regarding the association of obesity with other comorbidities, intending to optimize patient counseling.


Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/complications , Obesity, Morbid , Robotic Surgical Procedures/adverse effects , Prostate/surgery , Prostatectomy/adverse effects , Treatment Outcome , Recovery of Function , Propensity Score
2.
Int. braz. j. urol ; 47(5): 1072-1073, Sept.-Oct. 2021.
Article in English | LILACS | ID: biblio-1286814

ABSTRACT

ABSTRACT Introduction: One of the most remarkable characteristics of urothelial carcinomas is multifocality. However, occurrence of synchronous bladder cancer and upper urinary tract urothelial cancer (UTUC) is exceptional. Minimally invasive approach for these synchronous tumors was just occasionally reported (1-4). The aim of this video article is to describe step-by-step the technique for simultaneous laparoscopic nephroureterectomy and robot-assisted anterior pelvic exenteration with intracorporeal ileal conduit urinary diversion (ICUD). Patients and methods: A 66-year-old female presented with synchronous BCG refractory non-muscle invasive bladder cancer and a right-side UTUC. She was a former smoker and had previously been submitted to multiple transurethral resections of bladder tumor, BCG and right distal ureterectomy with ureteral reimplant. We performed a simultaneous laparoscopic right nephroureterectomy and robot-assisted anterior pelvic exenteration with totally intracorporeal ICUD. Combination of robot-assisted and pure laparoscopic approaches was proposed focusing on optimization of total operative time (TOT). Results: Surgery was uneventful. TOT was of 330 minutes. Operative time for nephroureterectomy, anterior pelvic exenteration and ICUD were 48, 135, 87 minutes, respectively. Estimated blood loss was 150mL. Postoperative course was unremarkable and patient was discharged after 7 days. Histopathological evaluation showed a pT1 high grade urothelial carcinoma plus carcinoma in situ both in proximal right ureter and bladder, with negative margins. Twelve lymph nodes were excised, all of them negative. Conclusion: In our preliminary experience, totally minimally invasive simultaneous nephroureterectomy and cystectomy with intracorporeal ICUD is feasible. Pure laparoscopic approach to upper urinary tract may be a useful tactic to reduce total operative time.


Subject(s)
Humans , Pelvic Exenteration , Urinary Diversion , Urinary Bladder Neoplasms/surgery , Robotics , Laparoscopy , Cystectomy , Nephroureterectomy
3.
Int. braz. j. urol ; 47(3): 558-565, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1154500

ABSTRACT

ABSTRACT Purpose: Incidence and mortality of prostate cancer (PCa) are still increasing in developing countries. Limited access to the health system or more aggressive disease are potential reasons for this. Ethnic and social differences in developed countries seem to make inappropriate to extrapolate data from other centers. We aim to report the epidemiological profile of a PSA-screened population from a cancer center in Brazil. Materials and Methods: We retrospectively selected 9.692 men enrolled in a PCa prevention program, comprising total PSA level and digital rectal examination at the first appointment, associated with complementary tests when necessary. Men aged over 40 years-old were included after shared decision-making process. Prostate biopsy (TRUS) was performed when clinically suspected for PCa. After the diagnosis, patients underwent appropriate treatment. Results: TRUS was performed in 5.5% of men and PCa incidence was 2.6%. Overall ratio between number of patients who needed to be screened in order to diagnose one cancer was 38.9 patients, with 2.1 biopsies performed to diagnose a cancer. Positive predictive value (PPV) of TRUS biopsy in this strategy was 47.2%, varying from 38.5% (<50 years-old) to 60% (>80 years-old). We evidenced 70 patients (27.9%) classified as low risk tumors, 74 (29.5%) as intermediate risk, and 107 (42.6%) as high-risk disease. Conclusions: PSA-screening remains controversial in literature. In front of a huge miscegenated people and considering the big proportion of high-risk PCa, even in young men diagnosed with the disease, it is imperative to inform patients and health providers about these data particularities in Brazil.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/epidemiology , Prostate-Specific Antigen/analysis , Biopsy , Brazil/epidemiology , Public Health , Predictive Value of Tests , Retrospective Studies , Early Detection of Cancer , Middle Aged
4.
Int. braz. j. urol ; 46(supl.1): 69-78, July 2020. tab
Article in English | LILACS | ID: biblio-1134299

ABSTRACT

ABSTRACT Introduction: Recently the COVID-19 pandemic became the main global priority; main efforts and health infrastructures have been prioritized in favor of COVID-19 battle and the treatment of benign diseases has been postponed. Renal cell cancer (RCC) patients configure a heterogenous populations: some of them present indolent cases which can safely have postponed their treatments, others present aggressive tumors, deserving immediate care. These scenarios must be properly identified before a tailored therapeutic choice. Objectives We propose a risk- based approach for patients with RCC, to be used during this unprecedented viral infection time. Materials and Methods: After a literature review focused in COVID-19 and current RCC treatments, we suggest therapeutic strategies of RCC in two sections: surgical approach and systemic therapy, in all stages of this malignance. Results: Patients with cT1a tumors (and complex cysts, Bosniak III/IV), must be put under active surveillance and delayed intervention. cT1b-T2a/b cases must be managed by partial or radical nephrectomy, some selected T1b-T2a (≤7cm) cases can have the surgery postponed by 60-90 days). Locally advanced tumors (≥cT3 and or N+) must be promptly resected. As possible, minimally invasive surgery and early hospital discharge are encouraged. Upfront cytoreduction, is not recommendable for low risk oligometastatic patients, which must start systemic treatment or even could be put under surveillance and delayed therapy. Intermediate and poor risk metastatic patients must start target therapy and/or immunotherapy (few good responders intermediate cases can have postponed cytoreduction). The recommendation about hereditary RCC syndromes are lacking, thus we recommend its usual care. Local or loco regional recurrence must have individualized approaches. For all cases, we suggest the application of a specific informed consent and a shared therapeutic choice. Conclusion: In the pandemic COVID -19 times, a tailored risk-based approach must be used for a safe management of RCC, aiming to not compromise the oncological outcomes of the patients.


Subject(s)
Humans , Pneumonia, Viral/epidemiology , Carcinoma, Renal Cell/therapy , Coronavirus Infections/epidemiology , Kidney Neoplasms/therapy , Pandemics , Betacoronavirus , SARS-CoV-2 , COVID-19 , Neoplasm Recurrence, Local , Nephrectomy
5.
Int. braz. j. urol ; 44(1): 114-120, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-892954

ABSTRACT

ABSTRACT Objectives Report the long-term outcomes of the AMS 800 artificial sphincer (AS) for the treatment post-prostatectomy incontinence (PPI) in a single center in Brazil. Materials and Methods Clinical data from patients who underwent the procedure were retrieved from the medical records of individuals with more than 1 year of follow-up from May 2001 to January 2016. Continence status (number of pads that was used), complications (erosion or extrusion, urethral atrophy, and infection), malfunctions, and need for secondary implantation were evaluated. The relationship between complications and prior or subsequent radiation therapy (RT) was also examined. Results From May 2001 to January 2016, 121 consecutive patients underwent AS implantation for PPI at an oncological referral center in Brazil. At the last visit, the AS remained implanted in 106 patients (87.6%), who reported adequate continence status (maximum of 1 pad/day). Eight-two subjects (67.8%) claimed not to be using pads on a regular basis at the final visit (completely dry). Revision occurred in 24 patients (19.8%). Radiation therapy (RT) for prostate cancer following radical prostatectomy was used in 47 patients before or after AS placement. Twelve patients with a history of RT had urethral erosion compared with 3 men without RT (p=0.004). Conclusion Considering our outcomes, we conclude that AS implantation yields satisfactory results for the treatment of PPI and should remain the standard procedure for these patients. Radiation therapy is a risk factor for complication.


Subject(s)
Humans , Male , Postoperative Complications/therapy , Prostatectomy/adverse effects , Urinary Incontinence/therapy , Urinary Sphincter, Artificial , Prosthesis Implantation/methods , Postoperative Complications/etiology , Radiotherapy Dosage , Urethra/surgery , Urinary Incontinence/etiology , Urodynamics , Brazil , Retrospective Studies , Risk Factors
8.
Int. braz. j. urol ; 42(6): 1136-1143, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-828936

ABSTRACT

ABSTRACT Introduction: The presence and extension of inguinal lymph node metastasis are the main prognostic factors in patients with penile cancer. Physical exam and image exams are not adequate to evaluate inguinal lymph nodes and many patients are submitted to non-therapeutic lymphadenectomies. However, it is known that not all patients with clinically or histologically negative inguinal lymph nodes evolve favorably. Casuistic and Methods: the authors evaluated the clinical and pathologic characteristics of 163 patients with penile carcinoma and clinically negative inguinal lymph nodes followed for three or more years and their impact on global survival (GS) and cancer-specific survival (CSS) in the 10-year follow-up. Primary pathologic tumor stage (p=0.025) and the presence of high grade of tumor differentiation (p=0.018) were predictive of CSS. The presence of high grade tumor was an independent specific prognostic factor of death risk (RR 14.08; p=0.019). Conclusion: high histologic grade was an independent predictive factor of specific death risk in patients with penile carcinoma and clinically negative lymph nodes followed for three or more years.


Subject(s)
Humans , Male , Adult , Aged , Penile Neoplasms/pathology , Carcinoma, Squamous Cell/pathology , Lymph Nodes/pathology , Penile Neoplasms/mortality , Prognosis , Brazil/epidemiology , Carcinoma, Squamous Cell/mortality , Risk Factors , Follow-Up Studies , Neoplasm Grading , Lymphatic Metastasis , Middle Aged , Neoplasm Staging
9.
Int. braz. j. urol ; 42(5): 866-867, Sept.-Oct. 2016.
Article in English | LILACS-Express | LILACS | ID: lil-796880
10.
Int. braz. j. urol ; 42(2): 179-179, Mar.-Apr. 2016.
Article in English | LILACS | ID: lil-782854
11.
Int. braz. j. urol ; 42(1): 1-1, Jan.-Feb. 2016.
Article in English | LILACS | ID: lil-777337

Subject(s)
Humans , Urology , Brazil
12.
Int. braz. j. urol ; 41(6): 1038-1039, Nov.-Dec. 2015.
Article in English | LILACS | ID: lil-769760
15.
Int. braz. j. urol ; 39(2): 182-188, Mar-Apr/2013. tab, graf
Article in English | LILACS | ID: lil-676266

ABSTRACT

Purpose To evaluate preoperative rectal electrical stimulation in the recovery of urinary continence in patients who undergo radical retropubic prostatectomy. Materials and Methods Patients were divided into 3 randomized groups: control, pelvic exercises, and electrical stimulation. A 1 hour pad-test, the ICIQ-SF, and the SF-36 were performed 1, 3, and 6 months after the surgical procedure. Results Of the 58 patients who were initially included in the study, 9 were excluded due to radiotherapy after surgical intervention, an indwelling urethral catheter for more than 30 days, high surgical risk, loss of follow-up, or incomplete participation in the study routines and spontaneous interruption. Forty-nine patients concluded the study (15 in the control group, 17 in the exercise group, and 17 in the electrical stimulation group). We did not observe any significant difference in the pad test (p > 0.05), the 8 domains of the SF-36, or ICIQ-SF score compared with control groups (control, exercise, and electrical stimulation). Conclusion Preoperative rectal electrical stimulation has no impact on continence status in patients who undergo radical retropubic prostatectomy. There is no difference in the three above mentioned groups with regard to urinary leakage and quality of life. .


Subject(s)
Aged , Humans , Male , Middle Aged , Electric Stimulation Therapy/methods , Muscle, Skeletal/physiology , Prostatectomy/adverse effects , Urinary Incontinence/prevention & control , Epidemiologic Methods , Exercise Therapy/methods , Muscle Contraction/physiology , Pelvic Floor , Preoperative Period , Prostatectomy/methods , Quality of Life , Time Factors , Treatment Outcome
16.
In. Lopes, Ademar; Chammas, Roger; Iyeyasu, Hirofumi. Oncologia para a graduação. São Paulo, Lemar, 3; 2013. p.471-482, tab. (Oncologia para a graduação).
Monography in Portuguese | LILACS | ID: lil-692034
17.
In. Lopes, Ademar; Chammas, Roger; Iyeyasu, Hirofumi. Oncologia para a graduação. São Paulo, Lemar, 3; 2013. p.483-492. (Oncologia para a graduação).
Monography in Portuguese | LILACS | ID: lil-692035
18.
Int. braz. j. urol ; 38(4): 456-465, July-Aug. 2012. tab
Article in English | LILACS | ID: lil-649438

ABSTRACT

PURPOSE: To analyze the immunohistochemical expression of the standard isoform of CD44 (CD44s) adhesion molecule in clear cell renal cell carcinoma (CCRCC) and its impact on clinical outcomes. MATERIALS AND METHODS: Ninety-nine consecutive patients treated surgically for RCC between 1992 and 2009 were selected. A single pathologist reviewed all cases to effect a uniform reclassification and determine the most representative tumor areas for construction of a tissue microarray. The same pathologist, who was blinded to the outcome of the cases, semi-quantitatively scored the staining intensity of CD44s in all specimens. The counting was done using the H-Score algorithm. RESULTS: Of the 99 immunostained RCC specimens, 57(57.7%) showed low expression, and 42(42.4%) showed high expression levels of CD44s. The expression of CD44s was directly associated with tumor size (p = 0.03), clinical stage (p = 0.02) and Fuhrman grade (p = 0.02). Disease specific survival (DSS) rates for patients whose specimens expressed low and high levels of CD44s was 88.1% and 67.5%, respectively (p = 0.009). Progression free survival (PFS) rates in patients with low and high expression of CD44s were 78.8% and 61.7%, respectively (p = 0.05). Classical features such as the presence of metastasis and clinical stage remained isolated predictors of survival. CONCLUSIONS: Immunohistochemical expression of CD44s was associated with important clinical variables such as stage and Fuhrman grade. However, it was not an independent predictor of survival. Therefore, we believe it has a limited role as a prognostic marker in patients with CCRCC.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , /analysis , Carcinoma, Renal Cell/immunology , Biomarkers, Tumor/analysis , Carcinoma, Renal Cell/chemistry , Carcinoma, Renal Cell/pathology , Epidemiologic Methods , Immunohistochemistry , Prognosis , Sex Distribution , Time Factors , Tissue Array Analysis
19.
Int. braz. j. urol ; 38(2): 155-166, Mar.-Apr. 2012. ilus, tab
Article in English | LILACS | ID: lil-623329

ABSTRACT

OBJECTIVE: To describe the epidemiological features and patterns of initial care for prostate cancer at public and private institutions in the State of Sao Paulo, Brazil. MATERIALS AND METHODS: A total of 1,082 physicians affiliated to the Sao Paulo Section of the Brazilian Society of Urology were invited to participate in this cross-sectional, web-based survey. Between September 2004 and September 2005, participating urologists entered data on demographic, clinical and pathological characteristics of patients diagnosed with prostate cancer in their practice. Data on patients attended at public institutions were analyzed and compared with those patients attended at private practice. RESULTS: One hundred and ten society members contributed with data from 1915 patients, 1026 (53.6%) of whom from public institutions. When compared with patients attended at private institutions, those attended at public institutions were older and more likely to be black, had higher serum prostate specific antigen (PSA) levels, had a higher probability of being diagnosed with metastatic disease, but were less likely to undergo prostatectomy (all P < 0.001). In multivariate analysis, age, biopsy Gleason score, and being attended at a public institution were independently associated with metastatic disease upon diagnosis. The significant predictors of nonsurgical treatment were age, black race, and higher serum levels of PSA. CONCLUSIONS: A statewide registry provides valuable information regarding patient demographics, clinical features, and patterns of care. The results of this study suggest that significant disparities exist for patients with prostate cancer attended at different health-care systems. The relative contribution of biological versus socioeconomic features remains uncertain.


Subject(s)
Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Delivery of Health Care/standards , Private Practice/statistics & numerical data , Prostatic Neoplasms/therapy , Public Sector/statistics & numerical data , Brazil/epidemiology , Cross-Sectional Studies , Health Facilities, Proprietary , Health Care Surveys/statistics & numerical data , Prostatectomy , Prostate-Specific Antigen/blood , Prostatic Neoplasms/epidemiology , Quality of Health Care , Societies, Medical , Socioeconomic Factors , Urology
20.
Appl. cancer res ; 29(4): 185-187, Oct.-Dec. 2009. ilus
Article in English | LILACS, Inca | ID: lil-547652

ABSTRACT

We report the case of a HIV-positive patient with teratoma malignant transformation in a retroperitoneal metastasis of testicular germ cell carcinoma, submitted to chemotherapy with complete laboratorial response and retroperitoneal lymph node dissection. The pathological analysis of the specimen demonstrated an admixture of non-germ cells within it (adenocarcinoma) with teratoma. Other primary malignancies were excluded. After 48 months, no disease recurrence or other primary neoplasm were diagnosed.


Subject(s)
Humans , Male , Young Adult , HIV , Acquired Immunodeficiency Syndrome , Cell Transformation, Neoplastic , Teratoma , Testicular Neoplasms , Germ Cells , Neoplasm Metastasis , Retroperitoneal Neoplasms
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