ANUAR IBRAHIM MITRE
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Departamento de Cirurgia, Faculdade de Medicina - Docente
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- The potential threats and benefits of nephron-sparing surgery can be predicted by any available score system(2022) MITRE, Anuar Ibrahim
- Pyeloplasty in Adults With Ureteropelvic Junction Obstruction in Poorly Functioning Kidneys: A Systematic Review(2021) FREITAS, Pedro. F. S.; BARBOSA, Joao. A. B. A.; ANDRADE, Hiury S.; ARAP, Marco A.; MITRE, Anuar I.; NAHAS, William C.; SROUGI, Miguel; DUARTE, Ricardo J.; SROUGI, VictorOBJECTIVES To systematically summarize the available evidence concerning the impact of pyeloplasty on symptoms and differential renal function (DRF) in adults with unilateral UPJO in poorly functioning kidneys (PFK), and to identify potential predictors of kidney function recovery that could help clinicians select candidates for pyeloplasty. METHODS A literature search (MEDLINE, Embase, Google Scholar, Scopus, ClinicalTrials.gov, and the WHO Clinical Trials Registry) and systematic review were performed up to September 2020 according to the PRISMA guidelines. PFK were defined as a baseline DRF =30% on renal scintigraphy. The primary endpoints were symptom relief and postoperative scintigraphic DRF. Predictors of kidney function recovery were evaluated and compared among studies. RESULTS Nine studies comprising 731 patients met the inclusion criteria and were included for evidence synthesis. A DRF increase >5% occurred in 13.3%-53.8% of 160 patients with a pre- and postoperative renal scan. Symptoms improved in 73.3%-93.3% of 141 adults after pyeloplasty. Neither patient's age, baseline DFR, comorbidities, degree of hydronephrosis, kidney parenchymal thickness, nor kidney biopsy findings consistently predicted a significant DRF increase among 375 patients undergoing pyeloplasty. CONCLUSION Based on a low level of evidence, pyeloplasty may relieve symptoms and stabilize kidney function in adults with UPJO in PFK. A significant number of patients showed a DRF increase >5%, yet no consistent predictor of kidney function recovery was identified. Until more evidence becomes available, pyeloplasty could be considered for selected cases after accounting for the risks of a failure requiring a future nephrectomy. (C) 2021 Elsevier Inc.
- The influence of interstitial cells of Cajal density in the outcomes of pyeloplasty in adults: A prospective analysis(2023) SROUGI, Victor; BANDEIRA, Rodolfo Anisio Santana de Torres; REIS, Sabrina Thalita; SANTOS, Gabriel Arantes dos; ANDRADE, Hiury da Silva; LEITE, Katia Ramos Moreira; HAMILTON-CHO, David; MITRE, Anuar Ibrahim; ARAP, Marco Antonio; SROUGI, Miguel; DUARTE, Ricardo JordaoPurpose: To evaluate if the density of interstitial cells of Cajal (ICC) in the ureteropelvic junction (UPJ) influences the outcomes of pyeloplasty in adults. Methods: Twenty-three patients with the diagnosis of ureteropelvic junction obstruction (UPJO) that underwent laparoscopic dismembered pyeloplasty were included. ICC density was measured using immunohistochemistry reaction for c-KIT expression in the resected UPJ segment. Pyeloplasty outcome was evaluated by patient self-report pain, urinary outflow using DTPA renogram and hydronephrosis assessment using ultrasound (US) at 12 months of follow-up. A logistic regression analysis was performed to assess the association of pyeloplasty outcomes and ICC density. Results: Low, moderate, and high ICC density were present in 17.4%, 30.4%, and 52.2% of the patients, respectively. Complete pain resolution was observed in 100%, 85.7%, and 75% of patients with low, moderate and high ICC density, respectively (p = 0.791). DTPA renogram improved in 75%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively (p = 0.739). Hydronephrosis improved in 25%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively (p = 0.032). Conclusions: Patients with high ICC density have a significant amelioration of hydronephrosis after pyeloplasty. However, ICC density is not associated with functional outcomes.
- The role of urinary KIM-1, NGAL, CA19-9 and beta 2-microglobulin in the assessment of ureteropelvic junction obstruction in adults(2017) MIRANDA, Eduardo P.; DUARTE, Ricardo J.; BESSA JR., Jose de; LOPES, Roberto I.; SROUGI, Victor; ANDRADE, Hiury S.; BANDEIRA, Rodolfo A. S. T.; ARAP, Marco A.; MITRE, Anuar I.; VIANA, Nayara I.; REIS, Sabrina T.; LEITE, Katia R. M.; SROUGI, MiguelPurpose: The objective of this study is to evaluate the diagnostic properties of urinary biomarkers in adults with ureteropelvic junction obstruction: KIM-1, NGAL, CA19-9, and beta 2-microglobulin. We also assessed urinary biomarker concentrations following pyeloplasty. Material and methods: We prospectively studied adults from December 2013 to February 2015. We included 47 patients with a mean age of 38.6 +/- 12.7 years. Each patient provided four samples of voided urine for biomarker measurement, one at pre-operative consultation and the others at 1, 3, and 6 months of post-operative follow-up. The control group consisted of 40 healthy individuals with no hydronephrosis on ultrasound evaluation. Results: KIM-1 had an area under the curve of 0.79 (95% CI 0.70-0.89), NGAL 0.71 (95% CI 0.61-0.83), CA19-9 0.70 (95% CI 0.60-0.81), and beta 2-microgloblin 0.61 (95% CI 0.50-0.73). KIM-1 was the most sensitive marker with a cut-off of 170.4 pg/mg creatinine (sensitivity 91.4%, specificity 59.1%), whereas CA19-9 was the most specific with a cut-off of 51.3 U/mg creatinine (sensitivity 48.9%, specificity 88.0%). Urinary concentrations of biomarkers decreased after pyeloplasty. Conclusions: The evaluation of urinary biomarkers is useful in adults undergoing pyeloplasty. KIM-1, NGAL, and CA19-9 were elevated and significantly decreased after surgery.
- Step-by-step Laparoscopic Vesiculectomy for Hemospermia(2017) MELLO, Marcos Figueiredo; ANDRADE, Hiury Silva; SROUGI, Victor; ARAP, Marco Antonio; MITRE, Anuar Ibrahim; DUARTE, Ricardo Jordao; SROUGI, MiguelHemospermia has been considered as a benign and self-limiting condition. It usually has an inflammatory or infectious cause. However, recurrent or persistent hemospermia may indicate a more serious underlying pathology, especially over 40 years of age. Biopsy or surgical excision is indicated in cases of suspicious findings during investigation, such as cysts or masses. Open surgery has been considered the definitive form of treatment, however, it can be associated with significant morbidity. With growing experience in laparoscopics, this approach is becoming the preferable way to access the seminal vesicles. Our objective is to demonstrate a step-by-step operative technique for laparoscopic unilateral vesiculectomy approach in a man with hemospermia. Case: A 61 year-old man presented with 1 year of hemospermia. He was treated empirically with a fluoroquinolone plus a nonsteroidal anti-inflammatory without resolution of symptoms. Ultrasonography and MRI showed a solid-cystic mass in the right seminal vesicle. The patient was submitted to a laparoscopic unilateral vesiculectomy. Histopathological analysis showed intraluminal dilatation with blood content. During follow-up, complete resolution of symptoms was seen. Results: Three patients composed our cohort. Mean age was 53 years-old (range 45-61 years), the right side was more commonly affected (two unilateral on the right and bilateral). Mean operative time was 55 minutes (range 40-120min). One patient presented amyloidosis in the histopathological analysis. All cases presented complete resolution of symptoms. Conclusions: Laparoscopic vesiculectomy is a safe and feasible approach in cases of hemospermia. This technique showed good outcomes and minimal morbidity.
- Infrared Thermometer: an accurate tool for temperature measurement during renal surgery(2013) MARCHINI, Giovanni Scala; DUARTE, Ricardo Jordao; MITRE, Anuar Ibrahim; TISEO, Bruno Camargo; CASSAO, Valter Dell'Acqua; TORRICELLI, Fabio Cesar Miranda; ARAP, Marco Antonio; SROUGI, MiguelPurpose: To evaluate infrared thermometer (IRT) accuracy compared to standard digital thermometer in measuring kidney temperature during arterial clamping with and without renal cooling. Materials and Methods: 20 pigs weighting 20Kg underwent selective right renal arterial clamping, 10 with (Group 1 - Cold Ischemia with ice slush) and 10 without renal cooling (Group 2 - Warm Ischemia). Arterial clamping was performed without venous clamping. Renal temperature was serially measured following clamping of the main renal artery with the IRT and a digital contact thermometer (DT): immediate after clamping (T0), after 2 (T2), 5 (T5) and 10 minutes (T10). Temperature values were expressed in mean, standard deviation and range for each thermometer. We used the T student test to compare means and considered p < 0.05 to be statistically significant. Results: In Group 1, mean DT surface temperature decrease was 12.6 +/- 4.1 degrees C (5-19 degrees C) while deep DT temperature decrease was 15.8 +/- 1.5 degrees C (15- 18 degrees C). For the IRT, mean temperature decrease was 9.1 +/- 3.8 degrees C (3-14 degrees C). There was no statistically significant difference between thermometers. In Group 2, surface temperature decrease for DT was 2.7 +/- 1.8 \degrees C (0-4 degrees C) and mean deep temperature decrease was 0.5 +/- 1.0 degrees C (0-3 degrees C). For IRT, mean temperature decrease was 3.1 +/- 1.9 degrees C (0-6 degrees C). No statistically significant difference between thermometers was found at any time point. Conclusions: IRT proved to be an accurate non-invasive precise device for renal temperature monitoring during kidney surgery. External ice slush cooling confirmed to be fast and effective at cooling the pig model.
- Robotic simple prostatectomy: Technical considerations and outcomes(2012) COLOMBO, J. R. Jr.; MITRE, A. I.The open approach has been the gold standard for simple prostatectomy, either through a retropubic enucleation with an anterior transverse prostatic capsulotomy (Millin) or through a suprapubic transvesical access. The simple laparoscopic prostatectomy may be an alternative to open simple prostatectomy with potentially lower morbidity, lower blood loss, faster recovery, shorter hospital stay, and earlier return to normal activities In 2002, Mariano et al.7 first described the technique for laparoscopic simple prostatectomy that was modified by several authors using both transperitoneal and extraperitoneal approaches. The American Urological Association (AUA) and European Association of Urology (EAU) guidelines suggest that open surgery should be the treatment for prostate volume higher than 80 g. Similarly to others procedures, some skilled urologists have replaced the open simple prostatectomy by the laparoscopic counterpart. Robotics brought contributions to laparoscopic simple prostatectomy allowing the enucleation of adenoma without the need for special devices due to the advantages provided by better visualization and robotic-articulated instruments. It also potentially facilitates hemostatic sutures to control the main prostatic vessels, resulting in reduced intraoperative blood loss. The closure of bladder and/or prostatic capsule is easier with robotic assistance. Robotic simple prostatectomy seems to have a shorter learning curve than pure laparoscopic, what would be a real alternative to a larger number of urologists to perform such a procedure with the minimally invasive approach. The drawbacks of robotic simple prostatectomy are the costs and the preferential transperitoneal approach. Although currently literature is scanty on this subject, multicentric studies with larger numbers of subjects are expected to compare the open, laparoscopic, and robotic simple prostatectomy. © Springer-Verlag London Limited 2012.
- Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus(2021) FARIA, Eliney Ferreira; MACIEL, Carlos Vaz Melo; BERGER, Andre; MITRE, Anuar; DAUSTER, Breno; FREITAS JR., Celso Heitor; FRAGA, Clovis; CHADE, Daher; DALL'OGLIO, Marcos; CARVALHO, Francisco; CAMPOS, Franz; CARVALHAL, Gustavo Franco; LEMOS, Gustavo Caserta; GUIMARAES, Gustavo; ZAMPOLLI, Hamilton; ALVES, Joao Ricardo; MANZANO, Joao Padua; FORTES, Marco Antonio; ROCHA, Marcos Flavio Holanda; RUBINSTEIN, Mauricio; LUZ, Murilo; ROMANELLI, Pedro; COELHO, Rafael; ROCHA, Raphael; MACHADO, Roberto Dias; REIS, Rodolfo Borges dos; ZEQUI, Stenio; GUIDA, Romulo; MUGLIA, Valdair; TOBIAS-MACHADO, MarcosRadical 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.
bookPart Infecções urológicas: uretrites-prostatites-epididimites e orquites(2015) MITRE, Anuar Ibrahim; PIOVESAN, Affonso Celso- Laparoscopic Ureterocalicostomy Technique(2023) NUNES, Romulo S. S.; SUARTZ, Caio V.; ANDRADE, Hiury S.; JORDAO, Ricardo D.; SROUGI, Victor; MITRE, Anuar I.; NAHAS, William C.; ARAP, Marco A.Purpose: Ureterocalicostomy is a technique that was first described by Neuwirt in 1948 (1) The laparoscopic access was initiated in 2003 by Cherullo et al. (2), following the established principles of open surgery. In 2004, Gill et al. had two patients with UPJO treated with laparoscopic ureterocalicostomy, with success (3). In 2014, Arap et. al. presented a case series with good results in adults and children in our service (4). There are factors that prepare the surgeon for an ureterocalicostomy, such as the renal cortex thickness, although the decision is mainly taken during the procedure (5).Material and Methods: A 24 years-old female patient with right lumbar pain was referred to our institution. She already had a right open pyeloplasty two years ago. The CT scan presented a right hydronephrotic kidney, DMSA scan with 30% of relative function and a DTPA scan with an obstructive pattern.Results: A laparoscopic ureterocalicostomy was performed due to the intra-operative findings (inferior kidney pole thickness and challenging access to the uretero-pelvic junction). The overall time was 130 minutes with no complications. The patient was discharged in two days and the double J was withdrawn in four weeks. The CT scan within one year demonstrates a reduction of the hydronephrosis. She had no more lumbar pain.Conclusion: In complex cases, the laparoscopic ureterocalicostomy proves to be a safe and efficient procedure, with a free tension-free anastomosis and the advantages of the laparoscopic access.