ANUAR IBRAHIM MITRE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- 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.
- 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.
- Laparoscopic pyeloplasty as an alternative to nephrectomy in adults with poorly functioning kidneys due to ureteropelvic junction obstruction(2021) NASCIMENTO, Bruno; ANDRADE, Hiury S.; MIRANDA, Eduardo P.; BARBOSA, Joao Arthur Brunhara Alves; MOSCARDI, Paulo R.; ARAP, Marco A.; I, Anuar Mitre; SROUGI, Miguel; SROUGI, Victor; DUARTE, Ricardo J.Objectives To evaluate outcomes of laparoscopic pyeloplasty (LP) in adults with poorly functioning kidney due to ureteropelvic junction obstruction (UPJO). Methods A retrospective comparative analysis was performed between adult patients who underwent LP due to UPJO with differential renal function (DRF) <= 15% and DRF > 15%. LP success rate and complications were assessed. LP success was defined as symptoms improvement and DRF improvement or stabilization. DRF and estimated glomerular filtration rate (eGFR) were analyzed before and 12 months after surgery to evaluate renal function recovery. DRF was estimated using Tc-99 m DMSA renal scintigraphy. Results Among 121 LP performed in the study period at our institution, 15 and 42 were included in the DRF <= 15% and DRF > 15% groups, respectively. At a median follow-up of 17.8 months, all patients with DRF <= 15% reported symptoms improvement. LP success rate was 86.7% and 90.5% (p = 0.65) for patients with DRF <= 15% and DRF > 15%, respectively. There were no complications in the DRF <= 15% group, while there were three complications recorded in the DRF > 15% group (Clavien 2 and 3b). In the DRF <= 15% group, mean pre-operative and post-operative DRF was 9.5% +/- 3.6 and 10.5% +/- 7.8 (p = 0.49), respectively. Median pre-operative and post-operative eGFR was 68.5 ml/min and 79.8 ml/min (p = 0.93), respectively. Two patients had DRF improvement after LP. Conclusions LP in adult patients with UPJO and poor function kidneys is an effective and safe procedure. DRF recovery is seen in a minority of the patients; however, LP is an alternative to nephrectomy.
- Reply to: Axel Heidenreich. Still Unanswered: The Role of Extended Pelvic Lymphadenectomy in Improving Oncological Outcomes in Prostate Cancer. Eur Urol 2021;79:605-6(2021) LESTINGI, Jean F. P.; GUGLIELMETTI, Giuliano B.; TRINH, Quoc-Dien; COELHO, Rafael F.; JR, Jose Pontes; BASTOS, Diogo A.; CORDEIRO, Mauricio D.; SARKIS, Alvaro S.; FARAJ, Sheila F.; MITRE, Anuar I.; SROUGI, Miguel; NAHAS, William C.
- Extended Versus Limited Pelvic Lymph Node Dissection During Radical Prostatectomy for Intermediate- and High-risk Prostate Cancer: Early Oncological Outcomes from a Randomized Phase 3 Trial(2021) LESTINGI, Jean F. P.; GUGLIELMETTI, Giuliano B.; TRINH, Quoc-Dien; COELHO, Rafael F.; PONTES, Jose Jr Jr; BASTOS, Diogo A.; CORDEIRO, Mauricio D.; SARKIS, Alvaro S.; FARAJ, Sheila F.; I, Anuar Mitre; SROUGI, Miguel; NAHAS, William C.Background: The role of extended pelvic lymph node dissection (EPLND) in the surgical management of prostate cancer (PCa) patients remains controversial, mainly because of a lack of randomized controlled trials (RCTs). Objective: To determine whether EPLND has better oncological outcomes than limited PLND (LPLND. Design, setting and participants: This was a prospective, single-center phase 3 trial in patients with intermediate-or high-risk clinically localized PCa. Intervention: Randomization (1:1) to LPLND (obturator nodes) or EPLND (obturator, external iliac, internal iliac, common iliac, and presacral nodes) bilaterally. Outcome measurements and statistical analysis: The primary endpoint was biochemi-cal recurrence & ndash;free survival (BRFS). Secondary outcomes were metastasis-free survival (MFS), cancer-specific survival (CSS), and histopathological findings. The trial was designed to show a minimal 15% advantage in 5-yr BRFS by EPLND. Results and limitations: In total, 300 patients were randomized from May 2012 to December 2016 (150 LPLND and 150 EPLND). The median BRFS was 61.4 mo in the LPLND group and not reached in the EPLND group (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.63 & ndash;1.32; p = 0.6). Median MFS was not reached in either group (HR 0.57, 95% CI 0.17 & ndash;1.8; p = 0.3). CSS data were not available because no patient died from PCa before the cutoff date. In exploratory subgroup analysis, patients with preoperative biopsy International Society of Urological Pathology (ISUP) grade groups 3 & ndash;5 who were allocated to EPLND had better BRFS (HR 0.33, 95% CI 0.14 & ndash;0.74, interaction p = 0.007). The short follow-up and surgeon heterogeneity are limitations to this study. Conclusion: This RCT confirms that EPLND provides better pathological staging, while differences in early oncological outcomes were not demonstrated. Our subgroup analy-sis suggests a potential BCRFS benefit in patients diagnosed with ISUP grade groups 3 & ndash;5; however, these findings should be considered hypothesis-generating and further RCTs with larger cohorts and longer follow up are necessary to better define the role of EPLND during RP. Patient summary: In this study, we investigated early outcomes in prostate cancer patients undergoing prostatectomy according to the anatomic extent of lymph node resection. We found that extended removal of lymph nodes did not reduce biochemical recurrence of prostate cancer in the expected range.
bookPart Infecções urológicas - uretrites - prostatites - epididimites e orquite(2021) MITRE, Anuar Ibrahim; PIOVESAN, Affonso CelsobookPart Infecção do trato urinário(2021) MITRE, Anuar Ibrahim; BOTELHO, Luiz Antonio Assan