FRANCISCO CESAR CARNEVALE
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
14 resultados
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- Effects of Prostatic Artery Embolization on the Dynamic Component of Benign Prostate Hyperplasia as Assessed by Ultrasound Elastography: A Pilot Series(2019) ASSIS, Andre Moreira de; MOREIRA, Airton Mota; CARNEVALE, Francisco Cesar; MARCELINO, Antonio Sergio Zafred; CERRI, Luciana Mendes de Oliveira; ANTUNES, Alberto Azoubel; SROUGI, Miguel; CERRI, Giovanni GuidoPurposeTo determine the effects of prostatic artery embolization (PAE) on prostaticelasticity as assessed by Ultrasound Elastography (US-E), as well as to describe the feasibility and role of US-E as a novel tool in both pre- and post-PAE evaluation.Materials and MethodsThis is a prospective, single-center investigation that included eight patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline and 3-month follow-up evaluations were performed and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. US-E with measurement of the prostatic Elastic Modulus (EM) was performed before PAE and at 1-month follow-up.ResultsAfter PAE, US-E showed a significant reduction of prostatic EM as assessed in kPa (33.14 vs. 47.24, -29.8%, p=0.002) and in m/s (3.75 vs. 4.63, -19.0%, p<0.001). Also, the transitional/peripheral zone ratio was significantly reduced by 45.36% (0.53 vs. 0.97, p<0.05). All eight patients presented with significant LUTS improvement after PAE (p<0.05 for IPSS, QoL, prostate volume, peak urinary flow rate and PSA).ConclusionsFindings described in this study suggest that PAE significantly reduces prostaticEM, leading to a positive effect on BPH dynamic component related to prostatic elasticity. Also, it features US-E as an additional tool for pre- and post-PAE evaluation, describing a novel indication for this technology.
- Quality of Life and Clinical Symptom Improvement Support Prostatic Artery Embolization for Patients with Acute Urinary Retention Caused by Benign Prostatic Hyperplasia(2013) CARNEVALE, Francisco C.; MOTTA-LEAL-FILHO, Joaquim M. da; ANTUNES, Alberto A.; BARONI, Ronaldo H.; MARCELINO, Antonio S. Z.; CERRI, Luciana M. O.; YOSHINAGA, Eduardo M.; CERRI, Giovanni G.; SROUGI, MiguelPurpose: To show that prostatic artery embolization (PAE) improves quality of life (QoL) and lower urinary tract symptoms in patients with acute urinary retention caused by benign prostatic hyperplasia (BPH). Materials and Methods: This was a single-center prospective study of PAE in 11 patients with BPH managed With indwelling. urinary catheters. International Prostate Symptom Score (IPSS), ultrasound, magnetic resonance (MR) imaging, QoL, and urodynamic tests were used. to assess outcomes. Prostate size ranged from 30 to 90 g, and embolizations were performed with 300-500-mu m Embosphere microspheres. Results: The rate of technical success (ie, bilateral PAE) was 75%, and the rate of clinical success (ie, catheter removal and symptom improvement) was 91% (10 of 11 patients). Postembolization syndrome manifested as mild pain in the perineum, retropubic area, and/or urethra. Ten of 11 patients urinated spontaneously after Foley catheter removal 4-25 days after PAE (mean, 12.1 d). No major complications Were observed. Follow-up ranged from 19 to 48 months. than asymptomatic patient, a discrete area of hypoperfusion: suggesting small ischemia of the bladder was observed on 30-day MR imaging follow-up, but the bladder was normal on 90-day MR imaging. After 1 year, mean prostate volume reduction was greater than 30%, symptoms were mild (mean IPSS, 2.8 +/- 2.1; P = .04),. no erectile dysfunction was observed, and QoL,improved significantly (mean , 0.4 +/- 0.5; P = .001) using the paired t test. Conclusions: Patients with severe symptoms and acute urinary retention caused by BPH can be treated Safely by PAE, which improves clinical symptoms and QoL.
- Impact of 5-Alpha-Reductase Inhibitors Use at the Time of Prostatic Artery Embolization for Treatment of Benign Prostatic Obstruction(2019) CARDARELLI-LEITE, Leandro; ASSIS, Andre M. de; MOREIRA, Airton M.; ANTUNES, Alberto A.; CERRI, Giovanni G.; SROUGI, Miguel; CARNEVALE, Francisco C.Purpose: To compare the 12-month post-prostatic artery embolization (PAE) clinical outcomes of patients who were and were not taking 5-alpha-reductase inhibitors (5ARIs) at the time of PAE. Materials and Methods: A retrospective review was conducted of patients who underwent PAE from 2010 to 2017 due to lower urinary tract symptoms, secondary to benign prostatic hyperplasia (BPH). One hundred fifty-five patients were included and divided in 2 groups; these groups did not present statistically significant differences in their baseline characteristics-those taking 5ARIS (Y-5ARIs, n = 40) and those not taking 5ARIs (N-5ARIs, n = 115). International Prostate Symptom Score (IPSS), the sub-item Quality of Life (QoL), and the incidence of clinical failure were used as primary endpoints. Secondary endpoints included mean prostate volume reduction and mean peak flow rate (Q(max)) improvement. Clinical failure or recurrence was defined as absence of symptomatic improvement (IPSS >= 8 or QoL >= 3) or the need for invasive BPH treatment (PAE or transurethral resection of the prostate) during the 12-month follow-up period. Results: After 12-month follow-up, IPSS, QoL, and prostatic volume were significantly lower compared to baseline in both groups, and Q(max) showed a significant increase. No statistically significant differences were observed in outcomes between N-5ARIs and Y-5ARIs, and the clinical failure rate for both groups was approximately 20%. Conclusions: The use of 5ARIs did not show a detrimental effect on clinical outcomes of PAE, in either subjective (IPSS, QoL, and clinical failure) or objective (prostatic volume and Q(max)) parameters.
- Clinical, Laboratorial, and Urodynamic Findings of Prostatic Artery Embolization for the Treatment of Urinary Retention Related to Benign Prostatic Hyperplasia. A Prospective Single-Center Pilot Study(2013) ANTUNES, Alberto A.; CARNEVALE, Francisco C.; LEAL FILHO, Joaquim M. da Motta; YOSHINAGA, Eduardo M.; CERRI, Luciana M. O.; BARONI, Ronaldo H.; MARCELINO, Antonio S. Z.; CERRI, Giovanni G.; SROUGI, MiguelThis study was designed to describe the clinical, laboratorial, and urodynamic findings of prostatic artery embolization (PAE) in patients with urinary retention due to benign prostatic hyperplasia (BPH). A prospective study of 11 patients with urinary retention due to BPH was conducted. Patients underwent physical examination, prostate specific antigen (PSA) measurement, transrectal ultrasound, and magnetic resonance imaging. International prostate symptom score (IPSS), quality of life (QoL), and urodynamic testing were used to assess the outcome before and after 1 year. Clinical success was 91 % (10/11 patients) with a mean follow-up of 22.3 months (range, 12-41 months). At the first year follow-up, the mean IPSS score was 2.8 points (p = 0.04), mean QoL was 0.4 points (p = 0.001), mean PSA decreased from 10.1 to 4.3 ng/mL (p = 0.003), maximum urinary flow (Qmax) improved from 4.2 to 10.8 mL/sec (p = 0.009), and detrusor pressure (Pdet) decreased from 85.7 to 51.5 cm H2O (p = 0.007). Before PAE, Bladder Outlet Obstruction Index (BOOI) showed values > 40 in 100 % of patients. After PAE, 30 % of patients were > 40 (obstructed), 40 % were between 20 and 40 (undetermined), and 30 % were < 20 (unobstructed). Patients with a BOOI < 20 had higher PSA values at 1-day after PAE. Clinical and urodynamic parameters improved significantly after PAE in patients with acute urinary retention due to BPH. Total PSA at day 1 after PAE was higher in patients with unobstructed values in pressure flow studies.
- Prostatic Artery Embolization: Indications, Preparation, Techniques, Imaging Evaluation, Reporting, and Complications(2021) JR, Ubenicio Silveira Dias; MOURA, Mauricio Ruettimann Liberato de; VIANA, Publio Cesar Cavalcante; ASSIS, Andre Moreira de; MARCELINO, Antonio Sergio Zanfred; MOREIRA, Airton Mota; LEITE, Claudia Costa; CERRI, Giovanni Guido; CARNEVALE, Francisco Cesar; HORVAT, NatallyBenign prostatic hyperplasia (BPH) is a noncancerous growth of the transitional zone of the prostate, which surrounds the prostatic urethra. Consequently, it can cause lower urinary tract symptoms (LUTS) and bladder outlet obstruction symptoms that may substantially reduce a patient's quality of life. Several treatments are available for BPH, including medications such as alpha-blockers and 5 alpha-reductase inhibitors and surgical options including transurethral resection of the prostate and prostatectomy. Recently, prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option for selected men with BPH and moderate to severe LUTS. Adequate pre- and postprocedural evaluations with clinical examinations and questionnaires, laboratory tests, and urodynamic and imaging examinations (particularly US, MRI, and CT) are of key importance to achieve successful treatment. Considering that the use of PAE has been increasing in tertiary hospital facilities, radiologists and interventional radiologists should be aware of the main technical concepts of PAE and the key features to address in imaging reports in pre- and postprocedural settings. An invited commentary by Lopera is available online. Online supplemental material is available for this article. (C) RSNA, 2021
- Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Societe Francaise de Radiologie, and the British Society of Interventional Radiology(2019) MCWILLIAMS, Justin P.; BILHIM, Tiago A.; CARNEVALE, Francisco C.; BHATIA, Shivank; ISAACSON, Ari J.; BAGLA, Sandeep; SAPOVAL, Marc R.; GOLZARIAN, Jafar; SALEM, Riad; MCCLURE, Timothy D.; KAVA, Bruce R.; SPIES, James B.; SABHARWAL, Tarun; MCCAFFERTY, Ian; TAM, Alda L.
- Development of Research Agenda in Prostate Artery Embolization: Summary of Society of Interventional Radiology Consensus Panel(2020) DAVIS, Clifford; GOLZARIAN, Jafar; WHITE, Sarah; FISCHMAN, Aaron; RASTINEHAD, Ardeshir; ISAACSON, Ari; CARNEVALE, Francisco; FOSTER JR., Harris; FINDEISS, Laura; SAPOVAL, Marc; BOROFSKY, Michael; AYYAGARI, Raj; SALEM, Riad; BHATIA, Shivank; CARIDI, TheresaPurpose: To summarize the Society of Interventional Radiology Foundation's Research Consensus. Panel development of a research agenda on prostate artery embolization (PAE). Materials and Methods: PAE for the treatment of lower urinary tract symptoms has been shown to be safe and effective in decreasing symptoms and prostate size. Lack of randomized controlled trials (RCTs) on PAE in the United States has prevented inclusion in American Urologic Association guideline recommendations for treatment of lower urinary tract symptoms resulting from benign prostatic hyperplasia. Recognizing the need for well-designed trials, the SIR Foundation funded a Research Consensus Panel to prioritize a research agenda. The panel included interventional radiologists, urologists, SIR Foundation leadership, and industry representatives. I The goal of the meeting was to discuss weaknesses with current data and study design for development of US trials to report long-term outcomes data. Results: Final consensus on a research design could not be made because the group was split on 3 research designs: (i) RCT of PAE versus sham with crossover of the sham group. (ii) RCT of PAE versus simple prostatectomy. (iii) RCT of PAE versus holmium laser enucleation of the prostate/thulium laser enucleation of the prostate. The panel recommended a nonindustry-funded registry to obtain real-world data. Conclusions: Level 1 data are required to be included in the American Urologic Association guidelines for treatment of benign prostatic hyperplasia. Because of concerns with all 3 study designs, the panel did not reach a consensus. Further meetings are planned with the panel to select among these research designs.
- Advanced image guidance for prostatic artery embolization - a multicenter technical note(2021) CARNEVALE, Francisco Cesar; MCCLURE, Timothy; CADOUR, Farah; VIDAL, Vincent; ASSIS, Andre Moreira de; MOREIRA, Airton Mota; ROCHA, Arthur Diego Dias; REBET, Aya; NUTTING, CharlesBackground Prostatic artery embolization (PAE) is associated with patients' quality of life improvements and limited side effects compared to surgery. However, this procedure remains technically challenging due to complex vasculature, anatomical variations and small arteries, inducing long procedure times and high radiation exposure levels both to patients and medical staff. Moreover, the risk of non-target embolization can lead to relevant complications. In this context, advanced imaging can constitute a solid ally to address these challenges and deliver good clinical outcomes at acceptable radiation levels. Main text This technical note aims to share the consolidated experience of four institutions detailing their optimized workflow using advanced image guidance, discussing variants, and sharing their best practices to reach a consensus standardized imaging workflow for PAE procedure, as well as pre and post-operative imaging. Conclusions This technical note puts forth a consensus optimized imaging workflow and best practices, with the hope of helping drive adoption of the procedure, deliver good clinical outcomes, and minimize radiation dose levels and contrast media injections while making PAE procedures shorter and safer.
- Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization(2020) UFLACKER, Andre B.; HASKAL, Ziv J.; BAERLOCHER, Mark O.; BHATIA, Shivank S.; CARNEVALE, Francisco C.; DARIUSHNIA, Sean R.; FAINTUCH, Salomao; GABA, Ron C.; GOLZARIAN, Jafar; MIDIA, Mehran; NIKOLIC, Boris; SAPOVAL, Marc R.; WALKER, T. Gregory
- CIRSE Standards of Practice on Prostatic Artery Embolisation(2020) CORNELIS, Francois H.; BILHIM, Tiago; HACKING, Nigel; SAPOVAL, Marc; TAPPING, Charles R.; CARNEVALE, Francisco Cesar