MARCOS FIGUEIREDO MELLO
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- A prospective and randomized study comparing the use of alarms, desmopressin and imipramine in the treatment of monosymptomatic nocturnal enuresis(2023) MELLO, Marcos Figueiredo; LOCALI, Rafael Fagionato; ARAUJO, Rogerio Mattos; REIS, Joceara Neves; SAIOVICI, Samuel; MELLO, Luiz Figueiredo; ROCHA, Flavio Eduardo TrigoBackground Monosymptomatic enuresis (MNE) results from a pathogenic triad that may include lack of vaso-pressin secretion during sleep, reduced functional bladder capacity and inability to wake up during sleep. The treatment of MNE can be performed through behavioral therapy, use of alarms or medi-cations such as desmopressin and imipramine.Objective To compare the effectiveness of different treat-ments of MNE.Study design Prospective and randomized study comparing different intervention and a control group (receiving only behavior therapy) for MNE. Inclusion criteria: age between 5 and 16 years old, with MNE, evalu-ated at the pediatric urology outpatient clinic of Hospital Infantil Menino Jesus. At first visit children were submitted to behavior therapy (urotherapy) for 3 months, children were subsequently characterized according to the ICCS as non-responders, partial responders, or full responders. Those partial re-sponders or non-responders received a patient ID and were randomized to four groups: Alarm Group (G1), Desmopressin Group -DDAVP (G2), Imipramine Group (G3) and Control (G4). All groups were moni-tored monthly, for a period of 6 months. After 6 months, the children were reevaluated for MNE.Results 93 patients were enrolled. Mean age was 10.96 years with a standard deviation of 2.28 years, 59,1% were male. All groups had improvement in the number of dry nights (Table). Taking in account success the population full responders and partial responders: Alarm Group (G1) achieve success in 100% of cases, Desmopressin Group -DDAVP (G2) in 63.6% of cases, Imipramine Group (G3) in 73.7% of cases (Table 3). No drugs side effects were observed in both groups (G2 and G3), there was no dropout in patients who used alarms.Discussion Our data suggests that the use of alarms is the most effective treatment of ENM with superior results when compared to imipramine and DDAVP. The small number of participants is a weakness of the study, as well as the lack of a voiding diary at the end of the study.Conclusion All therapeutics options utilized in the treatment of MNE are safe, effective and has a low rate of abandonment.
- Urinary extracellular matrix proteins as predictors of the severity of ureteropelvic junction obstruction in children(2021) MELLO, Marcos Figueiredo; REIS, Sabrina Thalita dos; KONDO, Enzo Yagi; BESSA JUNIOR, Jose de; DENES, Francisco Tibor; LOPES, Roberto IglesiasIntroduction Ureteropelvic junction obstruction (UPJO) particu-larly represents a challenge in regard to manage-ment, as not all hydronephrosis (HN) represent a kidney-damaging state. Urinary biomarkers have been proposed as noninvasive tools. Extracellular matrix (ECM) proteins are associated with tissue fibrosis in the setting of UPJO and is poorly explored. Objective To investigate whether urinary ECM proteins are useful to discriminate the severity of urinary obstruction on unilateral UPJO. Study design Children with unilateral UPJO were prospective enrolled. Urinary (u) matrix metalloproteinases (MMP-1,-2,-9 and TIMP-1,-2) as well as clinical characteristics were measured in the following groups: 26 children with obstructive HN at initial diagnosis and after six months of dismembered pyeloplasty; 22 children with non-obstructive HN at diagnosis and after six months of observation; 26 children without any urinary tract condition, as the control group. Results were assessed statistically using for homogenous groups, a one-way analysis of variances (ANOVA) and for nonparametric groups, Mann-Whitney test or Kruskal-Wallis test was per -formed. ROC curves were performed. Results Baseline samples demonstrated a higher concentra-tion of uMMP-1/Cr, uMMP-2/Cr, u-TIMP-1/Cr and u-TIMP-2/Cr in obstructive HN group; uMMP-9/Cr levels were higher in non-obstructive HN group and all studied biomarkers had lower concentrations for the control group. On follow-up, for the obstructive HN group, urinary concentration of uTIMP-1/Cr and uTIMP-2/Cr decreased, and uMMP-1/Cr, uMMP-2/Cr and uMMP-9/Cr increased when comparing preop-erative to postoperative values. In the non-obstructive HN group, all proteins analyzed were stable after six months of observation. ROC curves analysis showed a promising diagnostic profile for the detection of obstructive HN for uTIMP-1/Cr (area under the curve-AUC-; of 0.692), uTIMP-2/Cr (AUC of 0.678) and for uMMP-2/Cr (AUC of 0.655). Discussion The severity of kidney obstruction could correlate with the urinary ECM proteins concentration in this study. This is concordant with prior studies demon-strating that a disruption of the balance of accu-mulation/degradation of the ECM proteins occur on obstructive uropathy. Limitations of our study include the older age of our patients and that these markers had no influence at all on the surgical decision. Conclusion We demonstrate that obstructive HN have signifi-cantly higher uMMP-2, uTIMP-1 and uTIMP-2 con-centrations. Particularly, uTIMP-2 levels were correlated to severity of obstruction and therefore, it might be a useful urinary biomarker to correctly allocate children with HN between surgical man-agement vs follow-up. After pyeloplasty, uTIMP-1 and uTIMP-2 presented a progressive decrease postoperatively, which is also highly desirable for urinary markers.