FLAVIO EDUARDO TRIGO ROCHA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
19 resultados
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- Profile of sexuality and symptoms of lower urinary tract in non-institutionalized elderly(2020) TAHA, Khaled Ahmed; ROCHA, Flavio Trigo; CASTILHO, LisiasIntroduction: Urinary or sexual dysfunction in the elderly are underreported. However, they are highly prevalent. This study aims to identify the prevalence of these conditions. Objective: The aim is to carry out an investigation in non-institutionalized individuals over 60 years of age, to obtain data on its sexual and urinary health in Sao Paulo, Campinas, Santo Andre and Londrina. Results: 6.000 questionnaires were distributed, and 3425 were included in the study, for the analysis of the questionnaires separately. In relation to ADAM, 92% of the 1385 evaluated were suspicious of androgen deficiency (ADAM). As for the male sexual function, it was observed 37% of premature ejaculation. As for the female sexual function, 1300 (74%) did not practice sexual intercourse and the main reasons were: lack of partner and lack of sexual desire. In addition, 988 (78%) of women who had no sexual intercourse responded that they didn't want sex and, more importantly, about 22% of them would like to have sexual intercourse. International prostate symptom score (IPSS) showed gradual worsening of urinary symptoms with increasing age, being the most prevalent: nocturia and urinary urgency. As for the female IPSS, we noted that even after 80 years, the majority have mild symptoms related to voiding dysfunction; with increasing age there is a gradual increase in the result of the IPSS. Conclusion: Due to the large number of sexual and urinary disorders found, we recommend the improvement in health conditions, promoting a better quality of life in the elderly.
- 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.
- Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy(2019) NEUMAIER, Mark Fernando; SEGALL JUNIOR, Carlos Henrique; HISANO, Marcelo; ROCHA, Flavio Eduardo Trigo; ARAP, Sami; ARAP, Marco A.Introduction: Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. Objective: Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sirio-Liban8 Hospital (SLH), a private institution, in Sao Paulo, from April 2008 to December 2015. Materials and Method: Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and followup data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. Results: Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. Conclusion: Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.
- Neurogenic bladder - concepts and treatment recommendations(2022) TRUZZI, Jose Carlos; ALMEIDA, Fernando Goncalves de; SACOMANI, Carlos Alberto; REIS, Joceara; ROCHA, Flavio Eduardo TrigoIntroduction: Bladder and urinary sphincter malfunctioning that results from some change in the central and/or peripheral nervous system is defined as neurogenic bladder. The urinary tract symptoms that can be related to its filling, emptying, or both have a significant impact on the quality of life of individuals. The present review was based on the document prepared for the public health system in Brazil as a treatment guidelines proposal. Material and Methods: Survey questions were structured as per PICO (Population, Intervention, Control, and Outcome). Search strategies were defined and performed in the MEDLINE/Pubmed, Embase, Epistemonikos and Google Scholar databases. The selection of articles followed the evidence hierarchy concept; evidence body was identified, and the quantitative study data were extracted. The quality of evidence and grade of recommendation were qualitatively assessed according to GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results: A total of 2.707 articles were identified, with 49 of them being selected to compose the basis for this review. Neurogenic bladder treatments were classified according to their focus on filling or emptying symptoms and sub- classified in pharmacological and surgical treatments. Conclusion: Treatment guidelines are important tools for the public health system to promote the best practice when treating neurogenic bladder patients.
- Overactive bladder-18 years - Part II(2016) TRUZZI, Jose Carlos; GOMES, Cristiano Mendes; BEZERRA, Carlos A.; PLATA, Ivan Mauricio; CAMPOS, Jose; GARRIDO, Gustavo Luis; ALMEIDA, Fernando G.; AVERBECK, Marcio Augusto; FORNARI, Alexandre; SALAZAR, Anibal; DELL'ORO, Arturo; CINTRA, Caio; SACOMANI, Carlos Alberto Ricetto; TAPIA, Juan Pablo; BRAMBILA, Eduardo; LONGO, Emilio Miguel; ROCHA, Flavio Trigo; COUTINHO, Francisco; FAVRE, Gabriel; GARCIA, Jose Antonio; CASTANO, Juan; REYES, Miguel; LEYTON, Rodrigo Eugenio; FERREIRA, Ruiter Silva; DURAN, Sergio; LOPEZ, Vanda; REGES, RicardoTraditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.
- Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease(2014) GOMES, Cristiano M.; SAMMOUR, Zein M.; BESSA JUNIOR, Jose de; BARBOSA, Egberto R.; LOPES, Roberto I.; SALLEM, Flavio S.; TRIGO-ROCHA, Flavio E.; BRUSCHINI, Homero; NITTI, Victor W.; SROUGI, MiguelOBJECTIVES: To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease. METHODS: In a prospective study, 33 consecutive men (mean age 59.2 +/- 7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated. RESULTS: Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4 +/- 7.5 to 11.1 +/- 6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8 +/- 1.1 to 1.0 +/- 1.0 (p<0.001) and the maximum urinary flow varied from 9.3 +/- 4.4 to 11.2 +/- 4.6 ml/s (p = 0.025). The severity of neurological impairment was the only predictor of the clinical response. Additionally, patients with a Unified Parkinson's Disease Rating Scale score lower than 70 had a significantly higher chance of clinical improvement with doxazosin treatment than those with higher Unified Parkinson's Disease Rating Scale scores did (RR = 3.10, 95% CI = [1.15 to 5.37], p = 0.011). CONCLUSIONS: Doxazosin resulted in the improvement of lower urinary tract symptoms and the maximum flow rate and was well tolerated in men with Parkinson's disease. The response to treatment is dependent on the severity of neurological disability.
bookPart Incontinência urinária(2023) ROCHA, Flavio Eduardo Trigo; ZILOTTI, Leonardo Trovo- Overactive bladder-18 years - Part I(2016) TRUZZI, Jose Carlos; GOMES, Cristiano Mendes; BEZERRA, Carlos A.; PLATA, Ivan Mauricio; CAMPOS, Jose; GARRIDO, Gustavo Luis; ALMEIDA, Fernando G.; AVERBECK, Marcio Augusto; FORNARI, Alexandre; SALAZAR, Anibal; DELL'ORO, Arturo; CINTRA, Caio; SACOMANI, Carlos Alberto Ricetto; TAPIA, Juan Pablo; BRAMBILA, Eduardo; LONGO, Emilio Miguel; ROCHA, Flavio Trigo; COUTINHO, Francisco; FAVRE, Gabriel; GARCIA, Jose Antonio; CASTANO, Juan; REYES, Miguel; LEYTON, Rodrigo Eugenio; FERREIRA, Ruiter Silva; DURAN, Sergio; LOPEZ, Vanda; REGES, RicardoOveractive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals - including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.
- Renal function in children with congenital neurogenic bladder(2011) OLANDOSKI, Karen Previdi; KOCH, Vera; TRIGO-ROCHA, Flavio EduardoAIMS: Preservation of renal function in children with congenital neurogenic bladder is an important goal of treatment for the disease. This study analyzed the evolution of renal function in patients with congenital neurogenic bladder. METHODS: We reviewed the records of 58 pediatric patients with respect to the following attributes: gender, age, etiology of neurogenic bladder, reason for referral, medical/surgical management, episodes of treated urinary tract infections, urodynamics, DMSA scintigraphy, weight, height, blood pressure, glomerular filtration rate, microalbuminuria and metabolic acidosis. Statistical analysis was performed, adopting the 5% significance level. RESULTS: The mean age at presentation was 4.2 +/- 3.5 years. Myelomeningocele was the most frequent etiology (71.4%). Recurrent urinary tract infection was the reason for referral in 82.8% of the patients. Recurrent urinary tract infections were diagnosed in 84.5% of the patients initially; 83.7% of those patients experienced improvement during follow-up. The initial mean glomerular filtration rate was 146.7 +/- 70.1 mL/1.73 m(2)/min, and the final mean was 193.6 +/- 93.6 mL/1.73 m(2)/min, p = 0.0004. Microalbuminuria was diagnosed in 54.1% of the patients initially and in 69% in the final evaluation. Metabolic acidosis was present in 19% of the patients initially and in 32.8% in the final assessment. CONCLUSIONS: Patient referral to a pediatric nephrologist was late. A reduction in the number of urinary tract infections was observed with adequate treatment, but microalbuminuria and metabolic acidosis occurred frequently despite adequate management.
bookPart Doenças da próstata(2020) ROCHA, Flávio Eduardo Trigo