CLAUDIO BOVOLENTA MURTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
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- Effectiveness of Intrarectal Povidone-iodine Cleansing Plus Formalin Disinfection of the Needle Tip in Decreasing Infectious Complications After Transrectal Prostate Biopsy: A Randomized Controlled Trial(2022) PONTES-JUNIOR, Jose; FREIRE, Tiago Magalhaes; PUGLIESI, Felipe Guimaraes; COSTA, Felipe Machado de Moura; SOUZA, Vinicius Meneguette Gomes De; GALUCCI, Fabio Pescarmona; ALBERTINI, Aline; COUTO, Adriano Borba; MURTA, Claudio Bovolenta; GUGLIELMETTI, Giuliano Betoni; NAHAS, William C.; JUNIOR, Adalberto Andriolo; NETO, Alcides Mosconi; CLARO, Joaquim Francisco de AlmeidaPurpose:Prostate biopsy is mostly performed through the transrectal route worldwide and infectious complications may occur in up to 7% of cases. Therefore, alternative strategies to decrease infectious complications are needed. Our aim was to evaluate the effectiveness of intrarectal povidone-iodine cleansing plus formalin disinfection of the needle tip in decreasing infectious complications after transrectal ultrasound guided prostate biopsy.Materials and Methods:We conducted a prospective, single-center, phase III trial in patients undergoing transrectal ultrasound guided prostate biopsy randomized 1:1 to rectal mucosa cleansing with gauze soaked in 10% povidone-iodine solution wrapped around the gloved index finger and needle tip disinfection by immersion in a 10% formalin solution before each puncture vs control group. The primary end point was the rate of infectious complications defined as 1 or more of the following events: fever, urinary tract infection, or sepsis.Results:Overall, 633 patients were randomized to the intervention group and 623 to the control group. The infectious complication rate was 3.9% in the intervention group and 6.4% in the control group (RR 0.61; 95% CI 0.36-0.99; P = .049). The rates of sepsis, urinary tract infection, and fever were 0.3% vs 0.5% (P = .646), 2.3% vs 4.1% (P = .071), and 1.3% vs 1.9% (P = .443), respectively. The positive urine culture rate was 5.2% in the intervention group and 9% in the control group (RR 0.57; P = .015). There was no statistically significant difference between the groups regarding the occurrence of noninfectious adverse events.Conclusions:Intrarectal povidone-iodine cleansing plus formalin disinfection of the biopsy needle tip was associated with a reduction in infectious complications after transrectal prostate biopsy.
- Perioperative Morbidity of Radical Prostatectomy After Intensive Neoadjuvant Androgen Blockade in Men With High-Risk Prostate Cancer: Results of Phase II Trial Compared to a Control Group(2023) ILARIO, Eder N.; BASTOS, Diogo A.; GUGLIELMETTI, Giuliano B.; MURTA, Claudio B.; CARDILI, Leonardo; CORDEIRO, Mauricio D.; JUNIOR, Jose P.; COELHO, Rafael F.; NAHAS, William C.In this study, we investigated whether intense neoadjuvant therapy could increase the risk of complications in radical prostatectomy. After analyzing 124 patients we concluded that intense neoadjuvant therapy doesn't increase morbidity of radical prostatectomy and reduces positive surgical margins. The association of neoad-juvant therapy with extended pelvic lymphadenectomy may increase the risk of perioperative thromboembolic events.Introduction: Recent studies about intense neoadjuvant therapy followed by Radical Prostatectomy (RP) lack standard-ized cr iter ia regarding surgical complications and comparison to a group of patients who underwent RP without the use of neoadjuvant therapy. The aim of this study is to describe and compare the perioperative complication rates. Materials and Methods: This was a prospective, single-center phase II trial in patients with high-risk prostate cancer (HRPCa). The control group included HRPCa patients who underwent RP outside the clinical trial during the same study recruit-ment period. The interventional group was randomized (1:1) to receive neoadjuvant androgen deprivation therapy plus abiraterone with or without apalutamide followed by RP. Complications observed up to 30 days of surgery were classi-fied based on the Clavien-Dindo classification. Uni-and multivariate analyses were carried out to assess predictive factors associated with perioperative complications. Results: In total, 124 patients with HRPCa were underwent to RP between May 27, 2019 and August 6, 2021, including 61 patients in the intervention group and 63 patients in the control group. The general and major complications in the intervention group reached 29.6% and 6.6%, respectively, and 39.7% and 7.9% in the control group, respectively. There was no significant difference between groups. We observed 4.9% of thromboembolic event in the neoadjuvant group. Conclusions: There was no significant increase in morbidity rate in RP after intense neoadjuvant therapy. The association of intense androgen deprivation neoadjuvant therapy with RP and extended pelvic lymphadenectomy may increase the risk of a perioperative thromboembolic events.
- Reply by Authors(2022) PERRELLA, R.; VICENTINI, F. C.; PARO, E. D.; TORRICELLI, F. C. M.; MARCHINI, G. S.; DANILOVIC, A.; BATAGELLO, C. A.; MOTA, P. K. V.; FERREIRA, D. B.; COHEN, D. J.; MURTA, C. B.; CLARO, J. F. A.; GIUSTI, G.; MONGA, M.; NAHAS, W. C.; SROUGI, M.; MAZZUCCHI, E.
- Increased risk of bladder cancer recurrence due to bacillus Calmette-Guérin shortage in Brazil(2024) MURTA, Claudio Bovolenta; HAYEK, Kayann Kaled Reda El; DIAS, Bruno Cesar; YORIOKA, Marco Aurelio Watanabe; CASSAO, Valter DellAcqua; CLARO, Joaquim Francisco de AlmeidaOBJECTIVE: Our study aimed to evaluate the impact of bacillus Calmette-Guerin shortage on recurrence and progression in patients with non-muscle invasive bladder cancer in a Brazilian cohort. METHODS: We retrospectively reviewed the clinicopathological data of 409 patients who had their first transurethral resection of the bladder tumor for intermediate or high-risk non-muscle invasive bladder cancer between June 2014 and May 2021 in a tertiary public hospital in Brazil. Patients included had non-muscle-invasive urothelial carcinoma of the bladder resected completely for the first time, regardless of bacillus Calmette-Guerin use. Low-risk disease patients were excluded from the analysis. Demographic, clinicopathological, and bacillus Calmette-Guerin use data were collected from our database. Recurrence and progression data were obtained from patient records or through telephone interviews. Recurrence-free survival and progression-free survival were calculated from the date of transurethral resection of the bladder tumor until the events of recurrence, progression, last office visit, or phone interview. RESULTS: Within a median follow-up period of 26.7 months, 168 (41.1%) patients experienced a recurrence in a median time of 27 months (95%CI 16.1-38). Bacillus Calmette-Guerin was administered to 57 (13.9%) individuals after transurethral resection of the bladder tumor. Patients with >= 3 lesions (p<0.001), those with lesions >3 cm (p=0.02), and those without bacillus Calmette-Guerin treatment (p<0.001) had shorter recurrence-free survival. According to a Cox multivariate regression model, bacillus Calmette-Guerin use was independently associated with a reduced recurrence rate, with an HR of 0.43 (95%CI 0.25-0.72). Out of the patients studied, 26 (6.4%) experienced progression. T1 stage (p<0.001) and high-grade (p<0.001) were associated with shorter progression-free survival. Bacillus Calmette-Guerin did not influence bladder cancer progression. In the Cox multivariate analysis, high-risk disease was independently associated with progression (p<0.001). CONCLUSION: Our study confirms that non-muscle invasive bladder cancer exhibits a high recurrence rate. The use of adjuvant bacillus Calmette-Guerin in intermediate and high-risk patients significantly reduces this rate. Furthermore, the bacillus Calmette-Guerin shortage could have negatively impacted these patients.