MIGUEL SROUGI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
41 resultados
Resultados de Busca
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- Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones(2015) TORRICELLI, Fabio Cesar Miranda; DANILOVIC, Alexandre; VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scala; SROUGI, Miguel; MAZZUCCHI, EduardoThe use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed (R) database between January 1984 and October 2013 using ""shock wave lithotripsy"" and ""stone"" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.
conferenceObject ASSOCIATION OF VITAMIN D STATUS, DIABETES TYPE 2 AND HYPOGONADISM IN MEN WITH ERECTILE DIYSFUNCTION: A CROSS-SECTIONAL STUDY(2015) ALVARENGA, C.; GUGLIELMETTI, G.; CEZARINO, B.; SANTOS, A. Regina dos; CURY, J.; SROUGI, M.- Preoperative Planning with Noncontrast Computed Tomography in the Prone and Supine Position for Percutaneous Nephrolithotomy: A Practical Overview(2015) MARCHINI, Giovanni S.; BERTO, Fernanda Christina G.; VICENTINI, Fabio C.; SHAN, Chen Jen; SROUGI, Miguel; MAZZUCCHI, EduardoObjective: To evaluate kidney/adjacent organs positional changes in patients undergoing percutaneous nephrolithotomy (PCNL) using noncontrast computed tomography (NCCT) in prone and supine positions. Methods: Patients scheduled PCNL were prospectively enrolled in the study and underwent NCCT in supine and in prone position (with boosters). Two imaginary lines for the posterior calyx of upper/mid/lower poles of both kidneys in prone and supine decubitus were considered and compared. Line I (LI): drawn horizontally in the coronal plane in contact with the posterior edge of the kidney. Line II (LII): drawn from the antero-lateral edge of the vertebra through the middle of the posterior calyx (ideal puncture line). Renal depth (d) was measured from LI to the anterior extremity of the vertebra. The maximum access angle (a) considered the window available in the axial plane to perform a secure approach to each calyx. Results: Thirty-seven patients were analyzed; 56.7% were female; mean BMI was 28.3 +/- 4.9 kg/m(2). For the right kidney, prone position was associated with more organs crossed by LI (54.1% vs 18.9%; p<0.01) and LII (56.8% vs 27%; p=0.03) in the upper calyx. For the left kidney, LII crossed more organs in prone in the upper calyx (54.1% vs 29.7%; p=0.03). Both kidneys showed a tendency to be deeper in the supine position, which provided a wider access angle. Conclusions: Supine NCCT is not accurate to plan PCNL access in prone position. Prone decubitus is associated with more potential organ injuries in the upper pole. In supine, the kidney situates deeper in the abdomen but the access angle is wider than in prone.
conferenceObject ASSESSMENT OF THE MALE SEXUAL QUOTIENT SCALE RELIABILITY TO EVALUATE SEXUAL FUNCTION OF MEN WITH SPINAL CORD INJURY(2015) MIRANDA, Eduardo; GOMES, Cristiano; BESSA JUNIOR, Jose de; CASTRO FILHO, Jose de; BELLUCCI, Carlos; BATTISTELLA, Linamara; BARROS FILHO, Tarcisio; CARVALHO, Fabricio; ABDO, Carmita; BRUSCHINI, Homero; NAHAS, William; SROUGI, Miguel- Percutaneous nephrolithotomy in patients with solitary kidney: a critical outcome analysis(2015) TORRICELLI, Fabio C. M.; PADOVANI, Guilherme P.; MARCHINI, Giovanni S.; VICENTINI, Fabio C.; DANILOVIC, Alexandre; REIS, Sabrina T.; SROUGI, Miguel; MAZZUCCHI, EduardoPurpose: To describe our experience with percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys and analyze factors that can impact on intra-operative bleeding and postoperative complications. Materials and Methods: We reviewed our stone database searching for patients with solitary kidney who underwent PCNL from Jan-05 through Oct-13. Demographic data, stone characteristics, and intra-and postoperative outcomes were recorded. Spearman correlation was performed to assess which variables could impact on bleeding and surgical complications. Linear and logistic regressions were also performed. Results: Twenty-seven patients were enrolled in this study. The mean age and BMI were 45.6 years and 28.8Kg/m(2), respectively; 45% of cases were classified as Guys 3 (partial staghorn or multiple stones) or 4 (complete staghorn) - complex cases. Stone-free rate was 67%. Eight (29.6%) patients had postoperative complications (five of them were Clavien 2 and three were Clavien 3). On univariate analysis only number of tracts was associated with increased bleeding (p=0.033) and only operative time was associated with a higher complication rate (p=0.044). Linear regression confirmed number of access tracts as significantly related to bleeding (6.3, 95% CI 2.2-10.4; p=0.005), whereas logistic regression showed no correlation between variables in study and complications. Conclusions: PCNL in solitary kidneys provides a good stone-free rate with a low rate of significant complications. Multiple access tracts are associated with increased bleeding.
conferenceObject LONG-TERM EVALUATION OF TRANSURETHRAL INCISION OF THE PROSTATE FOR TREATMENT OF BENIGN PROSTATE HYPERPLASIA: ANALYSIS OF 75 CASES WITH A MEAN 8-YEAR FOLLOW-UP PERIOD(2015) CORDEIRO, Paulo; BARONE, Hugo; YOSHINAGA, Eduardo Muracca; NAKANO, Elcio; NAHAS, William C.; SROUGI, Miguel; ANTUNES, Alberto A.- 27 years of experience with the comprehensive surgical treatment of prune belly syndrome(2015) LOPES, R. I.; TAVARES, A.; SROUGI, M.; DENES, F. T.Introduction Prune belly syndrome (PBS) presents with three main features: abdominal wall flaccidity, urological abnormalities and cryptorchidism. As a result, urologists must consider the eventual repair of the abdominal wall flaccidity and urinary tract abnormalities, and the mandatory correction of cryptorchidism, as well as decide whether to perform the procedures in a single comprehensive approach or in multiple steps. Objectives To report experiences with comprehensive surgical management of prune belly syndrome. Material and methods From 1987 to 2014, 46 children with PBS were submitted for comprehensive surgical treatment. According to individual needs, treatment aimed to correct the abdominal flaccidity, reconstruct the urinary tract, and perform bilateral orchiopexy and circumcision, which were performed in one procedure. Urinary tract reconstruction was indicated whenever pyelo-ureteral dilatation with evidence of significant stasis and/or vesicoureteral reflux was associated with recurrent urinary tract infections (UTI). Treatment for this cohort included: 44 abdominoplasties, 40 upper urinary tract reconstructions, 44 cystoplasties associated with three appendico-vesicostomies, 46 bilateral orchiopexies and 36 circumcisions. The median age at surgery was 16 months and children were followed for a median of 143 months. Results Abdominal appearance and tonus were improved in 90% of the children after the primary surgery and 100% after reoperation. Upper urinary tract reconstruction was performed in most children and long-term follow-up showed functional stabilization of the urinary tract in about 90% of the children, with progression to renal failure in 10%. Lower urinary tract reconstruction was performed in most children (95.6%); on late follow-up, continence was observed in 81% of them, while incontinence was present in 19% and usually associated with polyuria. Adequate bladder emptying was possible in most boys (82.6%), while the remaining required clean intermittent catheterization. Pre-operative UTI was present in 89.1% and urinary sepsis in 15.2%. Postoperatively, the incidence of laboratorial UTI was significantly reduced to 39.1%, while urinary sepsis was absent. Bilateral orchiopexy was performed in all children, with 85% of the testes becoming normal in size and well located in the scrotum. Conclusions Comprehensive surgical treatment is feasible and has good long-term results. A considerable incidence of reoperations due to complications or progression of the disease was observed. The long-term results for reno-ureteral anatomy and function, bladder function, infection, testicular size and location, as well as abdominal aspect and tonus, show that comprehensive surgery is an adequate method for managing children with PBS.
conferenceObject LOW-VOLUME PROSTATE IN BENIGN PROSTATIC HYPERPLASIA (BPH): A RISK FACTOR FOR SYMPTOMATIC BLADDER DIVERTICULA REQUIRING SURGICAL TREATMENT(2015) YOSHINAGA, Eduardo Muracca; NAKANO, Elcio; MARCHINI, Giovanni S.; OYAMA, Renato Hajime; CORDEIRO, Paulo; NAHAS, William C.; SROUGI, Miguel; ANTUNES, Alberto A.- Diagnostic work-up and laparoscopic correction of an ectopic ureter(2015) CEZARINO, B. N.; LOPES, R. I.; OLIVEIRA, L. M.; DENES, F. T.; SROUGI, M.Introduction A duplex renal collecting system is a common congenital anomaly in children. Continuous dribbling (especially if after the toilet-training period) should raise suspicion of the presence of an ectopic ureter, which is most often associated with ureteral duplication. This video will demonstrate the complete diagnostic work-up necessary in these cases. Case report A 10-year-old girl presented with continuous dribbling. Ultrasonography and computerized tomography depicted a duplex system on the left side, with the upper pole ureter ectopically inserting into the vaginal cavity and good upper pole renal parenchyma. A careful urethrocystoscopy showed a topic right ureteral orifice and a topic lower pole left ureteral orifice. Retrograde pyelography was performed and displayed normal left lower pole anatomy. A vaginography was performed, which showed reflux to the ectopic ureter. Vaginoscopy clearly identified the ectopic ureteral orifice. A guide wire was introduced through this meatus and retrograde contrast injection confirmed the diagnosis of an ectopic ureter. Results At laparoscopy, a larger upper pole ureter and a normal lower pole ureter on the left side were identified. A termino-lateral ureteroureteral anastomosis was performed. After the procedure, the child reported immediate resolution of urinary dribbling. Conclusion In order to optimize its surgical correction, efforts should be made to appropriate localization of the ectopic ureter.
- Analysis of the learning curve for transurethral resection of the prostate. Is there any influence of musical instrument and video game skills on surgical performance?(2015) YAMACAKE, Kleiton Gabriel Ribeiro; NAKANO, Elcio Tadashi; SOARES, Iva Barbosa; CORDEIRO, Paulo; SROUGI, Miguel; ANTUNES, Alberto AzoubelObjective: To evaluate the learning curve for transurethral resection of the prostate (TURP) among urology residents and study the impact of video game and musical instrument playing abilities on its performance. Material and methods: A prospective study was performed from July 2009 to January 2013 with patients submitted to TURP for benign prostatic hyperplasia. Fourteen residents operated on 324 patients. The following parameters were analyzed: age, prostate-specific antigen levels, prostate weight on ultrasound, pre- and postoperative serum sodium and hemoglobin levels, weight of resected tissue, operation time, speed of resection, and incidence of capsular lesions. Gender, handedness, and prior musical instrument and video game playing experience were recorded using survey responses. Results: The mean resection speed in the first 10 procedures was 0.36 g/min and reached a mean of 0.51 g/min after the 20th procedure. The incidence of capsular lesions decreased progressively. The operation time decreased progressively for each subgroup regardless of the difference in the weight of tissue resected. Those experienced in playing video games presented superior resection speed (0.45 g/min) when compared with the novice (0.35 g/min) and intermediate (0.38 g/min) groups (p=0.112). Musical instrument playing abilities did not affect the surgical performance. Conclusion: Speed of resection, weight of resected tissue, and percentage of resected tissue improve significantly and the incidence of capsular lesions reduces after the performance of 10 TURP procedures. Experience in playing video games or musical instruments does not have a significant effect on outcomes.