ALBERTO AZOUBEL ANTUNES
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
16 resultados
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- 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.
bookPart Hiperplasia benigna da próstata(2013) SROUGI, Miguel; ANTUNES, Alberto Azoubel; DALL'OGLIO, Marcos- 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.
- Risk Factors for Male Lower Urinary Tract Symptoms: The Role of Metabolic Syndrome and Androgenetic Alopecia in a Latin American Population(2013) BARBOSA, Joao Arthur B. A.; MURACCA, Eduardo; NAKANO, Elcio; PARANHOS, Mario; NATALINO, Renato; CORDEIRO, Paulo; SROUGI, Miguel; ANTUNES, Alberto AzoubelOBJECTIVE To evaluate the association of male lower urinary tract symptoms (LUTS) with metabolic syndrome (MetS) and androgenetic alopecia in a Latin American population. METHODS We enrolled 907 patients for prospective evaluation at a single institution. LUTS were evaluated with the International Prostate Symptom Score (IPSS). Subjects were evaluated with respect to hypertension, diabetes, dyslipidemia, previous cardiovascular events, body mass index (BMI), waist and hip circumference, and a laboratorial investigation including prostate-specific antigen (PSA), C-reactive protein (CRP), and gonadal steroids. Alopecia was classified according to the Norwood-Hamilton scale. RESULTS Mean patient age was 61.0 years; 57.5% of subjects had moderate/severe LUTS; MetS was present in 17.2% of subjects and 53.9% were classified as bald. Age, hypertension, diabetes, dyslipidemia, alopecia, previous cardiovascular event, and elevated waist-to-hip ratio (WHR) were associated with moderate/severe LUTS and with storage symptoms (P < .05). On multivariable analysis, age (odds ratio [OR] 2.30, 95% confidence interval [CI] 1.63-3.25), cardiovascular events (OR 1.73, 95% CI 1.07-2.78), and WHR (OR 1.65, 95% CI 1.13-2.40) were independent predictors for LUTS. For storage symptoms, age (OR 1.80, 95% CI 1.28-2.54), cardiovascular event (OR 2.07, 95% CI 1.27-3.39), WHR (OR 1.54, 95% CI 1.06-2.25), and MetS (OR 1.70, 95% CI 1.01-2.86) were independent risk factors. Age and cardiovascular event were the only independent predictors for voiding symptoms. CONCLUSION Components of the MetS were strongly associated with moderate and severe LUTS. WHR and cardiovascular events were independent predictors of voiding and storage symptoms, and MetS was an independent predictor of storage symptoms. Alopecia was not an independent predictor of LUTS. UROLOGY 82: 182-188, 2013. (C) 2013 Elsevier Inc.
- Prostatic Artery Embolization for Enlarged Prostates Due to Benign Prostatic Hyperplasia. How I Do It(2013) CARNEVALE, Francisco C.; ANTUNES, Alberto A.Prostatic artery embolization (PAE) has emerged as an alternative to surgical treatments for benign prostatic hyperplasia (BPH). Patient selection and refined technique are essential for good results. Urodynamic evaluation and magnetic resonance imaging are very important and technical limitations are related to elderly patients with tortuous and atherosclerotic vessels, anatomical variations, difficulty visualizing and catheterizing small diameter arteries feeding the prostate, and the potential risk of bladder and rectum ischemia. The use of small-diameter hydrophilic microcatheters is mandatory. Patients can be treated safely by PAE with low rates of side effects, reducing prostate volume with clinical symptoms and quality of life improvement without urinary incontinence, ejaculatory disorders, or erectile dysfunction. A multidisciplinary approach with urologists and interventional radiologists is essential to achieve better results.
- Interactions between Lower Urinary Tract Symptoms and Cardiovascular Risk Factors Determine Distinct Patterns of Erectile Dysfunction: A Latent Class Analysis(2013) BARBOSA, Joao A. B. A.; MURACCA, Eduardo; NAKANO, Elcio; ASSALIN, Adriana R.; CORDEIRO, Paulo; PARANHOS, Mario; CURY, Jose E.; SROUGI, Miguel; ANTUNES, Alberto A.Purpose: An epidemiological association between lower urinary tract symptoms and erectile dysfunction is well established. However, interactions among multiple risk factors and the role of each in pathological mechanisms are not fully elucidated Materials and Methods: We enrolled 898 men undergoing prostate cancer screening for evaluation with the International Prostate Symptom Score (I-PSS) and simplified International Index of Erectile Function-5 (IIEF-5) questionnaires. Age, race, hypertension, diabetes, dyslipidemia, metabolic syndrome, cardiovascular disease, serum hormones and anthropometric parameters were also evaluated. Risk factors for erectile dysfunction were identified by logistic regression. The 333 men with at least mild to moderate erectile dysfunction (IIEF 16 or less) were included in a latent class model to identify relationships across erectile dysfunction risk factors. Results: Age, hypertension, diabetes, lower urinary tract symptoms and cardiovascular event were independent predictors of erectile dysfunction (p < 0.05). We identified 3 latent classes of patients with erectile dysfunction (R-2 entropy = 0.82). Latent class 1 had younger men at low cardiovascular risk and a moderate/high prevalence of lower urinary tract symptoms. Latent class 2 had the oldest patients at moderate cardiovascular risk with an increased prevalence of lower urinary tract symptoms. Latent class 3 had men of intermediate age with the highest prevalence of cardiovascular risk factors and lower urinary tract symptoms. Erectile dysfunction severity and lower urinary tract symptoms increased from latent class 1 to 3. Conclusions: Risk factor interactions determined different severities of lower urinary tract symptoms and erectile dysfunction. The effect of lower urinary tract symptoms and cardiovascular risk outweighed that of age. While in the youngest patients lower urinary tract symptoms acted as a single risk factor for erectile dysfunction, the contribution of vascular disease resulted in significantly more severe dysfunction. Applying a risk factor interaction model to prospective trials could reveal distinct classes of drug responses and help define optimal treatment strategies for specific groups.
conferenceObject EXPRESSION PROFILE OF CD105 IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA (BPH): A NEW ANGIOGENIC MARKER(2013) BIOLO, Karlo; KIRIHARA, Ricardo; REIS, Sabrina T.; VIANA, Nayara I.; SAJOVIC, Paulo; ARAUJO, Luiz Henrique; LEITE, Katia R.; SROUGI, Miguel; ANTUNES, Alberto A.- Transient Ischemic Rectitis as a Potential Complication after Prostatic Artery Embolization: Case Report and Review of the Literature(2013) MOREIRA, Airton Mota; MARQUES, Carlos Frederico Sparapan; ANTUNES, Alberto Azoubel; NAHAS, Caio Sergio Rizkallah; NAHAS, Sergio Carlos; ARIZA, Miguel Angel de Gregorio; CARNEVALE, Francisco CesarProstatic artery embolization (PAE) is an alternative treatment for benign prostatic hyperplasia. Complications are primarily related to non-target embolization. We report a case of ischemic rectitis in a 76-year-old man with significant lower urinary tract symptoms due to benign prostatic hyperplasia, probably related to nontarget embolization. Magnetic resonance imaging revealed an 85.5-g prostate and urodynamic studies confirmed Inferior vesical obstruction. PAE was performed bilaterally. During the first 3 days of follow-up, a small amount of blood mixed in the stool was observed. Colonoscopy identified rectal ulcers at day 4, which had then disappeared by day 16 post PAE without treatment. PAE is a safe, effective procedure with a low complication rate, but interventionalists should be aware of the risk of rectal nontarget embolization.
conferenceObject ROLE OF MICRORNAS IN REGULATING TISSUE INFLAMMATION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA: PRELIMINARY RESULTS(2013) OLIVEIRA, Fabio; SAGAE, Vitor; REIS, Sabrina T.; VIANA, Nayara I.; LEITE, Katia R.; SROUGI, Miguel; ANTUNES, Alberto A.- Prima-1 induces apoptosis in bladder cancer cell lines by activating p53(2013) PIANTINO, Camila B.; REIS, Sabrina T.; VIANA, Nayara I.; SILVA, Iran A.; MORAIS, Denis R.; ANTUNES, Alberto A.; DIP, Nelson; SROUGI, Miguel; LEITE, Katia R.OBJECTIVES: Bladder cancer represents 3% of all carcinomas in the Brazilian population and ranks second in incidence among urological tumors, after prostate cancer. The loss of p53 function is the main genetic alteration related to the development of high-grade muscle-invasive disease. Prima-1 is a small molecule that restores tumor suppressor function to mutant p53 and induces cancer cell death in various cancer types. Our aim was to investigate the ability of Prima-1 to induce apoptosis after DNA damage in bladder cancer cell lines. METHOD: The therapeutic effect of Prima-1 was studied in two bladder cancer cell lines: T24, which is characterized by a p53 mutation, and RT4, which is the wild-type for the p53 gene. Morphological features of apoptosis induced by p53, including mitochondrial membrane potential changes and the expression of thirteen genes involved in apoptosis, were assessed by microscopic observation and quantitative real-time PCR (qRT-PCR). RESULTS: Prima-1 was able to reactivate p53 function in the T24 (p53 mt) bladder cancer cell line and promote apoptosis via the induction of Bax and Puma expression, activation of the caspase cascade and disruption of the mitochondrial membrane in a BAK-independent manner. CONCLUSION: Prima-1 is able to restore the transcriptional activity of p53. Experimental studies in vivo may be conducted to test this molecule as a new therapeutic agent for urothelial carcinomas of the bladder, which characteristically harbor p53 mutations.