MARCELO HISANO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, 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
22 resultados
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- Lower urinary tract symptoms in children and adolescents with Williams-Beuren syndrome(2017) SAMMOUR, Z. M.; BESSA JR., J. de; HISANO, M.; BRUSCHINI, H.; KIM, C. A.; SROUGI, M.; GOMES, C. M.Introduction Williams-Beuren syndrome (WBS) is a genetic condition caused by a microscopic deletion in the chromosome band 7q11.23. Individuals with WBS may present with congenital cardiovascular defects, neurodevelopmental disturbances and structural abnormalities of the urinary tract. Lower urinary tract symptoms (LUTS) seem to be frequent in this population, but studies on this topic are scarce and based on small case series. Objective To systematically evaluate the prevalence of lower urinary tract symptoms (LUTS) and the acquisition of bladder control in a large population with WBS. Study design A cross-sectional study evaluating 87 consecutive patients with WBS; there were 41 girls and 46 boys. Genetic studies confirmed WBS in all patients. Subjects were clinically evaluated with: a history of LUTS obtained from the parents and child, a structured questionnaire of LUTS, a 3-day urinary frequency-volume chart, a quality of life question regarding LUTS, and physical examination. A history regarding the acquisition of bladder control was directly evaluated from the parents. Results Mean age of patients was 9.0 +/- 4.2 years, ranging from 3 to 19 years. Based on the symptoms questionnaire and the frequency-volume chart, 70 patients (80.5%) were symptomatic. The most common symptom was urgency, affecting 61 (70.1%) patients, followed by increased urinary frequency in 60 (68.9%) patients, and urge-incontinence in 53 (60.9%), as shown in Summary Fig. More than half of the children reported nocturnal enuresis, including 61% of the girls and 52% of the boys. Twenty-three patients (25.6%) had a history of urinary tract infections. The mean age for acquisition of dryness during the day was 4.4 +/- 1.9 years. Parents of 61 patients (70.1%) acknowledged that LUTS had a significant impact on the quality of life of their children. Discussion A high prevalence of LUTS was confirmed with a significant negative impact on quality of life in a large population of children and adolescents with WBS. It was shown for the first time that the achievement of daytime bladder control is delayed in children with WBS. Although LUTS are not recognized as one of the leading features of the syndrome, it is believed that it should be considered as a significant characteristic of the clinical diagnosis of WBS. Conclusions LUTS are highly prevalent in children and adolescents with WBS and have a significant negative impact on patient's quality of life.
- Cranberries and lower urinary tract infection prevention(2012) HISANO, Marcelo; BRUSCHINI, Homero; NICODEMO, Antonio Carlos; SROUGI, MiguelLower urinary tract infections are very common diseases. Recurrent urinary tract infections remain challenging to treat because the main treatment option is long-term antibiotic prophylaxis; however, this poses a risk for the emergence of bacterial resistance. Some options to avoid this risk are available, including the use of cranberry products. This article reviews the key methods in using cranberries as a preventive measure for lower urinary tract infections, including in vitro studies and clinical trials.
- 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.
- Is there a model to teach and practice retroperitoneoscopic nephrectomy?(2013) HISANO, Marcelo; DUARTE, Ricardo Jordao; COLOMBO JR., Jose Roberto; SROUGI, MiguelIntroduction: Although the retroperitoneal approach has been the preferred choice for open urological procedures, retroperitoneoscopy is not the preferred approach for laparoscopy. This study aims to develop a training model for retroperitoneoscopy and to establish an experimental learning curve. Material and methods: Fifteen piglets were operated on to develop a standard retroperitoneoscopic nephrectomy (RPN) training model. All procedures were performed with three ports. Intraoperative data (side, operative time, blood loss, peritoneal opening) were recorded. Animals were divided into groups A, the first eight, and B, the last seven cases. Data were statistically analyzed. Results: We performed fifteen RPNs. The operative time varied from 15 to 50 minutes (median 30 minutes). Blood loss varied from 5 to 100 mL (median 20 mL). We experienced five peritoneal openings; we had two surgical vascular complications managed laparoscopically. There was statistical difference between groups A and B for peritoneal opening (p = 0.025), operative time (p = 0.0037), and blood loss (p = 0.026). Discussion: RPN in a porcine model could simulate the whole procedure, from creating the space to nephrectomy completion. Experimental learning curve was eight cases, after statistical data analysis. Conclusion: RPN in a porcine model is feasible and could be very useful for teaching and practicing retroperitoneoscopy.
conferenceObject THE GUY'S STONE SCORE: A VERY PRACTICAL AND USEFUL TOOL TO PREDICT THE OUTCOMES OF PERCUTANEOUS NEPHROLITHOTOMY (PCNL)(2012) VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scala; MAZZUCCHI, Eduardo; CHEDID NETO, Elias Assad; BRITO, Arthur Henrique; DANILOVIC, Alexandre; HISANO, Marcelo; CLARO, Joaquim Almeida; SROUGI, MiguelOBJECTIVE: To evaluate the applicability of the Guy’s stone score for complete supine PCNL. METHODS: 117 patients that underwent to complete supine PCNL were classified according the Guy’s stone score. The data were prospectively collected but the classification according to the score was done by review of the pre-operative CT scans. All patients were operated by the same surgeon and had a pre and post operative CT scan and at the final followup. The outcomes and complications were compared among the 4 groups. RESULTS: The table 1 shows the demographic and outcomes. The groups were similar except for the median stone diameter. The differences among groups were statistically different after stratification according to the Guy’s stone score in relation to operative time, hemoglobin drop, transfusions, complications, tubeless rate, immediate success, auxiliary procedures, PCNL revisions and final success rate. CONCLUSIONS: The Guy’s stone score showed to be a very practical and useful tool to predict the outcomes of PCNL.- Congenital genitourinary abnormalities in children with Williams-Beuren syndrome(2014) SAMMOUR, Zein M.; GOMES, Cristiano M.; BESSA JR., Jose de; PINHEIRO, Marcello S.; KIM, Chong A. E.; HISANO, Marcelo; BRUSCHINI, Homero; SROUGI, MiguelObjective: Williams-Beuren syndrome (WBS) is an autosomal dominant disorder caused by a gene deletion on chromosome 7q11.23. Patients with WBS usually show a group of features such as developmental delay, cardiovascular anomalies, mental retardation, and characteristic facial appearance. Abdominal wall defects, external genitalia anomalies, and structural abnormalities of the urinary tract have been scarcely evaluated and were the focus of our study. Materials and methods: We prospectively evaluated 41 boys and 38 girls with WBS, with a mean age of 8.8 +/- 4.1 (range 3-19 years). All patients were examined for the evaluation of inguinal and umbilical hernias and genital anomalies. All patients were offered a radiological evaluation, including urinary tract ultrasound, voiding cystourethrogram, and dimercaptosuccinic acid renal scintigraphy (DMSA scan). Results: Of the 41 boys, 30 (73.1%) had abnormalities on physical examination, including bilateral undescended testis in 13 (31.7%), retractile testis in four (9.7%), hypospadias in four (9.7%), and unilateral cryptorchidism in three (7.3%) patients. Of the 38 female subjects, 17 (44.7%) had at least one abnormality, including umbilical hernia in 11 (28.9%), unilateral inguinal hernia in four (10.5%), and bilateral inguinal hernia in three (7.8%) patients. Uroradiological abnormalities were found in 41 patients (51.9%). On sonography, six (7.6%) patients had unilateral hydronephrosis, three (3.8%) had a duplicated collecting system, and two (2.5%) had kidney stones. On DMSA, performed in 36 patients, four (11.1%) had unilateral renal scarring and two (5.5%) had bilateral renal scarring. Cystourethrography was obtained from 56 patients, of whom 27 (48.2%) had bladder diverticulum, 18 (32.1%) had bladder wall trabeculation, and three (5.3%) had vesicoureteral reflux. We found no association of urological abnormalities with cardiovascular defects. Conclusions: Patients with WBS have a high prevalence of abdominal wall, external genitalia, and urological abnormalities, emphasizing the importance of proper physical examination and radiological investigation in this population.
- Longitudinal Improvement of Lower Urinary Tract Symptoms in Williams-Beuren Syndrome(2021) SAMMOUR, Zein M.; HISANO, Marcelo; JR, Jose de Bessa; BRUSCHINI, Homero; NAHAS, William C.; SROUGI, Miguel; GOMES, Cristiano M.Purpose: Williams-Beuren syndrome is a chromosomal disorder caused by a deletion at region 7q11.23. Lower urinary tract symptoms are highly prevalent and significantly affect quality of life. We assessed the long-term out-comes of lower urinary tract symptoms in children with Williams-Beuren syndrome. Materials and Methods: From February 2001 to July 2016, 90 patients with Williams-Beuren syndrome were evaluated in our hospital, of whom 31 (20 boys) had at least 5 years of followup. Baseline evaluation included a history of lower urinary tract symptoms, frequency-volume chart and the impact on quality of life measured on a scale of 0 (delighted) to 6 (terrible). Pharmacological therapy with oxybutynin or doxazosin was offered to symptomatic patients. We present the outcome of lower urinary tract symptoms after 5 and 10 years of followup. Results: At baseline 27 (87.1%) patients were symptomatic. Median duration of followup was 10 (range 6-13) years. Pharmacological therapy was started for 25 (92.6%) symptomatic patients at baseline, including oxybutynin for 19 (76.0%), doxazosin for 1 (4.0%) and a combination of the 2 agents for 5 (20.0%). Medical therapy was still in use by 61.2% after 5 years and 52.9% after 10 years (p=0.043). Median duration of pharmacological treatment was 7 (range 6-11) years. A significant improvement of lower urinary tract symptoms was observed over time, with 35.5% and 29.5% patients considered symptomatic after 5 years and 10 years, respectively (p < 0.001). Quality of life was also markedly improved over time (p < 0.001). Conclusions: This long-term study showed significant improvement of lower urinary tract symptoms in children and adolescents with Williams-Beuren syndrome over time. Long-term pharmacological treatment was needed in most patients.
- The Bacterial Spectrum and Antimicrobial Susceptibility in Female Recurrent Urinary Tract Infection: How Different They Are From Sporadic Single Episodes?(2015) HISANO, Marcelo; BRUSCHINI, Homero; NICODEMO, Antonio Carlos; GOMES, Cristiano Mendes; LUCON, Marcos; SROUGI, MiguelOBJECTIVE To analyze and compare the etiological uropathogens and the susceptibility profile findings on urine culture between sporadic cases of community-acquired, uncomplicated urinary tract infection (UTI) and recurrent UTI cases in women. MATERIALS AND METHODS We retrospectively analyzed the clinical data of 1629 women with uncomplicated UTI evaluated at our hospital between January 2007 and December 2012. Patients were divided into 2 groups: (1) no recurrent UTI and (2) recurrent UTI. We analyzed the microbiological findings and compared susceptibility profiles between groups. RESULTS A total of 420 women were included. Group 1 had 233 (55.5%) patients and group 2 had 187 (44.5%). Escherichia coli was the most common agent in both groups (76.4% and 74.3%, respectively; P = .625), whereas Staphylococcus saprophyticus (8.2%) was the second most common in group 1, and Enterococcus faecalis was the second most common in group 2 (8.0%). Nitrofurantoin was the only oral agent that maintained the susceptibility profile in both groups (87.1% and 88.7%, respectively; P =.883). For E coli infections, only nitrofurantoin and amoxicillin/clavulanate maintained susceptibility rates more than 90% in both groups. CONCLUSION UTI episodes in patients with recurrent UTI had similar bacterial spectra, but different susceptibility profiles compared with those from patients with nonrecurrent infections. The susceptibility rate for nitrofurantoin in patients with recurrent UTI remained high and comparable to the observed in patients with sporadic UTI, reinforcing its indication for empirical treatment while waiting for urine culture results. (C) 2015 Elsevier Inc.
- Empiric antimicrobial treatment in women with recurrent urinary tract infection(2021) HISANO, Marcelo; BRUSCHINI, Homero; GOMES, Cristiano M.
- CAN WE TREAT FEMALE RECURRENT URINARY TRACT INFECTION WITHOUT URINE CULTURE? COMPARATIVE ANALYSIS OF BACTERIOLOGY AND SUSCEPTIBILITY PROFILE(2014) HISANO, Marcelo; BRUSCHINI, Homero; NICODEMO, Antonio Carlos; LUCON, Marcos; GOMES, Cristiano Mendes; BARACAT, Fabio; FIGUEIREDO, Jose Alaor de; SROUGI, Miguel
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