FRANCISCO TIBOR DENES

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder

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Autor: LOPES, Roberto Iglesias ×

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  • article 0 Citação(ões) na Scopus
  • article 11 Citação(ões) na Scopus
    Urethral duplication type influences on the complications rate and number of surgical procedures
    (2017) LOPES, Roberto Iglesias; GIRON, Amilcar Martins; MELLO, Marcos Figueiredo; BARBOSA NETO, Cristovao Machado; SANTOS, Joana dos; MOSCARDI, Paulo Renato Marcelo; SROUGI, Victor; DENES, Francisco Tibor; SROUGI, Miguel
    Introduction: Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies. Material and Methods: We report thirteen boys with urethral duplication managed in our institution between 1988-02015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification. Results: Mean patient's age was 38.3 +/- 34.7 months (3-0136 months). Mean follow-up was 7.7 +/- 3.4 years (3y8m-014y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%). Required surgeries were 3.53 +/- 2.84 procedures per patient. Considering groups: Type IIA2 4.25 +/- 3.28, type IIA1 4 +/- 1.41 and type IA 1.33 +/- 0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2. Conclusions: Patients with incomplete duplication (type I A or I B) can totally be asymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individualized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.
  • article 1 Citação(ões) na Scopus
    Single-stage Abdominoplasty Using Groin Flaps Without Osteotomies: Management of Exstrophy-epispadias Complex
    (2018) GIRON, Amilcar Martins; MELLO, Marcos Figueiredo; BERJEAUT, Ricardo Haidar; MACHADO, Marcos Giannetti; SILVA, Gabriel Carvalho dos Anjos; CEZARINO, Bruno Nicolino; OLIVEIRA, Lorena Marcalo; LOPES, Roberto Iglesias; DENES, Francisco Tibor
    BACKGROUND The optimal treatment for children born with exstrophy-epispadia complex is still a matter of AND OBJECTIVE debate.(1,2,3) We demonstrate the Single-Stage Abdominoplasty using Groin Flap technique to close the abdominal wall of children with classic bladder exstrophy (CBE) without osteotomy neither radical soft tissue mobilization. Advantages over current techniques are less risk of penile tissue loss and avoidance of osteotomies. MATERIAL AND METHODS Abdominal wall repair consists in using the hypogastric skin, rectus, and obliquus externus abdom inalis muscle fascial flaps. These groin flaps are rotated medially resulting in a very strong abdominal wall support. Groin flaps are made of rectus anterior fascia rotated medially, flipped over, and sutured with Prolene sutures to close the defect. By rotating the fascial flaps medially, complete reinforcement of the abdominal wall to the level of the pubic bone is achieved. This permits abdominal closure maintenance without tension. RESULTS Groin flap was applied to 128 patients with CBE referenced from all over the country. Most of these patients returned to their home areas making difficult their follow up. However, we have 44 cases that have regular clinical visits. Mean follow-up was 10.3 4.5 years (2 years 8 months-16 years). Successful closure was achieved in 43 patients (97.7%) as a single procedure; one patient had a complete wound dehiscence and needed another reconstruction (2.2%). Four patients (9.1%) presented abdominal hernias that needed surgical management. When continence is evaluated, we present similar literature rates (60%).(4) CONCLUSION Abdominal reconstruction using Groin flaps has advantages over the traditional approaches to CBE. It reduces the surgical steps and facilitates the closure of the abdominal wall without the need of osteotomies and consequent immobilization during the postoperative period. It is feasible at any age and can be also very useful as a salvage technique even after previous failed procedures. Finally, it minimizes the number of surgeries. (C) 2018 Elsevier Inc.
  • article 6 Citação(ões) na Scopus
    Management of functioning pediatric adrenal tumors
    (2021) LOPES, Roberto Iglesias; SUARTZ, Caio Vinicius; PEDRENHO NETO, Rubens; BERJEAUT, Ricardo Haidar; MENDONCA, Berenice; ALMEIDA, Madson Q.; FRAGOSO, Maria Candida Villares; DENES, Francisco Tibor
    Aim: The aim of this study is to present our experience in the management of hormonally active adrenal tumors in children.& nbsp; Material and methods: We did a retrospective chart review of all children with hormonally active adrenal tumors evaluated at the endocrinology clinic and operated at our institution between 1983 and 2019.& nbsp; Results: There were 75 patients included in the study, 58 with adrenocortical tumors (ACTs) and 17 with pheochromocytomas (PCCs). Within the group of patients with ACTs, there were 41 females and 17 males. The mean age was 58.3 (SD: 87.9; range: 9 & ndash;211) months. The clinical manifestation of the tumor's hormonal activity was virilization in 37 cases, Cushing syndrome in 5, and mixed in 16. A positive family history was present in 11 patients (18.9%). The mean tumor size was 48.2 (SD: 22.4; range: 7 & ndash;120) mm. The pathological diagnosis was adenoma in 42 cases, carcinoma in 15 cases, and macronodular hyperplasia in 1. Median follow-up was 192 (range: 50 & ndash;290) months. Tumor recurrence occurred in 6 patients (10.3%), and there were three disease-related deaths (5%). Within the group of patients with PCCs, there were 11 males and 6 females. The mean age was 146.7 (SD: 71.2; range: 60 & ndash;216) months. A positive family history was present in 7 patients (41.2%). The mean tumor size was 36.6 (SD: 16.7; range: 7 & ndash;120) mm. The pheochromocytoma was classified as benign in 15 cases and as malignant in 2. During a median follow-up of 180 (range: 127 & ndash;300) months, recurrence was observed in 6 cases (35.3%) and disease-related death in 1 case (5.9%).& nbsp; Conclusions: Proper diagnosis and management at our referral center were associated with a high cure rate, even in cases of malignant tumors. Familial surveillance is highly recommended.& nbsp; Level of evidence: Level IV.& nbsp; (c) 2020 Elsevier Inc. All rights reserved.
  • article 4 Citação(ões) na Scopus
    Gonadal Function and Reproductive System Anatomy in Postpubertal Prune-Belly Syndrome Patients
    (2020) LOPES, Roberto Iglesias; TAVARES, Alessandro; DENES, Francisco Tibor; COCUZZA, Marcello
    OBJECTIVE To gain insight into the causes of infertility in Prune Belly Syndrome (PBS) by evaluating reproductive system anatomy and gonadal function in a cohort of postpubertal PBS patients. METHODS We contacted all PBS patients 14 years old or older treated and followed at our institution. Age at orchiopexy, type of orchiopexy (with or without ligation of gonadal vessels), testicular volumes and positions were evaluated. Pelvic magnetic resonance imaging (to assess prostate size, seminal vesicles, and vas) and hormonal profile were ordered. Sperm analysis and analysis of urine after masturbation were performed after informed consent. RESULTS Fifteen patients were included in this study. Mean age was 19.2 years. Mean age at orchiopexy was 18 months. Fourteen patients (93.3%) had normal and orthotopic testes. Mean testicular volume was 6.9 cc. Eight patients collected semen, 5 of them (62.5%) had spermatozoa in the specimen and motile sperm was found in 4 (50%). Mean hormone levels were LH: 5.3 mg/dL, FSH: 6.9 mg/dL, testosterone 531 mg/dL. Magnetic resonance imaging revealed hypoplastic prostates in 66.6% and unilateral seminal vesicle absence in 66.6%. No vasal abnormality was noted. CONCLUSION Patients with PBS may have normal sexual hormonal levels. Motile spermatozoa were found in half of the patients. Our study highlights a high prevalence of prostate and seminal vesicle abnormalities that may represent an important cause for their infertility. (C) 2020 Elsevier Inc.
  • article 0 Citação(ões) na Scopus
    Multi-institutional Experience Comparing Outcomes of Adult Patients Undergoing Secondary Versus Primary Robotic Pyeloplasty REPLY
    (2020) LOPES, Roberto Iglesias; TAVARES, Alessandro; DENES, Francisco Tibor; COCUZZA, Marcello
  • bookPart
    Síndrome de prune belly
    (2021) LOPES, Roberto Iglesias; LUEDY, Felipe Amoedo; CEZARINO, Bruno Nicolino; DéNES, Francisco Tibor
  • article 11 Citação(ões) na Scopus
    Serum and Urinary Values of CA 19-9 and TGF beta 1 in a Rat Model of Partial or Complete Ureteral Obstruction
    (2015) LOPES, Roberto Iglesias; DENES, Francisco Tibor; BARTOLAMEI, Matheus Gesualdo; REIS, Sabrina; SANCHES, Talita Rojas; LEITE, Katia Ramos; SROUGI, Miguel; SEGURO, Antonio Carlos
    Introduction Abnormal levels of serum and urinary markers occur in the presence of renal damage associated to obstructive uropathy. Urinary and serum transforming growth factor beta 1 (TGF beta 1) and carbohydrate antigen (CA 19-9) have not yet been evaluated in an experimental model of obstructive uropathy. Material and Methods Rats were divided into seven groups: reference, sham operation, unilateral nephrectomy, complete unilateral ureteral obstruction, partial unilateral ureteral obstruction, partial bilateral ureteral obstruction, and unilateral nephrectomy with contralateral partial ureteral obstruction. Kidney and ureter morphometry, TGF beta 1 and CA 19-9 serum and urinary concentrations and CA 19-9 renal tissue expression were analyzed. Correlation of these markers to complete, partial obstruction, or unobstructed groups was performed. Results Pathological findings correlated positively with the degree of ureteral obstruction, but negatively with urinary CA 19-9 levels. Marked underexpression of CA 19-9 was observed in kidneys with complete ureteral obstruction. No statistically significant differences were found for urinary and serum TGF beta 1 and also for serum CA 19-9. Conclusion Urinary CA 19-9 correlated negatively with ureteral obstruction grade. Immunohistochemistry depicted CA 19-9 expression on epithelial tubular cells cytoplasm, suggesting renal origin. Serum and urinary TGF beta 1 did not show alterations in response to severity and length of urinary obstruction, which might be associated with less intense renal remodeling.
  • article 3 Citação(ões) na Scopus
    Laparoscopic hidden incision endoscopic surgery (hides) nephrectomy VS. Traditional laparoscopic nephrectomy: Non-inferior surgical outcomes and better cosmetic results
    (2021) CEZARINO, Bruno Nicolino; LOPES, Roberto Iglesias; BERJEAUT, Ricardo Haidar; DENES, Francisco Tibor
    Introduction The benefits of laparoscopic total nephrectomy in pediatric patients are well established. Traditional Ports placement (TPP) still follows Clayman's classic description: except for the umbilical scar, the other laparoscopic scars are exposed in the abdomen. Advances in robotic surgery permitted the development of HidES (hidden incision endoscopic surgery) technique, to obtain a better final cosmetic aspect with the scars located intraumbilically and in the hypogastric region, in an area easily hidden by underwear. As robotic surgery is related to higher costs and lacks availability, a pure laparoscopic HidES technique was developed. Objectives 1.Evaluate safety and efficacy of pure laparoscopic HidES.2. Compare HidES with TPP nephrectomy series to assess non-inferiority and cosmetic outcomes. Study design Twenty-one pediatric patients with symptomatic poor functioning kidneys (DMSA<10%) underwent HidES nephrectomy. Their intra and post-operative outcomes were recorded prospectively. HidES group was compared to an equivalent group of thirty-two patients who underwent TPP nephrectomy. Results There were no conversions to open surgery in the TPP or HidES groups. There was a significant difference in operative time between HidES (53.4min) and TPP (109.4 min), with p = 0.004 and the mean bleeding volume was 65.5 ml. There was no significant difference in bleeding between HidES (71 ml) and TPP (120 ml) (p = 0.06), no intraoperative complications and no complications above Clavien-Dindo II during the 6-week follow-up. Satisfaction reached 100% in HidES group, whereas in TPP satisfaction was 63% (p = 0.004). Discussion HidES benefit over TPP is to conceal visible scars above underwear, improving cosmetical outcome. A prospective HidES group was compared to a retrospective TPP database due to decreasing number of nephrectomies being performed, which is a limitation of our study. HidES surgeries were performed by pediatric urologists (associate staff) while TPP group surgeries were performed by PGY-5 urological residents assisted by the associate staff, which is a clear limitation and can explain shorter operative times for HidES. During HidES surgeries an improved visualization of the operative field by the inferior trocar positioning was noted, which helps the posterior dissection of renal pedicle. Previous published study comparing robotic TPP and HidES pyeloplasty showed equal results for both groups with cosmetic advantages. Objective satisfaction was assessed with statistically advantage in favor of HidES procedure, consonant with other evidence that supports the benefit of scar location in patient and parental satisfaction. Conclusion HidES nephrectomy proved to be safe, feasible and not inferior to the traditional nephrectomy in experienced hands, with better cosmesis. [GRAPHICS] .
  • article 14 Citação(ões) na Scopus
    Modified Abdominoplasty for Patients With the Prune Belly Syndrome
    (2014) DENES, Francisco Tibor; LOPES, Roberto Iglesias; OLIVEIRA, Lorena Marcalo; TAVARES, Alessandro; SROUGI, Miguel
    OBJECTIVE To present the results of a new technique for abdominoplasty in patients with the Prune Belly syndrome (PBS). METHODS Since 1985, 46 children with PBS underwent surgical treatment that included urinary tract reconstruction (UTR), orchidopexy, and abdominoplasty. In 41 patients, we performed the abdominoplasty as follows: (1) fusiform longitudinal resection of the mid-abdominal skin and subcutaneous tissue, with preservation of the musculo-aponeurotic fascia (MAF) and umbilicus, (2) ellipsoid unilateral longitudinal incision of the MAF in the most weakened side of the abdomen, producing 2 flaps, with the umbilicus being kept intact in the widest flap, (3) after UTR and bilateral orchiopexy, suture fixation of the widest MAF layer to the inner side of the contralateral abdominal wall, creating an inner MAF layer, (4) lateral suture fixation of the other flap over the inner layer, creating an outer MAF layer with a buttonhole exposing the umbilicus, that is sutured to the outer layer, and (5) approximation of the skin edges with incorporation of the umbilicus in the suture. RESULTS Skin coaptation was excellent in all patients, and no trimming was necessary in incision extremities. There was no dehiscence or skin necrosis and all patients presented immediate improvement of the abdominal tonus and appearance. Further improvement with growth was observed in all except 4 patients, 2 requiring secondary abdominoplasties. CONCLUSION We conclude that this technique is applicable in all forms of weakened abdomen typical of PBS, even in asymmetrical cases, requiring only 1 MAF incision, with good cosmetic and functional results. (C) 2014 Elsevier Inc.