RONALDO HUEB BARONI
Projetos de Pesquisa
Unidades Organizacionais
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina
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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.
- 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.
- Midterm Follow-Up After Prostate Embolization in Two Patients with Benign Prostatic Hyperplasia(2011) CARNEVALE, Francisco C.; MOTTA-LEAL-FILHO, Joaquim M. da; ANTUNES, Alberto A.; BARONI, Ronaldo H.; FREIRE, Geraldo C.; CERRI, Luciana M. O.; MARCELINO, Antonio S. Z.; CERRI, Giovanni G.; SROUGI, Miguel
- MRI Findings After Prostatic Artery Embolization for Treatment of Benign Hyperplasia(2014) FRENK, Nathan E.; BARONI, Ronaldo H.; CARNEVALE, Francisco C.; GONCALVES, Octavio M. G.; ANTUNES, Alberto A.; SROUGI, Miguel; CERRI, Giovanni G.OBJECTIVE. The purpose of this article is to assess and describe the MRI findings after prostatic artery embolization for treatment of benign prostatic hyperplasia. MATERIALS AND METHODS. We retrospectively evaluated 17 patients who underwent prostatic artery embolization as part of different prospective studies to evaluate this alternative treatment of benign prostatic hyperplasia. Clinical results were evaluated by assessment of urinary catheterization and International Prostate Symptom Score (IPSS). Serial MRI examinations were performed, and the prostatic central gland and peripheral zone were evaluated for signal intensity changes and the presence and characteristics of infarcted areas. Statistical analysis was performed with ANOVA for repeated measures and Student t test. RESULTS. All patients had clinical success, as defined by the removal of indwelling urinary catheter or decreased IPSS after embolization. Infarcts were seen in 70.6% of the subjects, exclusively in the central gland, were almost always characterized by hyperintensity on T1-weighted images and predominant hypointensity on T2-weighted images, and became smaller (mean reduction, p < 0.001) and isointense to the remaining of the central gland over time. Volume reduction of the prostate after embolization was significant (averaging 32.0% after 12-18 months; p < 0.001) only in patients with infarcts. No statistically significant association was seen between the development of infarcts and IPSS. CONCLUSION. MRI can be used for assessing the development of infarcts and volume reduction in the prostate after embolization. Further studies are needed to correlate these findings to clinical outcome.
- Perioperative Temporary Occlusion of the Internal Iliac Arteries as Prophylaxis in Cesarean Section at Risk of Hemorrhage in Placenta Accreta(2011) CARNEVALE, Francisco Cesar; KONDO, Mario Macoto; SOUSA JR., Wilson de Oliveira; SANTOS, Aline Barbosa; LEAL FILHO, Joaquim Mauricio da Motta; MOREIRA, Airton Mota; BARONI, Ronaldo Hueb; FRANCISCO, Rossana Pulcinelli Vieira; ZUGAIB, MarceloPurpose The purpose of this study was to describe the preliminary results of prophylactic temporary balloon occlusion of the internal iliac arteries for bleeding control in patients with placenta accreta during cesarean hysterectomy. Methods From May 2006 to March 2010, 21 patients diagnosed with placenta accreta using ultrasound and/or magnetic resonance imaging were submitted to prophylactic balloon occlusion before hysterectomy. Fluoroscopy, balloon occlusion time, surgical duration, intraoperative blood loss, transfusion volume, and procedure complications were analyzed. Results The mean age was 30.5 years with a mean of 3.6 previous gestations. Imaging studies revealed that all patients had placenta accreta and all were submitted to cesarean hysterectomy. One hysterectomy was due to previous diagnosis of fetal death and another due to cesarean with uterine curettage. Mean fluoroscopy time was 7.5 min, balloon occlusion time was 164 min, and surgery duration was 260 min. Estimated blood loss was 1,671.5 ml with mean reposition fluids of 3,538 ml of crystalloids, 309.5 ml of colloids, and 1.24 ml of packed red blood cells. Two patients were submitted to thromboembolectomy due to prolonged surgical time. There was no maternal or fetal mortality related to the procedure. Conclusions The results demonstrated that prophylactic balloon occlusion of internal iliac artery is a safe method and appears to reduce blood loss and transfusion requirements in patients diagnosed with placenta accreta who undergo cesarean hysterectomy. Antenatal imaging diagnosis of placenta accreta enables preoperative planning.