BRUNO CHIESA GOUVEIA NASCIMENTO
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
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Laparoscopic pyeloplasty as an alternative to nephrectomy in adults with poorly functioning kidneys due to ureteropelvic junction obstruction(2021) NASCIMENTO, Bruno; ANDRADE, Hiury S.; MIRANDA, Eduardo P.; BARBOSA, Joao Arthur Brunhara Alves; MOSCARDI, Paulo R.; ARAP, Marco A.; I, Anuar Mitre; SROUGI, Miguel; SROUGI, Victor; DUARTE, Ricardo J.Objectives To evaluate outcomes of laparoscopic pyeloplasty (LP) in adults with poorly functioning kidney due to ureteropelvic junction obstruction (UPJO). Methods A retrospective comparative analysis was performed between adult patients who underwent LP due to UPJO with differential renal function (DRF) <= 15% and DRF > 15%. LP success rate and complications were assessed. LP success was defined as symptoms improvement and DRF improvement or stabilization. DRF and estimated glomerular filtration rate (eGFR) were analyzed before and 12 months after surgery to evaluate renal function recovery. DRF was estimated using Tc-99 m DMSA renal scintigraphy. Results Among 121 LP performed in the study period at our institution, 15 and 42 were included in the DRF <= 15% and DRF > 15% groups, respectively. At a median follow-up of 17.8 months, all patients with DRF <= 15% reported symptoms improvement. LP success rate was 86.7% and 90.5% (p = 0.65) for patients with DRF <= 15% and DRF > 15%, respectively. There were no complications in the DRF <= 15% group, while there were three complications recorded in the DRF > 15% group (Clavien 2 and 3b). In the DRF <= 15% group, mean pre-operative and post-operative DRF was 9.5% +/- 3.6 and 10.5% +/- 7.8 (p = 0.49), respectively. Median pre-operative and post-operative eGFR was 68.5 ml/min and 79.8 ml/min (p = 0.93), respectively. Two patients had DRF improvement after LP. Conclusions LP in adult patients with UPJO and poor function kidneys is an effective and safe procedure. DRF recovery is seen in a minority of the patients; however, LP is an alternative to nephrectomy.
- A Critical Analysis of Methodology Pitfalls in Duplex Doppler Ultrasound in the Evaluation of Patients With Erectile Dysfunction: Technical and Interpretation Deficiencies(2020) NASCIMENTO, Bruno; MIRANDA, Eduardo P.; TERRIER, Jean-Etienne; CARNEIRO, Felipe; MULHALL, John P.Background: Penile duplex Doppler ultrasound (PDDU) is a minimally invasive tool to evaluate erectile hemodynamics in patients with erectile dysfunction (ED). Despite decades of use, there is still a large variability in PDDU protocols, and a high rate of false diagnosis is reported. Aim: Review of PDDU methodology in the published literature addressing protocol heterogeneity, technical and interpretation challenges. Methods: A PubMed literature search was performed using the search terms ""penile doppler ultrasound"", ""penile duplex ultrasound"" or ""penile ultrasound"", and ""Erectile dysfunction"". Studies were analyzed for the presence of the following elements in reporting of the PDDU protocol: (i) intracavernosal vasoactive agents used, (ii) use of a redosing protocol, (iii) means of rigidity assessment, (iv) report of at-home best-quality erection, (v) normative criteria for peak systolic velocity (PSV) and end-diastolic velocity (EDV), and (vi) use of time-based hemodynamics assessment. Inclusion criteria were studies available in English, from 2005 onwards, and with full text. Exclusion criteria were review, descriptive or short communication articles, animal studies, and studies in populations other than those with ED. Outcomes: A critical review of the heterogeneity in published literature was performed to guide a structured discussion of methodological challenges and to create a list of recommendations. Results: Significant heterogeneity was seen in key methodological aspects. Fifty percent of studies reported the use of prostaglandin E1 only, and 12% of studies did not mention the agent used. Redosing as part of the PDDU protocol was mentioned in only 26% of studies. The majority (56%) did not mention any form of rigidity assessment. The most frequently used grading system was the Erection Hardness Score (14%). Overall, most studies (59%) used a timed-base protocol for hemodynamic assessment. No clear consensus was defined for normative criteria for PSV and EDV, 39% defining a normal PSV as >= 30 cm/s, and 57% using EDV values <= 5 cm/sec as normal. Clinical Implications: The absence of standardization has led to inadequate reporting of key factors which has rendered data interpretation and comparison between studies challenging. Strengths and Limitations: Our strengths include an extensive review of literature, with a structured analysis of the impact of each methodological pitfall. Our main limitation is the fact that protocol reporting, and not its application, was assessed. Conclusion: Despite its widespread use, analysis of the literature on PDDU use in the ED population shows marked protocol heterogeneity, rendering data interpretation a problem.
- The psychiatric impact of COVID-19 pandemic on sexual health(2021) PAUL, Gustavo M.; NASCIMENTO, Bruno C.; AFIF-ABDO, Joao; COUTINHO, Francisco R.; MIRANDA, Eduardo P.; ABDO, Carmita H. N.
- Testosterone Recovery Profiles After Cessation of Androgen Deprivation Therapy for Prostate Cancer(2019) NASCIMENTO, Bruno; MIRANDA, Eduardo P.; JENKINS, Lawrence C.; BENFANTE, Nicole; SCHOFIELD, Elizabeth A.; MULHALL, John P.Introduction: Androgen deprivation therapy (ADT) is frequently used in the treatment of prostate cancer worldwide. Variable testosterone (T) recovery profiles after ADT cessation have been cited. Aim: To evaluate T recovery after cessation of ADT. Methods: We reviewed our institutional prospectively maintained database of patients with prostate cancer who received ADT. Serum early morning total T (TT) levels, collected at baseline and periodically after ADT cessation, were analyzed. Patient age, baseline T level, duration of ADT, and presence of diabetes and sleep apnea were selected as potential predictors of T recovery. 3 metrics of T recovery after 24 months of ADT cessation were analyzed: return to non-castrate level (TT > 50 ng/dL), return to normal (T > 300 ng/dL), and return back to baseline level (BTB). Multivariable time-to-event analysis (Cox proportional hazards), chi(2) test, logistic regression model, and Kaplan-Meier curve were performed to define impact of the above predictors on time and chance of T recovery. Main Outcome Measures: Time and chance of T recovery to non-castrate level (TT > 50 ng/dL), return to normal (T > 300 ng/dL), and return BTB. Results: 307 men with a mean age of 65 +/- 8 years were included. Mean duration of ADT was 17 +/- 25 months, and median follow-up was 31 +/- 35 months. Mean TT values were 379 ng/dL at baseline and 321 ng/dL at > 24 months. At 24 months after cessation of ADT, 8% of men remained at castrate level, 76% returned to TT > 300 ng/dL, and 51% had returned BTB. Lower baseline T levels (TT < 400 ng/dL) and ADT duration > 6 months were associated with a lower likelihood of recovery to normal TT at 24 months. Age > 65 years and receiving ADT for > 6 months were significantly associated with a slower T recovery. Clinical Implications: T recovery after ADT is not certain and may take longer than expected. Considering the range of side effects of low T, we believe that these findings must be discussed with patients before initiating such therapies. Strengths & Limitations: Our strengths consisted of a relatively large database, long follow-up, and clinically meaningful endpoints. Limitations included the retrospective design of the study. Conclusion: T recovery rates after ADT cessation vary according to patient age, ADT duration, and baseline T levels. Approximately one-quarter of patients failed to normalize their TT level, and one-tenth of men remained at castrate levels 24 months after ADT cessation.
- Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in Brazil(2020) MIRANDA, Eduardo P.; NASCIMENTO, Bruno; TORRES, Luiz Otavio; GLINA, Sidney
- Recurrent Penile Fracture-Case Report and Alternative Surgical Approach(2018) NASCIMENTO, Bruno; GUGLIELMETTI, Giuliano B.; MIRANDA, Eduardo P.; IVANOVIC, Renato F.; BATAGELLO, Carlos A.; NAHAS, William C.; SROUGI, Miguel; CURY, JoseIntroduction: Penile refracture is an exceedingly rare event, with very few published studies. To the best of our knowledge, this is the first documented case in the literature of penile fracture with 3 same-site recurrences. Aims: To describe the case of a 25-year-old Caucasian man with recurrent penile fracture ultimately treated with resuture and patch reinforcement. Methods: Patient history (clinical and surgical) and literature review. Results: After the 3rd same-site recurrence, patch reinforcement over the sutured area was performed. The patient had an uneventful recovery and no recurrences to date. Conclusion: There is no evidence indicating the superiority of non-absorbable sutures. Bovine pericardium reinforcement over the sutured area was used to minimize the chance of another recurrence. More studies are necessary to investigate its safety and efficacy in this scenario.