HOMERO BRUSCHINI
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
13 resultados
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- PSA Levels in Men With Spinal Cord Injury and Under Intermittent Catheterization(2011) TORRICELLI, Fabio Cesar Miranda; LUCON, Marcos; VICENTINI, Fabio; GOMES, Cristiano Mendes; SROUGI, Miguel; BRUSCHINI, HomeroAim: To evaluate serum PSA levels of patients with spinal cord injury (SCI) submitted or not to CIC in comparison to those of the general population. Methods: We retrospectively studied 140 men with SCI admitted in our department from January 2005 to May 2009. Thirty-four SCI patients had PSA levels available, comprising 21 under CIC and 13 without CIC. Patients under CIC performed it 4-6 times a day and mean time of catheterization was 72.4 months (range 30-192). The most common etiology of SCI was fall from height (33%), followed by car/motorcycle crashes (15%). Control group was composed by 670 healthy men that were referred to our service to evaluation of Kidney donation or cancer prostate screening. We used Student's t-test and variance analysis (ANOVA) for age and PSA comparison between the groups. Results: Overall, patients with SCI and controls had similar mean age (54 vs. 57 years old, P = 0.11) and mean PSA level (1.81 vs. 1.95 ng/ml, P = 0.66). SCI patients were divided into with and without CIC. Patients without CIC had similar mean age (60 vs. 57 years old, P 0.11) and similar PSA values when compared to controls (1.72 vs. 1.95 ng/ml, P = 0.89). Patients under CIC were compared to controls with similar age (50 vs. 47 years, P = 0.0332) and their PSA levels were greater (1.86 vs. 0.79 ng/ml, P = 0.026). Conclusion: Clean intermittent catheterization increased PSA levels approximately doubling its value. Neurourol. Urodynam. 30:1522-1524, 2011. (C) 2011 Wiley Periodicals, Inc.
- Periurethral muscle-derived mononuclear cell injection improves urethral sphincter restoration in rats(2017) TURCO, Marcelo Pitelli; SOUZA, Alex Balduino de; SOUSA, Isida de Campos; FRATINI, Paula; VERAS, Mariana Matera; RODRIGUES, Marcio Nogueira; BESSA JR., Jose de; BROLIO, Marina Pandolphi; LEITE, Katia Ramos Moreira; BRUSCHINI, Homero; SROUGI, Miguel; MIGLINO, Maria Angelica; GOMES, Cristiano MendesAimsInvestigate the effect of a novel cell-based therapy with skeletal muscle-derived mononuclear cells (SMDMCs) in a rat model of stress urinary incontinence. MethodsMale Wistar-Kyoto rats' hind limb muscles were enzymatically dissociated, and SMDMCs were isolated without needing expansion. The cell population was characterized. Twenty female rats underwent urethrolysis. One week later, 10 rats received periurethral injection of 10(6) cells (SMDMC group), and 10 rats received saline injections (Saline group). Ten rats underwent sham surgery (Sham group). Four weeks after injection, animals were euthanized and the urethra was removed. The incorporation of SMDMCs in the female urethra was evaluated with fluorescence in situ hybridization for the detection of Y-chromosomes. Hematoxylin and eosin, Masson's trichrome staining, and immunohistochemistry for actin and myosin were performed. The muscle/connective tissue, actin and myosin ratios were calculated. Morphological evaluation of the urethral diameters and fractional areas of the lumen, mucosa, and muscular layer was performed. ResultsSMDMCs population was consistent with the presence of muscle cells, muscle satellite cells, perivascular cells, muscle progenitor cells, and endothelial cells. SMDMCs were incorporated into the urethra. A significant decrease in the muscle/connective tissue ratio was observed in the Saline group compared with the SMDMC and Sham groups. The proportions of actin and myosin were significantly decreased in the Saline group. No differences were observed in the morphometric parameters. ConclusionsSDMSC were incorporated into the rat urethra and promoted histological recovery of the damaged urethral sphincter, resulting in decreased connective tissue deposition and increased muscle content.
- Contemporary Trends in the Epidemiology of Traumatic Spinal Cord Injury: Changes in Age and Etiology(2015) BELLUCCI, Carlos Henrique Suzuki; CASTRO FILHO, Jose Everton de; GOMES, Cristiano Mendes; BESSA JR., Jose de; BATTISTELLA, Linamara Rizzo; SOUZA, Daniel Rubio de; SCAZUFCA, Marcia; BRUSCHINI, Homero; SROUGI, Miguel; BARROS FILHO, Tarcisio E. P.Background: Epidemiological features of spinal cord injury (SCI) have been changing over the last decades. We evaluated the contemporary trends in the epidemiology of traumatic SCI patients from a rehabilitation center. Methods: In a cross-sectional study, a consecutive series of 348 patients with traumatic SCI were evaluated. Variables were collected through an epidemiological form, which included gender, age at injury, duration and cause of SCI. We investigated SCI epidemiological trends over time including the association between gender and age at injury with SCI features such as etiology, injury severity and level. Results: The mean age at SCI has increased from 26.0 +/- 11.8 in patients with SCI before 2003 to 37.9 +/- 15.7 in those with SCI after 2009 (p < 0.001). Gunshot wounds were the main cause of injury in patients with SCI before 2003, dropping from 40.6 to 16.9% after 2009 and being surpassed by road traffic injuries (38.6%) and falls (31.4%) after 2009 (p < 0.001). Gender, SCI severity and level have not changed significantly over the time. Conclusions: There was a major increase in the average age of patients as well as changes in the etiology of SCI over the past fifteen years, including a significant decrease in gunshot wounds and an increase in the frequency of road traffic injuries and falls. These changes and accompanying risk factors must be taken into consideration when planning measures to prevent SCI. (C) 2015 S. Karger AG, Basel
- Endovascular repair of a nearly fatal iliac artery injury after endoureterotomy(2013) LOPES, Roberto Iglesias; TORRICELLI, Fabio Cesar Miranda; GOMES, Cristiano Mendes; CARNEVALE, Francisco; BRUSCHINI, Homero; SROUGI, MiguelEndourological methods are attractive procedures for the treatment of ureterointestinal stenosis. However, serious complications may occur. This article reports the case of an endovascular repair of a nearly fatal ruptured common iliac artery pseudoaneurysm after endoureterotomy. A 62-year-old man submitted to bilateral ureteroileostomy developed left ureteroileal anastomosis stricture. Endourological treatment with the Acucise (R) cutting balloon was performed and 4 days after the procedure the patient presented with massive bleeding through the ileal stoma and hypovolemic shock. Arteriography identified the source of bleeding as a pseudoaneurysm of the left common iliac artery. Repair with an endovascular graft stopped the bleeding immediately. Endovascular treatment of vascular injury after endoureterotomy should be considered.
- Cross-cultural adaptation and validation of the neurogenic bladder symptom score questionnaire for brazilian portuguese(2019) CINTRA, Lisley Keller Liidtke; BESSA JUNIOR, Jose de; KAWAHARA, Victor Ikky; FERREIRA, Thereza Phitoe Abe; SROUGI, Miguel; BATTISTELLA, Linamara Rizzo; SOUZA, Daniel Rubio de; BRUSCHINI, Homero; GOMES, Cristiano MendesObjective: To cross-culturally adapt and check for the reliability and validity of the neurogenic bladder symptom score questionnaire to Brazilian portuguese, in patients with spinal cord injury and multiple sclerosis. Materials and Methods: The questionnaire was culturally adapted according to international guidelines. The Brazilian version was applied in patients diagnosed with neurogenic bladder due to spinal cord injury or multiple sclerosis, twice in a range of 7 to 14 days. Psychometric properties were tested such as content validity, construct validity, internal consistency, and test-retest reliability. Results: Sixty-eight patients participated in the study. Good internal consistency of the Portuguese version was observed, with Cronbach alpha of 0.81. The test-retest reliability was also high, with an Intraclass Correlation Coefficient of 0.86 [0.76 - 0.92] (p<0.0001). In the construct validity, the Pearson Correlation revealed a moderate correlation between the Portuguese version of the NBSS and the Qualiveen-SF questionnaire (r = 0.66 [0.40-0.82]; p < 0.0001). Conclusions: The process of cross-cultural adaptation and validation of the NBSS questionnaire for the Brazilian Portuguese in patients with neurogenic lower urinary tract dysfunction was concluded.
- Update on complications of synthetic suburethral slings(2017) GOMES, Cristiano Mendes; CARVALHO, Fabricio Leite; BELLUCCI, Carlos Henrique Suzuki; HEMERLY, Thiago Souto; BARACAT, Fabio; BESSA JR., Jose de; SROUGI, Miguel; BRUSCHINI, HomeroSynthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.
- Evaluation of Sexual Dysfunction in Men With Spinal Cord Injury Using the Male Sexual Quotient(2016) MIRANDA, Eduardo P.; GOMES, Cristiano Mendes; BESSA JR., Jose de; ABDO, Carmita Helena Najjar; BELLUCCI, Carlos Henrique Suzuki; CASTRO FILHO, Jose Everton de; CARVALHO, Fabricio Leite de; SOUZA, Daniel Rubio de; BATTISTELLA, Linamara Rizzo; SCAZUFCA, Marcia; BRUSCHINI, Homero; BARROS FILHO, Tarcisio; SROUGI, Miguel.Objective: To assess different aspects of sexual function in men with spinal cord injury (SCI) using the Male Sexual Quotient (MSQ), a newly developed tool to assess sexual function and satisfaction. Design: Cross-sectional study. Setting: Tertiary rehabilitation center. Participants: Patients (N=295) older than 18 years (mean age +/- SD, 40.7 +/- 14.5y) with SCI for more than 1 year (median time since SCI, 3.6y; range, 1.6-7.0y) were assessed from February to August 2012. Patients completed the MSQ questionnaire and the Sexual Health Inventory for Men (SHIM). Interventions: Not applicable. Main Outcome Measures: Performance in various domains of sexual function was evaluated using the MSQ and SHIM questionnaires. Results: Erectile function, ejaculation, and orgasm were the most severely affected domains. The median MSQ score was 40 (range, 8-66), and the median SHIM score was 5 (range, 0-16). The diagnostic properties of the 2 instruments were similar in the discrimination of sexually active subjects. The area under the receiver operating characteristic curve was .950 (95% confidence interval [CI], .923.979) for the MSQ and .942 (95% CI, .915.968) for the SHIM. There was a strong correlation between the 2 instruments (r=.826; 95% CI, .802.878). Conclusions: Different domains of sexual function are severely impaired in men with SCI, although their sexual interest remains high. The MSQ and SHIM scores strongly correlate, but the MSQ provides a more comprehensive assessment of sexual dysfunction in male patients with SCI. (C) 2016 by the American Congress of Rehabilitation Medicine
- 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
- Use of an Inflatable Silicone Balloon Improves the Success Rate of Bladder Autoaugmentation at Long-Term Followup(2011) ROCHA, Flavio Trigo; BRUSCHINI, Homero; FIGUEIREDO, Jose Alaor; MACHADO, Marcos Gianetti; GOMES, Cristiano Mendes; MASCARENHAS, Frederico; SROUGI, MiguelPurpose: Most groups have reported disappointing results with autoaugmentation or detrusor myectomy for low capacity/compliance neuropathic bladders. Failure may be due to an ischemic diverticulum or mucosal shrinkage. We investigated whether a Silimed (R) silicone balloon placed in the bladder after autoaugmentation could prevent these problems, improving surgical results. Materials and Methods: We compared the results of standard bladder autoaugmentation in 12 children (group 1) with those in 10 (group 2) who underwent the same surgery using a bladder conformer. The conformer was a silicone balloon filled with saline that remained in the bladder for 2 weeks. All patients had a neuropathic bladder with poor capacity and compliance, resulting in urinary leakage between catheterizations. Preoperative and postoperative evaluation included a voiding diary, ultrasound, voiding cystourethrogram and urodynamics. Results: In group 1 only 1 patient became dry, 4 had little improvement in continence, 4 remained unchanged and 3 became worse. In group 2, 6 patients (60%) become continent without medication, 2 (20%) become continent with oxybutynin and 2 remained unchanged. Bladder capacity and compliance did not change significantly in group 1. However, in group 2 capacity changed from a mean of 140 to 240 ml and mean +/- SD compliance increased from 15.6 +/- 16.8 to 34.3 +/- 22.8 ml/cm H(2)O (p = 0.02). Conclusions: The inflatable balloon improved our long-term results of bladder auto-augmentation. A larger series may be necessary to confirm procedure efficacy and safety.
- Voiding Dysfunction in Patients With Neuromyelitis Optica Spectrum Disorders(2016) CARVALHO, Fabricio Leite de; GOMES, Cristiano Mendes; APOSTOLOS-PEREIRA, Samira L.; BESSA JR., Jose; PINHEIRO, Marcello; MARCHIORI, Paulo E.; BRUSCHINI, Homero; SROUGI, Miguel; CALLEGARO, DagobertoAims: We assessed the lower urinary tract symptoms (LUTS) and urodynamic findings in patients with neuromyelitis optica spectrum disorders (NMO-SD), a recently defined neurological disease. Methods: We prospectively evaluated seven men and 23 women (mean age 41.1 +/- 13.5 years) with an established diagnosis of NMO-SD who were invited to participate irrespective of the presence of LUTS. Neurological evaluation was assessed with the Expanded Disability Status Scale (EDSS) and LUTS were evaluated with the Overactive Bladder questionnaire (OAB-V8) and the International Prostate Symptom Score (I-PSS). All patients underwent videourodynamics, transabdominal urinary tract sonography, urine culture, and serum creatinine levels. Results: The mean time of disease duration was 33.8 +/- 30.8 months. Neurological evaluation showed a mean EDSS score of 5.3 +/- 1.8. The most frequent videourodynamic findings were detrusor-sphincter dyssynergia (DSD) and detrusor overactivity (DO) in 11 (36.6%) patients, DSD without DO in seven (23.3%) and DO without DSD in six (20.0%) patients. Voiding dysfunction assessed by I-PSS and OAB-V8 increased with the degree of neurological impairment (P = 0.018; r = 0.42 and P = 0.006; r = 0.48 respectively). Patients with DSD had higher I-PSS (18.5 +/- 11.4 vs 7.0 +/- 9.2; P = 0.029) and OAB-V8 scores (22.8 +/- 15.8vs 9.1 +/- 7.8; P = 0.008), and worse neurological impairment (mean EDSS 5.9 +/- 1.8 vs 4.5 +/- 1.5; P = 0.027). Conclusions: Most patients with NMO-SD have LUTS and voiding dysfunction, with DSD and DO as the main urodynamic findings. The severity of the neurological disease is a predictive factor for the occurrence of voiding dysfunction and detrusor-sphincter dyssynergia. (C) 2014 Wiley Periodicals, Inc.