JORGE MILHEM HADDAD
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject DEVELOPING CORE OUTCOME SETS IN MESH PROLAPSE SURGERY: QUALITY OF OUTCOME REPORTING, METHODOLOGICAL QUALITY AND PUBLICATION CHARACTERISTICS IN TRIALS ON SYNTHETIC MESH PROLAPSE INTERVENTIONS(2019) LOURENCO, T. R.; PERGIALIOTIS, V.; DUFFY, J. M.; DURNEA, C.; ELFITURI, A.; HADDAD, J. Milhem; BETSCHART, C.; FALCONI, G.; NYGAARD, C. C.; DOUMOUCHTSIS, S.- A systematic review of reported outcomes and outcome measures in randomized controlled trials on apical prolapse surgery(2019) LOURENCO, Thais Regina de Mattos; PERGIALIOTIS, Vasilis; DURNEA, Constantin; ELFITURI, Abdullatif; HADDAD, Jorge Milhem; BETSCHART, Cornelia; FALCONI, Gabriele; DOUMOUCHTSIS, Stergios K.Background Evidence on efficacy and safety of pelvic organ prolapse interventions is variable, and methodological flaws preclude meaningful synthesis of primary research data. Objective To evaluate variations in reported outcomes and outcome measures in randomized controlled trials (RCTs) on apical prolapse surgical interventions. Search strategy We searched Cochrane, EMBASE, MEDLINE, and Scopus for English-language articles published from inception to September 30, 2017, using the terms ""management"", ""repair"", ""operation"", and ""pelvic organ prolapse"". Selection criteria RCTs on apical prolapse surgical treatment. Data collection and analysis Outcomes and outcome measures were identified and categorized into domains. Studies were evaluated for quality of outcomes. Descriptive statistics were used to calculate frequencies. Main results Forty-three RCTs were included. Seventy-six outcomes and 66 outcome measures were identified. Bladder and ureteric injury were the most commonly reported intraoperative complications (19/31 studies; 61%). Quality of life was assessed by 19 different instruments and questionnaires. Fourteen (45%) of 31 studies used recurrence of prolapse as a postoperative anatomical outcome. Conclusions Substantial variation in reported outcomes and outcome measures was confirmed, precluding comparisons across trials and synthesis of the results. Development of a core outcome set will enable high-quality meta-analyses to be performed in the future.
conferenceObject URINARY INCONTINENCE IN FEMALE ATHLETES: SYSTEMATIC REVIEW(2017) LOURENCO, T. R.; MATSUOKA, P. K.; BARACAT, E. C.; HADDAD, J. M.- Urinary incontinence in female athletes: a systematic review(2018) LOURENCO, Thais Regina de Mattos; MATSUOKA, Priscila Katsumi; BARACAT, Edmund Chada; HADDAD, Jorge MilhemPeople are increasingly aware of healthy lifestyles. Extenuating practice can injure the pelvic floor. Urinary incontinence (UI) is a prevalent condition in women whether they exercise professionally or not. The most common symptom is stress UI. It is reported in a large variety of sports and may interfere with everyday life or training, leading athletes to change or compromise their performance or risk compromising it. We aimed to assess the prevalence of UI in female athletes and to determine whether the type of sport might also influence UI. A systematic review of the literature was performed by searching PubMed, the Cochrane Library, and LILACS up to 23 January 2017. The search strategy included the keywords pelvic floor disorders, urinary incontinence, athletes, and sports. The inclusion criterion was studies of women who performed any kind of sport with a prevalence of UI. The subjects were female, with no restriction for age, sport modality, or frequency of training. The outcome was prevalence of UI. The search identified 385 studies, 22 of which met the methodologic criteria for complete analysis. In this review, 7507 women aged 12 to 69 years were included. Only five studies compared physically active women to controls. Every study included high or moderate impact activities involving jumping, fast running, and rotational movements. In total, 17 sport modalities were analyzed. The prevalence of UI varied from 5.56% in low-impact activity to 80% in trampolining. In athletes, the prevalence of incontinence ranged from 10.88% to 80%, showing that the amount of training influences UI symptoms. High-impact activities showed a 1.9-fold prevalence over medium-impact activities and 4,59-fold prevalence over impact activities. Factors such as hormone use, smoking, or menopausal status could not be assessed since they were not detailed in most of the studies. These data suggest that sports practice increases the prevalence of UI and that the type of activity performed by women also has a bearing on the disorder.
- Comparison between anterior and posterior vaginal approach in apical prolapse repair in relation to anatomical structures and points of fixation to the sacrospinous ligament in fresh postmenopausal female cadavers(2023) JUNQUEIRA, Silvia Cristiane Alvarinho; LOURENCO, Thais Regina de Mattos; SOARES JUNIOR, Jose Maria; FONSECA, Lucilia Carvalho da; BARACAT, Edmund Chada; HADDAD, Jorge MilhemIntroduction and hypothesis The high prevalence of pelvic organ prolapse (POP) in women requires attention and constant review of treatment options. Sacrospinous ligament fixation (SSLF) for apical prolapse has benefits, high efficacy, and low cost. Our objective is to compare anterior and posterior vaginal approach in SSLF in relation to anatomical structures and to correlate them with body mass index (BMI). Methods Sacrospinous ligament fixation was performed in fresh female cadavers via anterior and posterior vaginal approaches, using the CAPIO (R) SLIM device (Boston Scientific, Natick, MA, USA). The distances from the point of fixation to the pudendal artery, pudendal nerve, and inferior gluteal artery were measured. Results We evaluated 11 cadavers with a mean age of 70.1 +/- 9.9 years and mean BMI 22.4 +/- 4.6 kg/m(2). The mean distance from the posterior SSLF to the ischial spine, pudendal artery, pudendal nerve, and inferior gluteal artery were 21.18 +/- 2.22 mm, 17.9 +/- 7.3 mm, 19.2 +/- 6.8 mm, and 18.9 +/- 6.9 mm respectively. The same measurements relative to the anterior SSLF were 19.7 +/- 2.7 mm, 18.6 +/- 6.7 mm, 19.2 +/- 6.9 mm, and 18.3 +/- 6.7 mm. Statistical analysis showed no difference between the distances in the two approaches. The distances from the fixation point to the pudendal artery and nerve were directly proportional to the BMI. Conclusions There was no difference in the measurements obtained in the anterior and posterior vaginal approaches. A direct correlation between BMI and the distances to the pudendal artery and pudendal nerve was found.
- A systematic review of reported outcomes and outcome measures in randomized trials evaluating surgical interventions for posterior vaginal prolapse to aid development of a core outcome set(2020) LOURENCO, Thais R. M.; PERGIALIOTIS, Vasilis; DURNEA, Constantin M.; ELFITURI, Abdullatif; HADDAD, Jorge M.; BETSCHART, Cornelia; FALCONI, Gabriele; NYGAARD, Christiana C.; BERGSTROM, Lina; PATTEL, Mittal; DOUMOUCHTSIS, Stergios K.Background Recent systematic reviews have demonstrated wide variations on outcome measure selection and outcome reporting in trials on surgical treatments for anterior, apical and mesh prolapse surgery. A systematic review of reported outcomes and outcome measures in posterior compartment vaginal prolapse interventions is highly warranted in the process of developing core outcome sets. Objective To evaluate outcome and outcome measures reporting in posterior prolapse surgical trials. Search strategy We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Selection criteria Randomized trials evaluating the efficacy and safety of different surgical interventions for posterior compartment vaginal prolapse. Data collection and analysis Two researchers independently assessed studies for inclusion, evaluated methodological quality, and extracted relevant data. Methodological quality, outcome reporting quality and publication characteristics were evaluated. Main results Twenty-seven interventional and four follow-up trials were included. Seventeen studies enrolled patients with posterior compartment surgery as the sole procedure and 14 with multicompartment procedures. Eighty-three reported outcomes and 45 outcome measures were identified. The most frequently reported outcomes were blood loss (20 studies, 74%), pain (18 studies, 66%) and infection (16 studies, 59%). Conclusions Wide variations in reported outcomes and outcome measures were found. Until a core outcome set is established, we propose an interim core outcome set that could include the three most commonly reported outcomes of the following domains: hospitalization; intraoperative, postoperative urinary, gastrointestinal, vaginal and sexual outcomes; clinical effectiveness. PROSPERO: CRD42017062456.
- A systematic review on reporting outcomes and outcome measures in trials on synthetic mesh procedures for pelvic organ prolapse: Urgent action is needed to improve quality of research(2019) LOURENCO, Thais R. de Mattos; PERGIALIOTIS, Vasilis; DUFFY, James M. N.; DURNEA, Constantin; ELFITURI, Abdullatif; HADDAD, Jorge M.; BETSCHART, Cornelia; FALCONI, Gabriele; DOUMOUCHTSIS, Stergios K.The use of synthetic mesh in pelvic organ prolapse surgery is being closely scrutinized because of serious concerns regarding life-changing complications such as erosion, pain, infection, bleeding, dyspareunia, organ perforation, and urinary problems. Randomized trials and their syntheses in meta-analysis offer a unique opportunity to assess efficacy and safety. However, outcomes and outcome measures need to be consistently selected, collected, and reported across randomized trials to be effectively combined in systematic reviews. Aims We evaluated outcome and outcome measure reporting across randomized controlled trials on surgical interventions using synthetic mesh for pelvic organ prolapse. Methods Systematic review of randomized controlled trials using synthetic mesh for the treatment of pelvic organ prolapse. The selected studies were evaluated using Jadad and MOMENT criteria. Outcomes and outcome measures were systematically identified and categorized. Results Seventy-one randomized trials were included. Twenty-four different types of mesh were identified. Included trials reported 110 different outcomes and 60 outcome measures. Erosion (40 trials, 78%), pain (29 trials, 56%), bleeding (31 trials, 61%), and dyspareunia (25 trials, 49%) were the most frequently reported outcomes. The longest follow up was 74 months. Conclusions Most randomized trials evaluating surgical interventions using synthetic mesh for pelvic organ prolapse failed to report on clinically important outcomes and to evaluate efficacy and safety over the medium- and long-term. Developing and implementing a minimum data set, known as a core outcome set, in future vaginal prolapse trials could help address these issues.
- Quality assessment of outcome reporting, publication characteristics and overall methodological quality in trials on synthetic mesh procedures for the treatment of pelvic organ prolapse for development of core outcome sets(2021) LOURENCO, Thais Regina de Mattos; PERGIALIOTIS, Vasilis; DURNEA, Constantin M.; ELFITURI, Abdullatif; HADDAD, Jorge Milhem; BETSCHART, Cornelia; FALCONI, Gabriele; NYGAARD, Christiana Campani; DOUMOUCHTSIS, Stergios K.Introduction and hypothesis Variations in outcome measures and reporting of outcomes in trials on surgery for pelvic organ prolapse (POP) using synthetic mesh have been evaluated and reported. However, the quality of outcome reporting, methodology of trials and their publication parameters are important considerations in the process of development of Core Outcome Sets. We aimed to evaluate these characteristics in randomized controlled trials on surgery for POP using mesh. Methods Secondary analysis of randomized controlled trials on surgical treatments using synthetic mesh for POP previously included in a systematic review developing an inventory of reported outcomes and outcome measures. The methodological quality was investigated with the modified Jadad criteria. Outcome reporting quality was evaluated with the MOMENT criteria. Publication parameters included publishing journal, impact factor and year of publication. Results Of the 71 previously reviewed studies published from 2000 to 2017, the mean JADAD score was 3.59 and the mean MOMENT score was 4.63. Quality of outcomes (MOMENT) was related to methodological quality (JADAD) (rho = 0.662; p = 0.000) and to year of publication (rho = 0.262; p = 0.028). Conclusions Methodological quality and outcome reporting quality appear correlated. However, publication characteristics do not have strong associations with the methodological quality of the studies. Evaluation of the quality of outcomes, methodology and publication characteristics are all an indispensable part of a staged process for the development of Core Outcome and Outcome Measure Sets.
conferenceObject FEMALE ATHLETES AND URINARY INCONTINENCE ACCORDING TO DIFFERENT INTENSITIES OF IMPACT: AN UPDATED SYSTEMATIC REVIEW WITH META-ANALYSIS(2021) LOURENCO, T.; MATSUOKA, P.; BARACAT, E.; DOUMOUCHTSIS, S.; HADDAD, J.