MIGUEL SROUGI
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
3 resultados
Resultados de Busca
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- Supine versus Prone Percutaneous Nephrolithotomy for Complex Stones: A Multicenter Randomized Controlled Trial(2022) PERRELLA, Rodrigo; VICENTINI, Fabio C.; PARO, Eliane D.; TORRICELLI, Fabio C. M.; MARCHINI, Giovani S.; DANILOVIC, Alexandre; BATAGELLO, Carlos A.; V, Priscila K. Mota; FERREIRA, Daniel B.; COHEN, David J.; MURTA, Claudio B.; CLARO, Joaquim F. A.; GIUSTI, Guido; MONGA, Manoj; NAHAS, William C.; SROUGI, Miguel; MAZZUCCHI, EduardoPurpose: High-quality evidence comparing supine to prone percutaneous nephrolithotomy (PCNL) for the treatment of complex stones is lacking. This study aimed to compare the outcomes of supine position (SUP) and prone position (PRO) PCNL. Materials and Method: A noninferior randomized controlled trial was per formed according to the CONSORT (Consolidated Standards for Reporting Trials) criteria. The inclusion criteria were patients over 18 years of age with complex stones. SUP was performed in the Barts flank-free modified position. Except for positioning, all the surgical parameters were identical. The primary outcome was the difference in the success rate on the first postoperative day (POD1) between groups. The secondary outcome was the difference in the stone-free rate (SFR) on the 90th postoperative day (final SFR). A non-inferiority margin of 15% was used. Demographic, operative, and safety variables were compared between the groups. Statistical significance was set at p <0.05. Results: Overall, 112 patients were randomized and their demographic characteristics were comparable. The success rates on POD1 were similar (SUP: 62.5% vs PRO: 57.1%, p = 0.563). The difference observed (-5.4%) was lower than the predefined limit. The final SFRs were also similar (SUP: 55.4% vs PRO: 50.0%, p =0.571). SUP had a shorter operative time (mean +/- SD 117.9 +/- 39.1 minutes vs 147.6 +/- 38.8 minutes, p <0.001) and PRO had a higher rate of Clavien >= 3 complications (14.3% vs 3.6%, p =0.045). Conclusions: Positioning during PCNL for complex kidney stones did not impact the success rates; consequently, both positions may be suitable. However, SUP might be associated with a lower high-grade complication rate.
- Reply by Authors(2022) PERRELLA, R.; VICENTINI, F. C.; PARO, E. D.; TORRICELLI, F. C. M.; MARCHINI, G. S.; DANILOVIC, A.; BATAGELLO, C. A.; MOTA, P. K. V.; FERREIRA, D. B.; COHEN, D. J.; MURTA, C. B.; CLARO, J. F. A.; GIUSTI, G.; MONGA, M.; NAHAS, W. C.; SROUGI, M.; MAZZUCCHI, E.
- Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer: A Multi-institutional Collaboration(2011) CHADE, Daher C.; SHARIAT, Shahrokh F.; CRONIN, Angel M.; SAVAGE, Caroline J.; KARNES, R. Jeffrey; BLUTE, Michael L.; BRIGANTI, Alberto; MONTORSI, Francesco; POEL, Henk G. van der; POPPEL, Hendrik Van; JONIAU, Steven; GODOY, Guilherme; HURTADO-COLL, Antonio; GLEAVE, Martin E.; DALL'OGLIO, Marcos; SROUGI, Miguel; SCARDINO, Peter T.; EASTHAM, James A.Background: Oncologic outcomes in men with radiation-recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP) are poorly defined. Objective: To identify predictors of biochemical recurrence (BCR), metastasis, and death following SRP to help select patients who may benefit from SRP. Design, setting, and participants: This is a retrospective, international, multi-institutional cohort analysis. There was amedian follow-up of 4.4 yr following SRP performed on 404 men with radiation-recurrent PCa from 1985 to 2009 in tertiary centers. Intervention: Open SRP. Measurements: BCR after SRP was defined as a serum prostate-specific antigen (PSA) >= 0.1 or >= 0.2 ng/ml (depending on the institution). Secondary end points included progression to metastasis and cancerspecific death. Results and limitations: Median age at SRP was 65 yr of age, and median pre-SRP PSA was 4.5 ng/ml. Following SRP, 195 patients experienced BCR, 64 developed metastases, and 40 died from PCa. At 10 yr after SRP, BCR-free survival, metastasis-free survival, and cancer-specific survival (CSS) probabilities were 37% (95% confidence interval [CI], 31-43), 77% (95% CI, 71-82), and 83% (95% CI, 76-88), respectively. On preoperative multivariable analysis, pre-SRP PSA and Gleason score at postradiation prostate biopsy predicted BCR (p = 0.022; global p < 0.001) and metastasis (p = 0.022; global p < 0.001). On postoperative multivariable analysis, pre-SRP PSA and pathologic Gleason score at SRP predicted BCR (p = 0.014; global p < 0.001) and metastasis (p < 0.001; global p < 0.001). Lymph node involvement (LNI) also predicted metastasis (p = 0.017). The main limitations of this study are its retrospective design and the follow-up period. Conclusions: In a select group of patients who underwent SRP for radiation-recurrent PCa, freedom from clinical metastasis was observed in > 75% of patients 10 yr after surgery. Patients with lower pre-SRP PSA levels and lower postradiation prostate biopsy Gleason score have the highest probability of cure from SRP.