RAFAEL FERREIRA COELHO

(Fonte: Lattes)
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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina

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Revista / Livro: European Urology ×

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Agora exibindo 1 - 10 de 19
  • article 270 Citação(ões) na Scopus
    Pentafecta: A New Concept for Reporting Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy
    (2011) PATEL, Vipul R.; SIVARAMAN, Ananthakrishnan; COELHO, Rafael F.; CHAUHAN, Sanket; PALMER, Kenneth J.; ORVIETO, Marcelo A.; CAMACHO, Ignacio; COUGHLIN, Geoff; ROCCO, Bernardo
    Background: Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures. Objective: A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed. Design, setting, and participants: From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group. Measurements: In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta. Results and limitations: Continence, potency, biochemical recurrence-free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age (p = 0.001) was confirmed as the only factor independently associated with the pentafecta. Conclusions: A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta, is being proposed. We believe that pentafecta outcomes more accurately represent patients' expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease.
  • article 110 Citação(ões) na Scopus
    Posterior Musculofascial Reconstruction After Radical Prostatectomy: A Systematic Review of the Literature
    (2012) ROCCO, Bernardo; COZZI, Gabriele; SPINELLI, Matteo G.; COELHO, Rafael F.; PATEL, Vipul R.; TEWARI, Ashutosh; WIKLUND, Peter; GRAEFEN, Markus; MOTTRIE, Alex; GABOARDI, Franco; GILL, Inderbir S.; MONTORSI, Francesco; ARTIBANI, Walter; ROCCO, Francesco
    Context: In 2001, Rocco et al. described a surgical technique whose aim was the reconstruction of the posterior musculofascial plate after radical prostatectomy (RP) to improve early return to urinary continence. Since then, many surgeons have applied this technique-either as it was described or with some modification-to open, laparoscopic, and robot-assisted RP. Objective: To review the outcomes reported in comparative studies analysing the influence of reconstruction of the posterior aspect of the rhabdosphincter after RP. The main outcome evaluated was urinary continence at 3-7 d, 30-45 d, 90 d, 180 d, and 1 yr after catheter removal. Evidence acquisition: A systematic review of the literature was performed in November 2011, searching the Medline, Embase, Scopus, and Web of Science databases. A ""freetext'' protocol using the terms posterior reconstruction of the rhabdosphincter, posterior rhabdosphincter, and early continence was applied. Studies published only as abstracts and reports from meetings were not included in this review. One thousand seven records were retrieved from the Medline database, 1541 from the Embase database, 1357 from the Scopus database, and 1041 from the Web of Science database. The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. Only papers evaluating use of this technique as the only technical modification among the groups were included. A cumulative analysis was conducted using Review Manager v. 5.1 software (Cochrane Collaboration, Oxford, UK). Evidence synthesis: Eleven studies were identified in the literature search, including two randomised controlled trials (RCTs), which were negative studies. The cumulative analysis of comparative studies showed that reconstruction of the posterior musculofascial plate improves early return of continence within the first 30 d after RP (p = 0.004), while continence rates 90 d after surgery are not affected by use of the reconstruction technique. The statistical significance of the reconstruction seems to decrease when higher continence rates are reported. Use of posterior rhabdosphincter reconstruction does not seem to be related to positive surgical margin (PSM) rates or with complications like acute urinary retention (AUR) and bladder neck stricture (BNS). Some studies suggested lower anastomotic leakage rates with the posterior musculofascial plate reconstruction technique. Conclusions: The role of reconstruction of the posterior musculofascial plate in terms of earlier continence recovery is encouraging but still controversial. Methodological flaws and poor surgical standardisation seem to be the major causes. In two RCTs and one parallel (not randomised) group trial, posterior rhabdosphincter reconstruction offered no significant advantage for return of early continence after RP. No significant complications related to the posterior musculofascial plate reconstruction technique have been reported so far. A multicentre RCT is necessary to clarify the possible role of the technique in terms of earlier continence recovery. (c) 2012 Published by Elsevier B.V. on behalf of European Association of Urology.
  • article 50 Citação(ões) na Scopus
    Retrograde Versus Antegrade Nerve Sparing During Robot-assisted Radical Prostatectomy: Which Is Better for Achieving Early Functional Recovery?
    (2013) KO, Young Hwii; COELHO, Rafael F.; SIVARAMAN, Ananthakrishnan; SCHATLOFF, Oscar; CHAUHAN, Sanket; ABDUL-MUHSIN, Haidar M.; CARRION, Rair Jose Valero; PALMER, Kenneth J.; CHEON, Jun; PATEL, Vipul R.
    Background: Although the retrograde approach to nerve sparing (NS) aimed at maximizing NS during robot-assisted radical prostatectomy (RARP) has been described, its significant benefits compared to the antegrade approach have not yet been investigated. Objective: To evaluate the impact of NS approaches on perioperative, pathologic, and functional outcomes. Design, setting, and participants: Five hundred one potent (Sexual Health Inventory for Men [SHIM] score >21) men underwent bilateral full NS and were followed up for a minimum of 1 yr. After propensity score matching, 344 patients were selected and were then categorized into two groups. Surgical procedure: RARP with antegrade NS (n = 172) or RARP with retrograde NS (n = 172). Outcome measurements and statistical analysis: Functional outcomes were assessed using validated questionnaires. Multivariable logistic regression models were applied. Results and limitations: Positive margin rates were similar (11.1% vs 6.9%; p = 0.192), and no correlation with the NS approach was found on regression analysis. At 3, 6, and 9 mo, the potency rate was significantly higher in the retrograde approach (65% vs 80.8% and 72.1% vs 90.1% and 85.3% vs 92.9%, respectively). The multivariable model indicated that the NS approach was an independent predictor for potency recovery at 3, 6, and 9 mo, along with age, gland size, and hyperlipidemia. After adjusting for these predictors, the hazard ratio (HR) for the retrograde relative to the antegrade approach was 2.462 (95% confidence interval [CI], 1.482-4.089; p = 0.001) at 3, 4.024 (95% CI, 2.171-7.457; p < 0.001) at 6, and 2.145 (95% CI, 1.019-4.514; p = 0.044) at 9 mo. Regarding continence, the recovery rates at each time point and the mean time to regaining it were similar, and the method of NS had no effect on multivariable analysis. The absence of randomization is a major limitation of this study. Conclusions: In patients with normal erectile function who underwent bilateral full NS, a retrograde NS approach facilitated early recovery of potency compared to that with an antegrade NS approach without compromising cancer control. (C) 2012 Published by Elsevier B. V. on behalf of European Association of Urology.
  • conferenceObject
    Randomized controlled trial comparing holmium laser en-bloc resection with monopolar transurethral resection in patients with large bladder tumors
    (2021) ISCAIFE, A.; RIBEIRO FILHO, L. A.; PEREIRA, M. W. Aparecido; GALLUCCI, F. Pescarmona; CHADE, D.; CARDILI, L.; COELHO, R. F.; SARKIS, A. Sadeki; SROUGI, M.; NAHAS, W. C.
  • article 0 Citação(ões) na Scopus
  • article 144 Citação(ões) na Scopus
    Influence of Modified Posterior Reconstruction of the Rhabdosphincter on Early Recovery of Continence and Anastomotic Leakage Rates after Robot-Assisted Radical Prostatectomy
    (2011) COELHO, Rafael F.; CHAUHAN, Sanket; ORVIETO, Marcelo A.; SIVARAMAN, Ananthakrishnan; PALMER, Kenneth J.; COUGHLIN, Geoff; PATEL, Vipul R.
    Background: Posterior reconstruction (PR) of the rhabdosphincter has been previously described during retropubic radical prostatectomy, and shorter times to return of urinary continence were reported using this technical modification. This technique has also been applied during robot-assisted radical prostatectomy (RARP); however, contradictory results have been reported. Objective: We describe here a modified technique for PR of the rhabdosphincter during RARP and report its impact on early recovery of urinary continence and on cystographic leakage rates. Design, setting, and participants: We analyzed 803 consecutive patients who underwent RARP by a single surgeon over a 12-mo period: 330 without performing PR and 473 with PR. Surgical procedure: The reconstruction was performed using two 6-in 3-0 Poliglecaprone sutures tied together. The free edge of the remaining Denonvillier's fascia was identified after prostatectomy and approximated to the posterior aspect of the rhabdosphincter and the posterior median raphe using one arm of the continuous suture. The second layer of the reconstruction was then performed with the other arm of the suture, approximating the posterior lip of the bladder neck and vesicoprostatic muscle to the posterior urethral edge. Measurements: Continence rates were assessed with a self-administrated, validated questionnaire (Expanded Prostate Cancer Index Composite) at 1, 4, 12, and 24 wk after catheter removal. Continence was defined as the use of ""no absorbent pads."" Cystogram was performed in all patients on postoperative day 4 or 5 before catheter removal. Results and limitations: There was no significant difference between the groups with respect to patient age, body mass index, prostate-specific antigen levels, prostate weight, American Urological Association symptom score, estimated blood loss, operative time, number of nerve-sparing procedures, and days with catheter. In the PR group, the continence rates at 1, 4, 12, and 24 wk postoperatively were 22.7%, 42.7%, 91.8%, and 96.3%, respectively; in the non-PR group, the continence rates were 28.7%, 51.6%, 91.1%, and 97%, respectively. The modified PR technique resulted in significantly higher continence rates at 1 and 4 wk after catheter removal (p = 0.048 and 0.016, respectively), although the continence rates at 12 and 24 wk were not significantly affected (p = 0.908 and p = 0.741, respectively). The median interval to recovery of continence was also statistically significantly shorter in the PR group (median: 4 wk; 95% confidence interval [CI]: 3.39-4.61) when compared to the non-PR group (median: 6 wk; 95% CI: 5.18-6.82; log-rank test, p = 0.037). Finally, the incidence of cystographic leaks was lower in the PR group (0.4% vs 2.1%; p = 0.036). Although the patients' baseline characteristics were similar between the groups, the patients were not preoperatively randomized and unknown confounding factors may have influenced the results. Conclusions: Our modified PR combines the benefits of early recovery of continence reported with the original PR technique with a reinforced watertight closure of the posterior anastomotic wall. Shorter interval to recovery of continence and lower incidence of cystographic leaks were demonstrated with our PR technique when compared to RARP with no reconstruction.
  • article 2 Citação(ões) na Scopus
  • article 49 Citação(ões) na Scopus
    Retrograde Release of the Neurovascular Bundle with Preservation of Dorsal Venous Complex During Robot -assisted Radical Prostatectomy: Optimizing Functional Outcomes
    (2020) CARVALHO, Paulo Afonso de; BARBOSA, Joao A. B. A.; GUGLIELMETTI, Giuliano B.; CORDEIRO, Mauricio Dener; ROCCO, Bernardo; NAHAS, William C.; PATEL, Vipul; COELHO, Rafael Ferreira
  • article 0 Citação(ões) na Scopus
    Reply from Authors re: Khurshid R. Ghani, Mani Menon. Posterior Reconstruction: Weighing the Evidence. Eur Urol 2012;62:791-3 The Posterior Reconstruction Debate
    (2012) ROCCO, Bernardo; COZZI, Gabriele; SPINELLI, Matteo G.; COELHO, Rafael F.; SANTORO, Luigi; PATEL, Vipul R.; ROCCO, Francesco
  • article 0 Citação(ões) na Scopus
    Reply to: Axel Heidenreich. Still Unanswered: The Role of Extended Pelvic Lymphadenectomy in Improving Oncological Outcomes in Prostate Cancer. Eur Urol 2021;79:605-6
    (2021) LESTINGI, Jean F. P.; GUGLIELMETTI, Giuliano B.; TRINH, Quoc-Dien; COELHO, Rafael F.; JR, Jose Pontes; BASTOS, Diogo A.; CORDEIRO, Mauricio D.; SARKIS, Alvaro S.; FARAJ, Sheila F.; MITRE, Anuar I.; SROUGI, Miguel; NAHAS, William C.