BRUNO CAMARGO TISEO
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
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conferenceObject A scoring system for testicular torsion: Decreasing costs and therapeutic delay(2012) BARBOSA, J. A. B. A.; OLIVEIRA, C. M.; TISEO, B. C.; PASSEROTTI, C. C.; SROUGI, M.; NGUYEN, H. T.; RETIK, A. B.NTRODUCTION & OBJECTIVES: Testicular torsion is a surgical emergency requiring prompt intervention to prevent testicular loss. Differential diagnosis is not easily done with clinical evaluation, and imaging studies are usually required, especially ultrasound, causing therapeutic delay. Our objective was to create a scoring system for clinical diagnosis of testicular torsion, thus eliminating the necessity of ultrasound (US). MATERIAL & METHODS: Patients presenting with acute scrotum at a tertiary care center were prospectively evaluated and physical examination was performed by the first urologist to see the patient. Scrotal ultrasound was performed in all patients after visit. Single variate analysis was performed and clinical variables associated with testicular torsion were identified. A scoring system was created based upon logistic regression with relevant variables from univariate analysis. Retrospective validation of the scoring system was performed including all patients seen with suspicion for testicular torsion at this institution up to 2 years prior to the beginning of the prospective evaluation. RESULTS: Two hundred and thirty one patients were enrolled in the first phase of the study. Mean age of patients was 12.1 years and mean duration of symptoms was 40.2 hours. Thirty-three patients had a final diagnosis of torsion. Clinical variables associated with torsion were scrotal swelling, nausea and vomiting from history and testicular swelling, high-riding test icle, horizontal lie of the testicle, increased consistency of the testicle to palpation, presence of a thickened spermatic cord, negative Prehn's sign, absent cremasteric reflex and fixed scrotal skin to testis on physical examination (p<0.05). A scoring system was created with 5 variables, and patients were stratified in low, intermediate and high risk for torsion. Twenty-two patients were at high risk for testicular torsion, all of which had a final diagnosis of torsion, and 170 patients were at low risk for torsion, none of which had a diagnosis for this condition. Low and high risk groups comprised 82% of all patients seen. Retrospective validation was performed for 116 patients and 83% of cases fell within low or high risk categories; all patients in the high risk category had a final diagnosis of torsion and none in the low risk group. CONCLUSIONS: The present scoring system is a valuable tool for diagnosis of testicular torsion, eliminating the necessity of ultrasound in 80% of cases. Prospective validation of this score is necessary.- Impact of body mass index, age and varicocele on reproductive hormone profile from elderly men(2016) YAMACAKE, K. G. R.; COCUZZA, M.; TORRICELLI, F. C. M.; TISEO, B. C.; FRATI, R.; FREIRE, G. C.; ANTUNES, A. A.; SROUGI, M.Objectives: To study the impact of obesity, age and varicocele on sexual hormones fof adult and elderly men. Materials and Methods: 875 men who were screened for prostate cancer were enrolled in this study. Data recorded comprised age, body mass index (BMI), serum levels of total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH) and follicular stimulating hormone (FSH). Patients were divided in groups according to their BMI in underweight, normal weight, overweight and obese grades 1, 2 or 3. First, it was studied the association between age, BMI, and hormone profile. Then, clinical varicocele was evaluated in 298 patients to assess its correlation to the others parameters. Results: Obese patients had lower levels of TT, FT and SHBG (p<0.001) compared to underweight or normal weight patients. There were no differences in age (p=0.113), FSH serum levels (p=0.863) and LH serum levels (p=0.218) between obese and non-obese patients. Obese grade 3 had lower levels of TT and FT compared to obese grade 1 and 2 (p<0.05). There was no difference in the SHBG levels (p=0.120) among obese patients. There was no association between varicocele and BMI; and varicocele did not impact on testosterone or SHBG levels. Conclusions: Men with higher BMI have a lower serum level of TT, FT and SHBG. The presence of clinical varicocele as well as its grade has no impact on hormone profile in elderly men.
- Infrared Thermometer: an accurate tool for temperature measurement during renal surgery(2013) MARCHINI, Giovanni Scala; DUARTE, Ricardo Jordao; MITRE, Anuar Ibrahim; TISEO, Bruno Camargo; CASSAO, Valter Dell'Acqua; TORRICELLI, Fabio Cesar Miranda; ARAP, Marco Antonio; SROUGI, MiguelPurpose: To evaluate infrared thermometer (IRT) accuracy compared to standard digital thermometer in measuring kidney temperature during arterial clamping with and without renal cooling. Materials and Methods: 20 pigs weighting 20Kg underwent selective right renal arterial clamping, 10 with (Group 1 - Cold Ischemia with ice slush) and 10 without renal cooling (Group 2 - Warm Ischemia). Arterial clamping was performed without venous clamping. Renal temperature was serially measured following clamping of the main renal artery with the IRT and a digital contact thermometer (DT): immediate after clamping (T0), after 2 (T2), 5 (T5) and 10 minutes (T10). Temperature values were expressed in mean, standard deviation and range for each thermometer. We used the T student test to compare means and considered p < 0.05 to be statistically significant. Results: In Group 1, mean DT surface temperature decrease was 12.6 +/- 4.1 degrees C (5-19 degrees C) while deep DT temperature decrease was 15.8 +/- 1.5 degrees C (15- 18 degrees C). For the IRT, mean temperature decrease was 9.1 +/- 3.8 degrees C (3-14 degrees C). There was no statistically significant difference between thermometers. In Group 2, surface temperature decrease for DT was 2.7 +/- 1.8 \degrees C (0-4 degrees C) and mean deep temperature decrease was 0.5 +/- 1.0 degrees C (0-3 degrees C). For IRT, mean temperature decrease was 3.1 +/- 1.9 degrees C (0-6 degrees C). No statistically significant difference between thermometers was found at any time point. Conclusions: IRT proved to be an accurate non-invasive precise device for renal temperature monitoring during kidney surgery. External ice slush cooling confirmed to be fast and effective at cooling the pig model.
- CAN WE TRUST IN VARICOCELE CLASSIFICATION AND TESTICULAR VOLUME MEASUREMENT BY PHYSICAL EXAMINATION?(2014) COCUZZA, Marcello; TISEO, Bruno; SROUGI, Victor; WOOD, Guilherme; RICARDO, Jose; SROUGI, Miguel
- Bariatric Surgery Impact on Reproductive Hormones, Semen Analysis, and Sperm DNA Fragmentation in Men with Severe Obesity: Prospective Study(2020) WOOD, Guilherme Jacom Abdulmassih; TISEO, Bruno C.; PALUELLO, Davi V.; MARTIN, Hamilton de; SANTO, Marco Aurelio; NAHAS, William; SROUGI, Miguel; COCUZZA, MarcelloPurpose Growing evidence in the literature suggests that obesity is capable of altering reproductive hormone levels and male fertility. Effects on classic semen parameters and sperm DNA fragmentation (SDF), however, have not been properly established. Additionally, the impact of bariatric surgery (BS) on those parameters is still controversial. Materials and Methods In Phase 1, 42 patients with obesity and 32 fertile controls were submitted to reproductive hormone evaluation, semen analysis, and SDF testing. In Phase 2, patients with obesity were submitted to BS or clinical follow-up and were invited to 6-month revaluation. Results Phase 1: Men with obesity have higher levels of estradiol, LH, and FSH and lower levels of total testosterone (TT) when compared with eutrophic fertile men. Additionally, they present worse semen parameters, with reduction in ejaculated volume and sperm concentration, worse sperm motility and morphology, and higher SDF. Phase 2: 32 patients returned to revaluation. Eighteen were submitted to BS (group S) and 14 were not submitted to any specific therapeutic regimen (group NS). In group S, TT more than doubled after surgery (294.5 to 604 ng/dL,p < 0.0001). Worsening of sperm concentration and total ejaculated sperm count were also noticed, and 2 patients became azoospermic after BS. SDF, however, improved after the procedure. No changes in the variables studied were observed in non-operated patients. Conclusion In this prospective study, we have found that BS results in improvements in reproductive hormone levels and SDF after 6-month follow-up. Sperm concentration, however, reduced after the procedure.
- Development and Initial Validation of a Scoring System to Diagnose Testicular Torsion in Children(2013) BARBOSA, Joao A.; TISEO, Bruno Camargo; BARAYAN, Ghassan A.; ROSMAN, Brian M.; TORRICELLI, Fabio Cesar Miranda; PASSEROTTI, Carlo C.; SROUGI, Miguel; RETIK, Alan B.; NGUYEN, Hiep T.Purpose: Testicular torsion is a surgical emergency requiring prompt intervention. Although clinical diagnosis is recommended, scrotal ultrasound is frequently ordered, delaying treatment. We created a scoring system to diagnose testicular torsion, decreasing the indication for ultrasound. Materials and Methods: We prospectively evaluated 338 patients with acute scrotum, of whom 51 had testicular torsion. Physical examination was performed by a urologist, and all patients underwent scrotal ultrasound. Univariate analysis and logistic regression were performed, and a scoring system for risk stratification of torsion was created. Retrospective validation was performed with 2 independent data sets. Results: The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1) and high riding testis (1). Cutoffs for low and high risk were 2 and 5 points, respectively. Ultrasound would be indicated only for the intermediate risk group. In the prospective data set 69% of patients had low, 19% intermediate and 11.5% high risk. Negative and positive predictive values were 100% for cutoffs of 2 and 5, respectively (specificity 81%, sensitivity 76%). Retrospective validation in 1 data set showed 66% of patients at low, 16% intermediate and 17% high risk. Negative and positive predictive values for cutoffs of 2 and 5 were 100% (specificity 97%, sensitivity 54%). The second retrospective data set included only torsion cases, none of which was misdiagnosed by the scoring system. Conclusions: This scoring system can potentially diagnose or rule out testicular torsion in 80% of cases, with high positive and negative predictive values for selected cutoffs. Ultrasound orders would be decreased to 20% of acute scrotum cases. Prospective validation of this scoring system is necessary.
conferenceObject DIAGNOSTIC ACCURACY OF PHYSICAL EXAMINATION COMPARED WITH COLOR DOPPLER ULTRASOUND IN THE DETERMINATION OF TESTIS SIZE AND VARICOCELE DIAGNOSIS.(2015) TISEO, B. C.; COCUZZA, M.; SROUGI, V.; WOOD, G. J.; ESTEVES, S.; SROUGI, M.- The urologist's role in the fight of COVID-19 pandemic: mandatory mindset shift on the frontline(2020) ISCAIFE, Alexandre; MARCHINI, Giovanni S.; SROUGI, Victor; TORRICELLI, Fabio C. M.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; MACHADO, Marcos; HISANO, Marcelo; TISEO, Bruno C.; BISSOLI, Julio C.; COCUZZA, Marcello; HALLAK, Jorge; SROUGI, Miguel; NAHAS, William C.
- Diagnostic accuracy of physical examination compared with color Doppler ultrasound in the determination of varicocele diagnosis and grading: Impact of urologists' experience(2020) COCUZZA, Marcello S.; TISEO, Bruno C.; SROUGI, Victor; WOOD, Guilherme J. A.; CARDOSO, Joao P. G. F.; ESTEVES, Sandro C.; SROUGI, MiguelBackground Treatment of palpable varicocele in infertile men with abnormal semen parameters is widely accepted, and physical examination (PE) remains a cornerstone for recommending varicocele repair. However, identification of clinical varicocele during PE can be challenging for both urology residents and consultants. Objective To compare the diagnostic accuracy of PE to color Doppler ultrasonography (CDU) for the diagnosis of varicocele in experienced and non-experienced examiners. Materials and methods Diagnostic accuracy study involving 78 patients attending a university-based infertility unit. Patients underwent scrotal PE by both experienced (over 10 years experience in male infertility) and non-experienced urologists (senior residents), and were subjected to CDU. varicocele diagnosis and varicocele grading were compared between examiner groups and to CDU. Accuracy measures were evaluated, and interobserver agreement was estimated using unweighted kappa statistics. A subgroup analysis for normal and high body mass index (BMI) was also performed for the same variables. Results Accuracy of PE for varicocele diagnosis was 63.5% with a positive predictive value (PPV) of 75.5%. The specificity and PPV of PE were higher among experienced than non-experienced urologists (82.0% CI: 74.27-88.26 and 81.1% CI: 74.39-86.44% vs 67.2% CI: 58.33-75.22 and 70.6% CI: 64.52-76.08, respectively). Agreements on varicocele diagnosis (k: 0.625 vs 0.517) and grading (k: 0.548 vs 0.418) by PE were higher among experienced than non-experienced urologists. Differences between eutrophic and overweight/obese patients were also suggested. Discussion and conclusions PE performed by infertility specialists identify patients with varicocele more precisely than non-specialists. However, PE alone has suboptimal accuracy for varicocele diagnosis. Our results indicate that PE should be followed by CDU to decrease the number of false positives and increase the diagnostic accuracy of varicocele diagnosis.
- Positive rheotaxis extended drop: a one-step procedure to select and recover sperm with mature chromatin for intracytoplasmic sperm injection(2017) MARTIN, Hamilton De; COCUZZA, Marcello S.; TISEO, Bruno C.; WOOD, Guilherme J. A.; MIRANDA, Eduardo P.; MONTELEONE, Pedro A. A.; SOARES JR., Jose Maria; SERAFINI, Paulo C.; SROUGI, Miguel; BARACAT, Edmund C.The purpose of this study was to develop a novel one-step ICSI approach to select sperm with better chromatin maturity than the conventional method. This was a pilot diagnostic study, which prospectively recruited men during a 6-month period in a University-affiliated infertility centre. Forty consecutive semen samples were provided for analysis. The positive rheotaxis extended drop (PRED) was set up creating a pressure and viscosity gradient. Each semen sample was divided into four aliquots: one aliquot for density gradient centrifugation (DGC), two aliquots for PRED (fresh semen (PRED-FS) and processed semen (PRED-DGC)), and one aliquot as the control (FS). In PRED, a mean of 200 spermatozoa were collected consecutively without selection from the outlet reservoir. The aniline blue assay was used to assess chromatin immaturity. The mean channel length, measured from inlet to outlet, was 32.55 +/- 0.86 mm, with a mean width of 1.04 +/- 0.21 mm. In 82.5% of cases (33/40), at least 50 spermatozoa were captured between 15 and 30 min. Improved chromatin maturity after the DGC preparation and the PRED approach was observed in all samples. This was reflected by a mean reduction from 28.65 +/- 8.97% uncondensed chromatin in the native ejaculates to 17.29 +/- 7.72% in DGC and 0.89 +/- 1.31% in the PRED approach (P < 0.01). The PRED method may improve the current ICSI technique by providing it with its own sperm selection process. ICSI would probably become an even more complete technique comprising selection, capture and injection of the male gamete.