FRANCISCO CESAR CARNEVALE
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
4 resultados
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- Quality of Life and Clinical Symptom Improvement Support Prostatic Artery Embolization for Patients with Acute Urinary Retention Caused by Benign Prostatic Hyperplasia(2013) CARNEVALE, Francisco C.; MOTTA-LEAL-FILHO, Joaquim M. da; ANTUNES, Alberto A.; BARONI, Ronaldo H.; MARCELINO, Antonio S. Z.; CERRI, Luciana M. O.; YOSHINAGA, Eduardo M.; CERRI, Giovanni G.; SROUGI, MiguelPurpose: To show that prostatic artery embolization (PAE) improves quality of life (QoL) and lower urinary tract symptoms in patients with acute urinary retention caused by benign prostatic hyperplasia (BPH). Materials and Methods: This was a single-center prospective study of PAE in 11 patients with BPH managed With indwelling. urinary catheters. International Prostate Symptom Score (IPSS), ultrasound, magnetic resonance (MR) imaging, QoL, and urodynamic tests were used. to assess outcomes. Prostate size ranged from 30 to 90 g, and embolizations were performed with 300-500-mu m Embosphere microspheres. Results: The rate of technical success (ie, bilateral PAE) was 75%, and the rate of clinical success (ie, catheter removal and symptom improvement) was 91% (10 of 11 patients). Postembolization syndrome manifested as mild pain in the perineum, retropubic area, and/or urethra. Ten of 11 patients urinated spontaneously after Foley catheter removal 4-25 days after PAE (mean, 12.1 d). No major complications Were observed. Follow-up ranged from 19 to 48 months. than asymptomatic patient, a discrete area of hypoperfusion: suggesting small ischemia of the bladder was observed on 30-day MR imaging follow-up, but the bladder was normal on 90-day MR imaging. After 1 year, mean prostate volume reduction was greater than 30%, symptoms were mild (mean IPSS, 2.8 +/- 2.1; P = .04),. no erectile dysfunction was observed, and QoL,improved significantly (mean , 0.4 +/- 0.5; P = .001) using the paired t test. Conclusions: Patients with severe symptoms and acute urinary retention caused by BPH can be treated Safely by PAE, which improves clinical symptoms and QoL.
- 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.
- Clinical, Laboratorial, and Urodynamic Findings of Prostatic Artery Embolization for the Treatment of Urinary Retention Related to Benign Prostatic Hyperplasia. A Prospective Single-Center Pilot Study(2013) ANTUNES, Alberto A.; CARNEVALE, Francisco C.; LEAL FILHO, Joaquim M. da Motta; YOSHINAGA, Eduardo M.; CERRI, Luciana M. O.; BARONI, Ronaldo H.; MARCELINO, Antonio S. Z.; CERRI, Giovanni G.; SROUGI, MiguelThis study was designed to describe the clinical, laboratorial, and urodynamic findings of prostatic artery embolization (PAE) in patients with urinary retention due to benign prostatic hyperplasia (BPH). A prospective study of 11 patients with urinary retention due to BPH was conducted. Patients underwent physical examination, prostate specific antigen (PSA) measurement, transrectal ultrasound, and magnetic resonance imaging. International prostate symptom score (IPSS), quality of life (QoL), and urodynamic testing were used to assess the outcome before and after 1 year. Clinical success was 91 % (10/11 patients) with a mean follow-up of 22.3 months (range, 12-41 months). At the first year follow-up, the mean IPSS score was 2.8 points (p = 0.04), mean QoL was 0.4 points (p = 0.001), mean PSA decreased from 10.1 to 4.3 ng/mL (p = 0.003), maximum urinary flow (Qmax) improved from 4.2 to 10.8 mL/sec (p = 0.009), and detrusor pressure (Pdet) decreased from 85.7 to 51.5 cm H2O (p = 0.007). Before PAE, Bladder Outlet Obstruction Index (BOOI) showed values > 40 in 100 % of patients. After PAE, 30 % of patients were > 40 (obstructed), 40 % were between 20 and 40 (undetermined), and 30 % were < 20 (unobstructed). Patients with a BOOI < 20 had higher PSA values at 1-day after PAE. Clinical and urodynamic parameters improved significantly after PAE in patients with acute urinary retention due to BPH. Total PSA at day 1 after PAE was higher in patients with unobstructed values in pressure flow studies.
- The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia(2013) CAMARA-LOPES, George; MATTEDI, Romulo; ANTUNES, Alberto A.; CARNEVALE, Francisco C.; CERRI, Giovanni G.; SROUGI, Miguel; ALVES, Venancio A.; LEITE, Katia R. M.Objective: Prostatic artery embolization (PAE) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH) is believed to be a safe procedure with a low risk of adverse side effects. Artery embolization is a viable treatment option in patients who are refractory to the classic noninvasive treatments. Knowledge of the histological characteristics of prostate tissue following the procedure is still limited. In this study, we describe the microscopic aspects of the prostate following PAE for BPH. Materials and Methods: Two patients underwent transurethral resections of the prostate (TURP) after PAE. Embolizations were performed under local anesthesia with an initial pelvic angiography to evaluate the iliac vessels and the prostate arteries using a 2.8 French microcatheter. The prostate was embolized with 300-500 mu m Microspheres (Embosphere (R)), using complete blood stasis as the end point. The prostate tissues were analyzed histologically to characterize the effects of the embolization. Results: The embolic material within the prostate tissue was easily identified as homogeneous, bright eosin-red spheroids filling the vessel lumens. Ischemic necrosis surrounded or not by chronic inflammatory reactions containing macrophages were considered as a result of the artery embolization. Also, some aspects related to the healing process were observed being fibrotic nodules surrounded by glands with squamous metaplasia of the epithelial lining the most important. In the remaining sections, due to the precocious surgical intervention, the classic findings of BPH were still present with the glandular and stromal hyperplasia associated with nonspecific chronic prostatitis. Conclusions: This is the first description of prostate histology in BPH patients treated by PAE, a new procedure that is being used increasingly as a therapeutic intervention. The recognition of the changes caused by this new modality of treatment has become a very important differential in a chronic granulomatous reaction of the prostate tissue.