PAULO AFONSO DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, 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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- Robotic-assisted radical cystectomy: the first multicentric Brazilian experience(2020) MOSCHOVAS, Marcio Covas; CHADE, Daher Cesar; ARAP, Marco Antonio; SARKIS, Alvaro Sadek; NAHAS, William Carlos; TANURE, Luiz Henrique Rodrigues; EBAID, Gustavo; FAZOLI, Arnaldo Jose de Carvalho; GUGLIELMETTI, Giuliano Betoni; BISTACCO, Carolina; CORDEIRO, Mauricio; AFONSO, Paulo; SIGHINOLFI, Maria Chiara; ROCCO, Bernardo; COELHO, Rafael FerreiraThe objective of this study is to report the first multicentric Brazilian series and learning curve of robotic radical cystectomy (RARC) with related intra- and postoperative outcomes. We retrospectively analyzed 37 RARC prospectively collected at four different centers in Brazil, from 2013 to 2019. We analyzed the patient's demographics, pathological tumor, and nodal status, as well as intra- and postoperative outcomes. Statistical analysis was performed with the IBM (SPSS version 25) software. Overall, 86% were male, and the median age was 69 years. 83% had muscle-invasive bladder cancer, and 17% a high-grade, recurrent non-muscle-invasive tumor. The median operative time was 420 min with 300 min as console time. Median blood loss was 350 ml and transfusion rate was 10%. In 68% of the cases, we performed an intracorporeal Bricker urinary diversion, 24% intracorporeal neobladder, and 8% ureterostomy. Six patients (16%) had a Clavien 1-2, 8% had Clavien 3, 2.5% had a Clavien 4, and 5% had Clavien 5. The median length of hospital stay was 7 days. The final pathological exam pointed out pT0 in 16%, pT1 in 8%, pT2 in 32%, >= pT3 in 27%, and 16% pTis. 95% had negative surgical margins. The survival at 30, 90, and 180 days was 98%, 95%, and 95%, respectively. To our knowledge, this is the first multicentric series of RARC reporting the learning curve in Brazil; even if still representing a challenging procedure, RARC could be safely and effectively faced by experienced surgeons at centers with high volumes of robotic surgery.
conferenceObject NEPHROMETRY SCORES ARE USELESS FOR EXPERIENCED UROLOGISTS IN CLINICAL PRACTICE(2017) NONEMACHER, Henrique; GUGLIELMETTI, Giuliano; ALBUQUERQUE, George Lins de; COELHO, Rafael; CORDEIRO, Mauricio; FAZOLI, Arnaldo; CARVALHO, Paulo Afonso; FREIRE, Tiago Magalhaes; HAYEK, Kayann Kaled R. el; PAGOTTO, Vitor; ALBUQUERQUE, George Lins de; ROCHA, Bruno Aragao; RODRIGUES, Diego Parga; KANAS, Alexandre Fligelman; VIANA, Publio Cesar Cavalcanti; NAHAS, WillianconferenceObject RENAL CELL CARCINOMA WITH PERIRENAL FAT INVASION: IS PARTIAL NEPHRECTOMY AS GOOD AS RADICAL SURGERY?(2017) GALLUCCI, Fabio; CORDEIRO, Mauricio; BARBOSA, Joao; CARVALHO, Paulo Afonso; NONEMACHER, Henrique; ILARIO, Eder; FAZOLI, Arnaldo; ABE, Daniel; CASSAO, Valter; MATTEDI, Romulo; NAHAS, William- Low serum testosterone is a predictor of high-grade disease in patients with prostate cancer(2017) ALBUQUERQUE, George A. M. Lins de; GUGLIELMETTI, Giuliano B.; BARBOSA, João Arthur B. A.; PONTES JR., José; FAZOLI, Arnaldo J. C.; CORDEIRO, Maurício D.; COELHO, Rafael F.; CARVALHO, Paulo Afonso de; GALLUCCI, Fábio P.; PADOVANI, Guilherme P.; PARK, Rubens; CURY, José; NONEMACHER, Henrique; SROUGI, Miguel; NAHAS, William C.Summary Objective: To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association. Method: We analyzed 695 patients undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors. Results: Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02). Conclusion: Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.