RICARDO JORDAO DUARTE
Projetos de Pesquisa
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Pyeloplasty in Adults With Ureteropelvic Junction Obstruction in Poorly Functioning Kidneys: A Systematic Review(2021) FREITAS, Pedro. F. S.; BARBOSA, Joao. A. B. A.; ANDRADE, Hiury S.; ARAP, Marco A.; MITRE, Anuar I.; NAHAS, William C.; SROUGI, Miguel; DUARTE, Ricardo J.; SROUGI, VictorOBJECTIVES To systematically summarize the available evidence concerning the impact of pyeloplasty on symptoms and differential renal function (DRF) in adults with unilateral UPJO in poorly functioning kidneys (PFK), and to identify potential predictors of kidney function recovery that could help clinicians select candidates for pyeloplasty. METHODS A literature search (MEDLINE, Embase, Google Scholar, Scopus, ClinicalTrials.gov, and the WHO Clinical Trials Registry) and systematic review were performed up to September 2020 according to the PRISMA guidelines. PFK were defined as a baseline DRF =30% on renal scintigraphy. The primary endpoints were symptom relief and postoperative scintigraphic DRF. Predictors of kidney function recovery were evaluated and compared among studies. RESULTS Nine studies comprising 731 patients met the inclusion criteria and were included for evidence synthesis. A DRF increase >5% occurred in 13.3%-53.8% of 160 patients with a pre- and postoperative renal scan. Symptoms improved in 73.3%-93.3% of 141 adults after pyeloplasty. Neither patient's age, baseline DFR, comorbidities, degree of hydronephrosis, kidney parenchymal thickness, nor kidney biopsy findings consistently predicted a significant DRF increase among 375 patients undergoing pyeloplasty. CONCLUSION Based on a low level of evidence, pyeloplasty may relieve symptoms and stabilize kidney function in adults with UPJO in PFK. A significant number of patients showed a DRF increase >5%, yet no consistent predictor of kidney function recovery was identified. Until more evidence becomes available, pyeloplasty could be considered for selected cases after accounting for the risks of a failure requiring a future nephrectomy. (C) 2021 Elsevier Inc.
- Laparoscopic pyeloplasty as an alternative to nephrectomy in adults with poorly functioning kidneys due to ureteropelvic junction obstruction(2021) NASCIMENTO, Bruno; ANDRADE, Hiury S.; MIRANDA, Eduardo P.; BARBOSA, Joao Arthur Brunhara Alves; MOSCARDI, Paulo R.; ARAP, Marco A.; I, Anuar Mitre; SROUGI, Miguel; SROUGI, Victor; DUARTE, Ricardo J.Objectives To evaluate outcomes of laparoscopic pyeloplasty (LP) in adults with poorly functioning kidney due to ureteropelvic junction obstruction (UPJO). Methods A retrospective comparative analysis was performed between adult patients who underwent LP due to UPJO with differential renal function (DRF) <= 15% and DRF > 15%. LP success rate and complications were assessed. LP success was defined as symptoms improvement and DRF improvement or stabilization. DRF and estimated glomerular filtration rate (eGFR) were analyzed before and 12 months after surgery to evaluate renal function recovery. DRF was estimated using Tc-99 m DMSA renal scintigraphy. Results Among 121 LP performed in the study period at our institution, 15 and 42 were included in the DRF <= 15% and DRF > 15% groups, respectively. At a median follow-up of 17.8 months, all patients with DRF <= 15% reported symptoms improvement. LP success rate was 86.7% and 90.5% (p = 0.65) for patients with DRF <= 15% and DRF > 15%, respectively. There were no complications in the DRF <= 15% group, while there were three complications recorded in the DRF > 15% group (Clavien 2 and 3b). In the DRF <= 15% group, mean pre-operative and post-operative DRF was 9.5% +/- 3.6 and 10.5% +/- 7.8 (p = 0.49), respectively. Median pre-operative and post-operative eGFR was 68.5 ml/min and 79.8 ml/min (p = 0.93), respectively. Two patients had DRF improvement after LP. Conclusions LP in adult patients with UPJO and poor function kidneys is an effective and safe procedure. DRF recovery is seen in a minority of the patients; however, LP is an alternative to nephrectomy.
- Short-term outcomes of pyeloplasty vs. nephrectomy in adult patients with ureteropelvic junction obstruction and differential renal function <= 15%(2021) FREITAS, Pedro F. S.; BARBOSA, Joao A. B. A.; CHO, David H.; BOFFA, Ana B. M.; ANDRADE, Hiury S.; ARAP, Marco A.; DUARTE, Ricardo J.; NAHAS, William C.; SROUGI, Miguel; SROUGI, VictorObjectives To compare symptom resolution and short-term renal function after pyeloplasty or nephrectomy in adults with ureteropelvic junction obstruction (UPJO) in poorly functioning renal units (PFRU). Methods Retrospective analysis of adult patients with UPJO and differential renal function (DRF) <= 15% who underwent laparoscopic pyeloplasty or nephrectomy. Primary endpoints included symptom resolution and estimated glomerular filtration rate (eGFR) at 12 months. Surgical complications were compared between groups. A secondary analysis was performed comparing baseline and postoperative DRF to evaluate the PFRU recovery potential after pyeloplasty. Results Sixty-three patients were included; 19 underwent pyeloplasty and 44 underwent nephrectomy. The mean age of the cohort was 39.5 +/- 13.8 years. Nephrectomy was associated with significantly higher intra-operative blood loss (p = 0.02). Operative time and length of hospital stay were not significantly different between groups. There were three complications in the nephrectomy group, and none in the pyeloplasty group (p = 0.34). Symptom resolution rates were equivalent between groups (73% vs. 76%; p = 0.78). The eGFR variation was not statistically different after pyeloplasty or nephrectomy (+6.2 vs. +0.1 mL/min/1.73m(2), respectively; p = 0.18). Patients undergoing pyeloplasty had no significant change in the mean DRF (baseline 9.5 vs. 10%; p = 0.99). Conclusion Pyeloplasty can be considered for selected patients with UPJO in PFRU as an organ-sparing alternative to nephrectomy. Although there was no significant gain in mean DRF, pyeloplasty prevented further functional loss and relieved symptoms in most cases in the short-term with at least the same complication rates of nephrectomy.
- Mobilization of a peritoneal dialysis catheter using an extra-corporeal magnet: preliminary experimental phase study(2021) SROUGI, Victor; FONSECA, Limirio M.; ZAMPOLLI, Luca J.; BOFFA, Ana Beatriz Madeira; ANDRADE, Hiury S.; ARAP, Marco A.; DUARTE, Ricardo J.; NAHAS, William C.; SROUGI, MiguelPurpose To evaluate in an experimental model, the mobility of a novel peritoneal dialysis catheter with a metallic tip (Mag-Cath) using an extra-corporeal magnet. Materials and methods The Mag-Cath was installed in a porcine model under general anesthesia using laparoscopic access. A senior urologist, a urology resident, and a 3rd-year medical student were assigned to complete 2 tasks guided by fluoroscopy: (1) Move the catheter tip from the right flank to the pelvis and (2) move the catheter tip from the pelvis to the left flank. Accomplishment and time to complete the tasks were recorded. Participants were asked independently to grade the difficulty of the tasks using an analog scale from 1 (extremely easy) to 10 (extremely difficult). Results All participants completed the tasks. The difficulty of the tasks was graded equal to 1 by the senior urologist and urology resident and equal to 3 by the medical student. The time to move the Mag-Cath from the right flank to the target was 14, 10, and 55 s for the senior urologist, urology resident, and medical student, respectively. The time to move the Mag-Cath from the target to the left flank was 17, 18, and 43 s for the senior urologist, urology resident, and medical student, respectively. Conclusion In this preliminary analysis, the use of an extra-corporeal magnet to move the Mag-Cath was feasible, with a low grade of difficulty, and individuals with different levels of expertise could perform it. Further studies in human subjects are needed to evaluate the clinical applicability of the Mag-Cath properly.