ALEXANDRE ISCAIFE
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
9 resultados
Resultados de Busca
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bookPart Retenção urinária aguda(2019) ISCAIFE, Alexandre; ANTUNES, Alberto Azoubel- Holmium Laser Enucleation of the Prostate Simulation: Analysis of Realism and Level of Difficulty by Holmium Laser Enucleation of the Prostate-naive Urologists(2019) ANTUNES, Alberto A.; ISCAIFE, Alexandre; BARBOSA, Joao Arthur B. A.; ANJOS, Gabriel dos; NAHAS, William C.; SROUGI, MiguelOBJECTIVE To evaluate the opinion of Holmium laser enucleation of the prostate (HoLEP)-naive urologists about a surgical simulator and the level of difficulty at each step. MATERIALS AND METHODS We evaluated 40 HoLEP-naive urologists in a course involving 4 steps: lecture introducing Holmium laser basics and technique; live surgery; video explaining prostate enucleation using simulators; and simulator trial. A survey was applied to evaluate content validity and face validity of the simulator. Subjects also ranked the level of difficulty of each surgical step. RESULTS All urologists agreed on the importance of a validated HoLEP simulator in training; 95% agreed that simulation-based training is essential for patient safety. The mean rate of face validity of all analyzed components was 8.4 (8.1-9.0). Instrumentation was considered the most realistic component, followed by laser-tissue interaction. Positioning the fiber and bladder neck incisions (BNIs) at 5 and 7-o'clock were the easiest steps. Detaching the median lobe from the bladder neck, BNI at 12, dividing the mucosal bridge distally, and joining the upper and lower incisions were the most difficult steps. Residents found more difficulty in joining the BNIs distally (3.6 vs 2.4, P = .006) and in dividing the mucosal bridge distally (4.0 vs 3.0, P = .038) when compared to specialists. CONCLUSIONS HoLEP-naive urologists found this simulator useful and important for patient safety. Most components were considered realistic. Simulation was able to reproduce the levels of difficulty usually found in real life cases. The level of expertise may influence the learning process of some steps. (C) 2019 Elsevier Inc.
conferenceObject CAN WE PREDICT WHICH PATIENTS WILL PRESENT RESOLUTION OF DETRUSOROVERACTIVITY (DO) AFTER TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)?(2015) ISCAIFE, Alexandre; REIS, Sabrina T.; ALBERTINI, Aline; NUNES, Marco A.; LUCON, Antonio M.; NAHAS, Willian C.; SROUGI, Miguel; ANTUNES, Alberto A.- Loss of TIMP-1 immune expression and tumor recurrence in localized prostate cancer(2015) REIS, Sabrina Thalita dos; VIANA, Nayara Izabel; ISCAIFE, Alexandre; PONTES-JUNIOR, Jose; DIP, Nelson; ANTUNES, Alberto Azoubel; GUIMARAES, Vanessa Ribeiro; SANTANA, Isaque; NAHAS, William Carlos; SROUGI, Miguel; LEITE, Katia Ramos MoreiraIntroduction and objective: Overexpression of MMPs has been related to biochemical recurrence after radical prostatectomy. TIMP1 and TIMP2 are controllers of MMPs and the aim of this study is to evaluate the expression levels of MMPs and their regulators using immunohistochemistry in tissue microarray of localized prostate cancer (PC). Materials and Methods: Immune-expression of MMP-9, MMP-2, TIMP1, TIMP-2, MMP-14 and IL8, were analyzed by immunohistochemistry in radical prostatectomy specimens of 40 patients with localized PC who underwent surgery between September 1997 and February 2000. Protein expression was considered as categorical variables, negative or positive. The results of the immune-expression were correlated to Gleason score (GS), pathological stage (TNM), pre-operatory PSA serum levels and biochemical recurrence in a mean follow up period of 92.5 months. Results: The loss of TIMP1 immune-expression was related to biochemical recurrence. When TIMP1 was negative, 56.3% patients recurred versus 22.2% of those whose TIMP1 was positive (p=0.042). MMP-9, MMP-2, IL8 and MMP-14 were positive in the majority of PC. TIMP-2 was negative in all cases. Conclusion: Negative immune-expression of TIMP1 is correlated with biochemical recurrence in patients with PC possibly by failing to control MMP-9, an important MMP related to cancer progression.
- Role of Genetic Polymorphisms in the Development and Prognosis of Sporadic and Familial Prostate Cancer(2016) REIS, Sabrina T.; VIANA, Nayara I.; LEITE, Katia R. M.; DIOGENES, Erico; ANTUNES, Alberto A.; ISCAIFE, Alexandre; NESRALLAH, Adriano J.; PASSEROTTI, Carlo C.; SROUGI, Victor; PONTES-JUNIOR, Jose; SALLES, Mary Ellen; NAHAS, William C.; SROUGI, MiguelBackgrounds Our aim was to evaluate the role of 20 genetic polymorphisms in the development and prognosis of sporadic and familial PC. A case-control study of 185 patients who underwent radical prostatectomy from 1997 to 2011. These patients were divided into two groups based on their family history. Gleason grade, PSA value and pathological TNM 2002 stage were used as prognostic factors. Blood samples from 70 men without PC were used as controls. The SNPs were genotyped using a TaqMan SNP Genotyping Assay Kit. Results Considering susceptibility, the polymorphic allele in the SNP rs2660753 on chromosome 3 was significantly more prevalent in controls (p = 0.01). For familial clustering, the polymorphic homozygote genotype of the SNP rs7931342 was five times more frequent in patients with familial PC compared to sporadic PC (p = 0.01). Regarding the SNP 1447295, the polymorphic homozygote genotype was more prevalent in patients with organ-confined PC (p = 0.05), and most importantly, the polymorphic allele occurred more frequently in patients without biochemical recurrence (p = 0.01). Kaplan-Meier analysis showed a median biochemical recurrence free survival of 124.2 compared to 85.6 months for patients with the wild-type allele (p = 0.007). Conclusion Our findings provide the evidence for the association of 20 recently highlighted SNPs and their susceptibility, familial clustering, staging, Gleason score and biochemical recurrence of PC. We believe that the association between these SNPs and PC may contribute to the development of alternative tools that can facilitate the early detection and prognosis of this disease.
- Is prostate infarction and acute urinary retention a possible complication of severe COVID-19 infection?(2020) DUARTE, Sergio A. C.; PEREIRA, Jessica G.; ISCAIFE, Alexandre; LEITE, Katia R. M.; ANTUNES, Alberto A.
- The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery(2018) ISCAIFE, Alexandre; ARFOS, Gabriel dos; NETO, Cristovao Barbosa; NAHAS, Willian Carlos; SROUGI, Miguel; ANTUNES, Alberto AzoubelIntroduction: The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It's role in acute urinary retention (AUR) is not totally understood. Objectives: To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery. Subjects and Methods: We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis. Results: There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD > 5.0 cm vs. <= 5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012). Conclusions: The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR.
- Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis(2016) CARNEVALE, Francisco C.; ISCAIFE, Alexandre; YOSHINAGA, Eduardo M.; MOREIRA, Airton Mota; ANTUNES, Alberto A.; SROUGI, MiguelTo compare clinical and urodynamic results of transurethral resection of the prostate (TURP) to original and PErFecTED prostate artery embolization (PAE) methods for benign prostatic hyperplasia. We prospectively randomized 30 patients to receive TURP or original PAE (oPAE) and compared them to a cohort of patients treated by PErFecTED PAE, with a minimum of 1-year follow-up. Patients were assessed for urodynamic parameters, prostate volume, international prostate symptom score (IPSS), and quality of life (QoL). All groups were comparable for all pre-treatment parameters except bladder contractility and peak urine flow rate (Q (max)), both of which were significantly better in the TURP group, and IIEF score, which was significantly higher among PErFecTED PAE patients than TURP patients. All groups experienced significant improvement in IPSS, QoL, prostate volume, and Q (max). TURP and PErFecTED PAE both resulted in significantly lower IPSS than oPAE but were not significantly different from one another. TURP resulted in significantly higher Q (max) and significantly smaller prostate volume than either original or PErFecTED PAE but required spinal anesthesia and hospitalization. Two patients in the oPAE group with hypocontractile bladders experienced recurrence of symptoms and were treated with TURP. In the TURP group, urinary incontinence occurred in 4/15 patients (26.7 %), rupture of the prostatic capsule in 1/15 (6.7 %), retrograde ejaculation in all patients (100 %), and one patient was readmitted for temporary bladder irrigation due to hematuria. TURP and PAE are both safe and effective treatments. TURP and PErFecTED PAE yield similar symptom improvement, but TURP is associated with both better urodynamic results and more adverse events.
- Can We Predict Which Patients will Experience Resolution of Detrusor Overactivity after Transurethral Resection of the Prostate?(2015) ANTUNES, Alberto Azoubel; ISCAIFE, Alexandre; REIS, Sabrina Thalita; ALBERTINI, Aline; NUNES, Marco Antonio; LUCON, Antonio Marmo; NAHAS, William Carlos; SROUGI, MiguelPurpose: We determined which clinical and urodynamic variables may be related to persistent detrusor overactivity after transurethral resection of the prostate. Materials and Methods: We studied 46 patients with bladder outlet obstruction due to benign prostatic hyperplasia who were treated with transurethral prostate resection from 2011 to 2012. All patients underwent urodynamic analysis preoperatively and 12 months postoperatively. Clinical and urodynamic variables in the preoperative period were correlated with the resolution of detrusor overactivity postoperatively. Results: Patients with detrusor overactivity in the preoperative period were older (65.2 vs 61.1 years, p = 0.041) and had a higher I-PSS (International Prostate Symptom Score) (25.2 vs 19, p = 0.014) and higher maximum flow rate (8.6 vs 6.6 ml per second, p = 0.039). Patients with persistent detrusor overactivity were statistically older than those with resolution (69 vs 63 years, p = 0.043). Detrusor overactivity persisted in 63.6% of patients with maximum cystometric capacity less than 250 ml compared to 20% of those with greater than 250 ml (p = 0.024). When analyzing urodynamic variables together, we found a 66.7% chance of persistent detrusor overactivity in patients with maximum cystometric capacity less than 250 ml and detrusor overactivity amplitude greater than 40 cm H2O (p = 0.041). When these characteristics were associated with early detrusor overactivity, the chance of persistent detrusor overactivity was 83.3% (p = 0.013). Conclusions: Advanced patient age together with low maximum cystometric capacity, and early and high detrusor overactivity amplitude are the most important predictors of persistent detrusor overactivity after relief of bladder outlet obstruction.