VICTOR SROUGI
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
12 resultados
Resultados de Busca
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- Surgical method influences specimen margins and biochemical recurrence during radical prostatectomy for high-risk prostate cancer: a systematic review and meta-analysis(2017) SROUGI, Victor; BESSA JR., Jose; BAGHDADI, Mohammed; NUNES-SILVA, Igor; COSTA, Jose Batista da; GARCIA-BARRERAS, Silvia; BARRET, Eric; ROZET, Francois; GALIANO, Marc; SANCHEZ-SALAS, Rafael; CATHELINEAU, XavierPurpose To perform a meta-analysis comparing the rates of positive surgical margins (PSM) and biochemical recurrence (BCR) between open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) in patients with high-risk prostate cancer. Methods A systematic review was performed on Pubmed, Embase and Scopus databases in August 2016, according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. References retrieved were evaluated using the Newcastle-Ottawa scale and the Black and Down's tool for quality assessment. Results Nine retrospective cohorts comparing ORP and RARP were selected and included in the meta-analysis. All studies reported the PSMs. Patients treated with RARP presented less risk of PSMs (risk difference -0.04, p 0.02) than those treated with ORP. Five articles reported hazard ratios for BCR-free survival. Patients treated with RARP had less risk of BCR (HR 0.72, 95% CI 0.58-0.89) than those treated with ORP. Reports for PSM assessment were considered of adequate quality, while the studies retrieved for BCR assessment were considered limited because of the heterogeneity of their results. Conclusion Patients with high-risk prostate cancer treated with RARP have less risk of having PSM and BCR when compared to those treated with ORP. A strong conclusion is precluded due to the observational nature of the studies retrieved for our analysis.
- Urethral duplication type influences on the complications rate and number of surgical procedures(2017) LOPES, Roberto Iglesias; GIRON, Amilcar Martins; MELLO, Marcos Figueiredo; BARBOSA NETO, Cristovao Machado; SANTOS, Joana dos; MOSCARDI, Paulo Renato Marcelo; SROUGI, Victor; DENES, Francisco Tibor; SROUGI, MiguelIntroduction: Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies. Material and Methods: We report thirteen boys with urethral duplication managed in our institution between 1988-02015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification. Results: Mean patient's age was 38.3 +/- 34.7 months (3-0136 months). Mean follow-up was 7.7 +/- 3.4 years (3y8m-014y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%). Required surgeries were 3.53 +/- 2.84 procedures per patient. Considering groups: Type IIA2 4.25 +/- 3.28, type IIA1 4 +/- 1.41 and type IA 1.33 +/- 0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2. Conclusions: Patients with incomplete duplication (type I A or I B) can totally be asymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individualized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.
- The role of urinary KIM-1, NGAL, CA19-9 and beta 2-microglobulin in the assessment of ureteropelvic junction obstruction in adults(2017) MIRANDA, Eduardo P.; DUARTE, Ricardo J.; BESSA JR., Jose de; LOPES, Roberto I.; SROUGI, Victor; ANDRADE, Hiury S.; BANDEIRA, Rodolfo A. S. T.; ARAP, Marco A.; MITRE, Anuar I.; VIANA, Nayara I.; REIS, Sabrina T.; LEITE, Katia R. M.; SROUGI, MiguelPurpose: The objective of this study is to evaluate the diagnostic properties of urinary biomarkers in adults with ureteropelvic junction obstruction: KIM-1, NGAL, CA19-9, and beta 2-microglobulin. We also assessed urinary biomarker concentrations following pyeloplasty. Material and methods: We prospectively studied adults from December 2013 to February 2015. We included 47 patients with a mean age of 38.6 +/- 12.7 years. Each patient provided four samples of voided urine for biomarker measurement, one at pre-operative consultation and the others at 1, 3, and 6 months of post-operative follow-up. The control group consisted of 40 healthy individuals with no hydronephrosis on ultrasound evaluation. Results: KIM-1 had an area under the curve of 0.79 (95% CI 0.70-0.89), NGAL 0.71 (95% CI 0.61-0.83), CA19-9 0.70 (95% CI 0.60-0.81), and beta 2-microgloblin 0.61 (95% CI 0.50-0.73). KIM-1 was the most sensitive marker with a cut-off of 170.4 pg/mg creatinine (sensitivity 91.4%, specificity 59.1%), whereas CA19-9 was the most specific with a cut-off of 51.3 U/mg creatinine (sensitivity 48.9%, specificity 88.0%). Urinary concentrations of biomarkers decreased after pyeloplasty. Conclusions: The evaluation of urinary biomarkers is useful in adults undergoing pyeloplasty. KIM-1, NGAL, and CA19-9 were elevated and significantly decreased after surgery.
conferenceObject A NEW INSIGHT FOR THE TREATMENT OF PRIMARY MACRONODULAR ADRENAL HYPERPLASIA: ADRENAL SPARING SURGERY EARLY OUTCOMES(2017) TANNO, Fabio; SROUGI, Victor; BRONDANI, Vania; ALMEIDA, Madson; MENDONCA, Berenice; SROUGI, Miguel; CHAMBO, Jose; FRAGOSO, Maria- Step-by-step Laparoscopic Vesiculectomy for Hemospermia(2017) MELLO, Marcos Figueiredo; ANDRADE, Hiury Silva; SROUGI, Victor; ARAP, Marco Antonio; MITRE, Anuar Ibrahim; DUARTE, Ricardo Jordao; SROUGI, MiguelHemospermia has been considered as a benign and self-limiting condition. It usually has an inflammatory or infectious cause. However, recurrent or persistent hemospermia may indicate a more serious underlying pathology, especially over 40 years of age. Biopsy or surgical excision is indicated in cases of suspicious findings during investigation, such as cysts or masses. Open surgery has been considered the definitive form of treatment, however, it can be associated with significant morbidity. With growing experience in laparoscopics, this approach is becoming the preferable way to access the seminal vesicles. Our objective is to demonstrate a step-by-step operative technique for laparoscopic unilateral vesiculectomy approach in a man with hemospermia. Case: A 61 year-old man presented with 1 year of hemospermia. He was treated empirically with a fluoroquinolone plus a nonsteroidal anti-inflammatory without resolution of symptoms. Ultrasonography and MRI showed a solid-cystic mass in the right seminal vesicle. The patient was submitted to a laparoscopic unilateral vesiculectomy. Histopathological analysis showed intraluminal dilatation with blood content. During follow-up, complete resolution of symptoms was seen. Results: Three patients composed our cohort. Mean age was 53 years-old (range 45-61 years), the right side was more commonly affected (two unilateral on the right and bilateral). Mean operative time was 55 minutes (range 40-120min). One patient presented amyloidosis in the histopathological analysis. All cases presented complete resolution of symptoms. Conclusions: Laparoscopic vesiculectomy is a safe and feasible approach in cases of hemospermia. This technique showed good outcomes and minimal morbidity.
- Focal brachytherapy for localized prostate cancer: Urinary toxicity depends on tumor location(2017) SROUGI, Victor; BARRET, Eric; NUNES-SILVA, Igor; BAGHDADI, Mohammed; GARCIA-BARRERAS, Silvia; PIERRAT, Noelle; ROZET, Francois; GALIANO, Marc; SANCHEZ-SALAS, Rafael; CATHELINEAU, Xavier; COSSET, Jean-MarcPURPOSE: To evaluate whether patients with prostate cancer have worse functional urinary recovery with focal brachytherapy (FBT) at the base versus the apex of the prostate. METHODS AND MATERIALS: The functional outcomes of patients treated with FBT at the base of the prostate were compared with those of patients treated with FBT at the apex. Urinary symptoms, continence, and erectile dysfunction were measured using the International Prostate Symptom Score (IPSS), International Continence Score (ICS), and International Index of Erectile Function (IIEF-5) questionnaires, respectively, at baseline and at 6, 12, and 24 months after treatment. RESULTS: Twenty-eight and 13 patients were treated with FBT at the apex and the base, respectively, of the prostate. A significant difference between groups was found in the IPSS score at 6 months (mean IPSS: apex 6.4 +/- 4.7, base 10.6 +/- 5.7; p = 0.02), but not at baseline or at 12 and 24 months after treatment. On multivariate analysis, only FBT at the base of the prostate remained an independent predictor of worsening urinary symptoms (odds ratio, 5.8; p = 0.04). CONCLUSIONS: At 6 months after FBT, significantly less urinary toxicity was found in patients who underwent FBT at the apex versus the base of the prostate. Continence and sexual side effects were minimal in all patients.
- Re: Robot-assisted Laparoscopic Prostatectomy Versus Open Radical Retropubic Prostatectomy: Early Outcomes from a Randomised Controlled Phase 3 Study(2017) SROUGI, Victor; SANCHEZ-SALAS, Rafael
- Effect of Prior Focal Therapy on Perioperative, Oncologic and Functional Outcomes of Salvage Robotic Assisted Radical Prostatectomy(2017) NUNES-SILVA, Igor; BARRET, Eric; SROUGI, Victor; BAGHDADI, Mohammed; CAPOGROSSO, Paolo; GARCIA-BARRERAS, Silvia; KANSO, Solange; TOURINHO-BARBOSA, Rafael; CARNEIRO, Arie; SANCHEZ-SALAS, Rafael; ROZET, Francois; GALIANO, Marc; CATHELINEAU, XavierPurpose: We assessed the impact of focal therapy on perioperative, oncologic and functional outcomes in men who underwent salvage robotic assisted radical prostatectomy compared to primary robotic assisted radical prostatectomy. Materials and Methods: Focal therapy was performed in patients presenting with Gleason score 3 + 3 or 3 + 4, clinical stage cT2a or less, serum prostate specific antigen 15 ng/ml or less, unilateral positive biopsy, maximum length of any positive core less than 10 mm and life expectancy greater than 10 years. Focal therapy was defined as target ablation of the index lesion plus a 1 cm safety margin in the normal ipsilateral prostatic parenchyma. The salvage group included 22 men who underwent salvage prostatectomy after focal therapy failure. The primary group was defined using matched pair 1:2 selection of 44 of 2,750 patients treated with primary prostatectomy. The primary and secondary end points were the between group differences in functional and oncologic outcomes, respectively. Results: Complication rates were comparable (p > 0.05). Pad-free probability was comparable between the groups at 1 and 2 years (p = 0.8). Recovery of erectile function was significantly lower after salvage robotic assisted radical prostatectomy (p = 0.008), which also showed a significantly lower probability of cumulative biochemical recurrence-free survival compared to primary robotic assisted radical prostatectomy (56.3% vs 92.4% at 2 years, p = 0.001). Salvage prostatectomy demonstrated a significantly increased risk of biochemical recurrence (HR 4.8, 95% CI 1.67-13.76, p = 0.004). Study limitations included the retrospective nature, the lack of randomization and the short followup. Conclusions: Salvage robotic assisted radical prostatectomy after focal therapy failure is feasible with acceptable complication rates. However, patients assigned to primary focal therapy should be advised about a poorer prognosis in terms of oncologic control and lower erectile recovery rates in case of a future salvage surgery.
- Adjuvant radiotherapy for the primary treatment of adrenocortical carcinoma: are we offering the best?(2017) SROUGI, Victor; BESSA JUNIOR, Jose; TANNO, Fabio Y.; FERREIRA, Amanda M.; HOFF, Ana O.; BEZERRA, Joao E.; ALMEIDA, Cristiane M.; ALMEIDA, Madson Q.; MENDONCA, Berenice B.; NAHAS, William C.; CHAMBO, Jose L.; SROUGI, Miguel; FRAGOSO, Maria C. B. V.Purpose: To evaluate the role of ARDT after surgical resection of ACC. Materials and Methods: Records of patients from our institutional ACC database were retrospectively assessed. A paired comparison analysis was used to evaluate the oncological outcomes between patients treated with surgery followed by ARDT or surgery only (control). The endpoints were LRFS, RFS, and OS. A systematic review of the literature and metaanalysis was also performed to evaluate local recurrence of ACC when ARDT was used. Results: Ten patients were included in each Group. The median follow-up times were 32 months and 35 months for the ARDT and control Groups, respectively. The results for LRFS (p= 0.11), RFS (p= 0.92), and OS (p= 0.47) were similar among subsets. The mean time to present with local recurrence was significantly longer in the ARDT group compared with the control Group (419 +/- 206 days vs. 181 +/- 86 days, respectively; p= 0.03). ARDT was well tolerated by the patients; there were no reports of late toxicity. The meta-analysis, which included four retrospective series, revealed that ARDT had a protective effect on LRFS (HR= 0.4; CI= 0.17-0.94). Conclusions: ARDT may reduce the chance and prolong the time to ACC local recurrence. However, there were no benefits for disease recurrence control or overall survival for patients who underwent this complementary therapy.
- Getting ready for the first robotic prostatectomy, from basics to real practice(2017) WAGNER, Christian; SROUGI, Victor; SANCHEZ-SALAS, RafaelPurpose of review Robot-assisted radical prostatectomy (RARP) has been embraced by urologists and has become a treatment standard in many countries already. Learning how to perform a RARP is challenging and has not yet been standardized. The current review summarizes the latest concepts regarding the most effective way of training for RARP. Recent findings The strategy to learn RARP should comprise didactic activities, skills lab training, participating in surgeries and mentorship. Skills lab and virtual simulators are valuable tools to develop manual abilities and to overcome the initial technical learning curve. Participating in surgeries is crucial for familiarization with the robot installation, steps of the surgical procedure and is essential for troubleshooting. Mentorship improves learning and is the safest way to initiate real practice. Innate and individual background variances were suggested to influence the learning process; however, there is paucity of robust evidence correlating previous surgical experience and, for example videogame playing with faster learning of RARP. Structured curricula were proposed to orient the training for robotic surgery; currently, only one is focused exclusively on urology. Summary Systematic training is the most effective way to learn and surpass the possibly intense learning curve of RARP. Training activities should focus on developing cognitive and manual abilities. The existing curricula for robotic surgery training still require constant refinement; however, they offer good and structured guidance to train for RARP.