MIGUEL SROUGI

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Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 3 Citação(ões) na Scopus
    Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function
    (2020) TORRICELLI, Fabio C. M.; CARVALHO, Regina S.; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; BATAGELLO, Carlos A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, Eduardo
    INTRODUCTION: Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. METHODS: Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. RESULTS: Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien <= 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). CONCLUSION: sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stonefree rate.
  • article 8 Citação(ões) na Scopus
    Internal validation and decision curve analysis of a preoperative nomogram predicting a postoperative complication in pheochromocytoma surgery: An international study
    (2020) PHILLIPS, John; BLOOM, Jonathan; YARLAGADDA, Vidhush; SCHULTZ, Luciana; GORDETSKY, Jennifer; TANNO, Fabio Y.; CHAMBO, Jose L.; ALMEIDA, Madson Q.; V, Maria C. B. Fragoso; SROUGI, Miguel; SROUGI, Victor; RAIS-BAHRAMI, Soroush
    Objectives To develop a preoperative nomogram that would predict the risk of a postoperative complication for pheochromocytoma patients undergoing adrenalectomy using an international database. Methods We retrospectively analyzed preoperative variables and postoperative outcomes in patients who underwent adrenalectomy for pheochromocytoma in three institutions from 2000 to 2017. Internal validation of a generated nomogram was carried out with receiver operating characteristics, calibration plots, and decision curve analyses. Results A total of 153 patients who had undergone 166 adrenalectomies were included in the study. Overall, post-adrenalectomy complications were seen in 30% of patients, whereas 9.6% of patients sustained a Clavien >= 3a complication. Independent predictors of a complication were a history of hypertension, body mass index, tumor size, and Charlson Comorbidity Index score. On internal validation, the multivariable model generated a nomogram that predicted a postoperative complication or clinically hemodynamic event with an area under the curve of 0.86, showed good calibration and had an overall net benefit. Conclusions An internally validated nomogram combining body mass index, Charlson Comorbidity Index score and tumor size can predict the probability of a post-adrenalectomy complication in those with and without hypertension. The model, the first of its kind in pheochromocytoma surgery, identifies patients at risk of a postoperative complication at the time of their presentation with pheochromocytoma.
  • conferenceObject
    DO THE REGULATION OF MATRIX METALLOPROTEINASES AND TISSUE INHIBITORS OF MATRIX METALLOPROTEINASES HAVE ANY ASSOCIATION WITH PEYRONIE'S DISEASE?
    (2020) NETO, Cristovao Barbosa; REIS, Sabrina T.; ARANTES, Gabriel; NASCIMENTO, Bruno; SAYAO, Rogerio; LEITE, Katia Ramos; SROUGI, Miguel; NAHAS, William; CURY, Jose
  • article 17 Citação(ões) na Scopus
    A New Insight into the Surgical Treatment of Primary Macronodular Adrenal Hyperplasia
    (2020) TANNO, Fabio Yoshiaki; SROUGI, Victor; ALMEIDA, Madson Q.; YAMAUCHI, Fernando Ide; COELHO, Fernando Morbeck Almeida; NISHI, Mirian Yumie; ZERBINI, Maria Claudia Nogueira; SOARES, Iracy Silvia Correa; PEREIRA, Maria Adelaide Albergaria; CHARCHAR, Helaine Laiz Silva; LACOMBE, Amanda Meneses Ferreira; BRONDANI, Vania Balderrama; SROUGI, Miguel; NAHAS, Willian Carlos; MENDONCA, Berenice B.; CHAMBO, Jose Luis; FRAGOSO, Maria Candida Barisson Villares
    Purpose: This prospective study presents the results of a new approach in the treatment of primary macronodular adrenal hyperplasia (PMAII), with simultaneous total adrenalectomy of the larger adrenal gland and partial adrenalectomy of the contralateral adrenal gland (adrenal-sparing surgery). Materials and Methods: We performed a prospective study including 17 patients with PMAH treated surgically with adrenal-sparing surgery in a tertiary referral hospital, with a median follow-up of 41 months. Clinical, hormonal, and genetic parameters were evaluated before surgery and during follow-up. All patients had at least 1 radiological examination before and after the procedure. Results: Among the 17 patients, all but 1 patient had complete hypercortisolism control, and 12 recovered normal adrenal function after surgery. Significant improvement in clinical parameters was observed: weight loss (P = .004); reduction of both systolic (P = .001) and diastolic (P = .001) blood pressure; and reduction in the number of antihypertensive drugs (P < .001). Intra-, peri-, and postoperative complications were not observed. Conclusion: Adrenal-sparing surgery is a safe and feasible procedure to treat patients with PMAH, providing a substantial chance of hypercortisolism control without the disadvantages of lifetime corticosteroid replacement. (C) Endocrine Society 2020.
  • article 1 Citação(ões) na Scopus
    Nomograms using a small panel of genes for predicting the diagnosis and aggressiveness of prostate cancer
    (2020) LEITE, Katia R. M.; ORTEGA, Fabio L.; DAMIANI, Lucas P.; GUIMARAES, Vanessa; VIANA, Nayara; SILVA, Iran A.; REIS, Sabrina T.; PIMENTA, Ruan; ADONIAS, Sanarelly P.; CHAMMAS, Cristina; SROUGI, Miguel; NAHAS, Willian
  • article 27 Citação(ões) na Scopus
    Bariatric Surgery Impact on Reproductive Hormones, Semen Analysis, and Sperm DNA Fragmentation in Men with Severe Obesity: Prospective Study
    (2020) WOOD, Guilherme Jacom Abdulmassih; TISEO, Bruno C.; PALUELLO, Davi V.; MARTIN, Hamilton de; SANTO, Marco Aurelio; NAHAS, William; SROUGI, Miguel; COCUZZA, Marcello
    Purpose Growing evidence in the literature suggests that obesity is capable of altering reproductive hormone levels and male fertility. Effects on classic semen parameters and sperm DNA fragmentation (SDF), however, have not been properly established. Additionally, the impact of bariatric surgery (BS) on those parameters is still controversial. Materials and Methods In Phase 1, 42 patients with obesity and 32 fertile controls were submitted to reproductive hormone evaluation, semen analysis, and SDF testing. In Phase 2, patients with obesity were submitted to BS or clinical follow-up and were invited to 6-month revaluation. Results Phase 1: Men with obesity have higher levels of estradiol, LH, and FSH and lower levels of total testosterone (TT) when compared with eutrophic fertile men. Additionally, they present worse semen parameters, with reduction in ejaculated volume and sperm concentration, worse sperm motility and morphology, and higher SDF. Phase 2: 32 patients returned to revaluation. Eighteen were submitted to BS (group S) and 14 were not submitted to any specific therapeutic regimen (group NS). In group S, TT more than doubled after surgery (294.5 to 604 ng/dL,p < 0.0001). Worsening of sperm concentration and total ejaculated sperm count were also noticed, and 2 patients became azoospermic after BS. SDF, however, improved after the procedure. No changes in the variables studied were observed in non-operated patients. Conclusion In this prospective study, we have found that BS results in improvements in reproductive hormone levels and SDF after 6-month follow-up. Sperm concentration, however, reduced after the procedure.
  • article 1 Citação(ões) na Scopus
    Postoperative Renal Function in Patients Undergoing Unilateral Nephrectomy: Development of a Prediction Model Using Preoperative Risk Factors and Cr-51-EDTA Clearance
    (2020) ANDRADE, Hiury S.; SROUGI, Victor; ARAP, Marco A.; MITRE, Anuar I.; CAMARGO, Cristina P.; ZARGAR, Homayoun; KAOUK, Jihad H.; NAHAS, Willian C.; SROUGI, Miguel; DUARTE, Ricardo J.
    Objectives: To analyze the preoperative variables associated to the postoperative glomerular filtration rate (GFR) outcomes after nephrectomy for benign and malignant conditions, measured by the reference isotopic technique Cr-51-ethylene diamine tetra-acetic (Cr-51-EDTA) and to create a model to predict the short-term postoperative GFR. Secondary aim was to evaluate which of the common equations for GFR estimation (Cockcroft-Gault, Modification of Diet in Renal Disease [MDRD] or Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) has the best correlation with the Cr-51-EDTA. Methods: Patients undergoing unilateral nephrectomy from 2014 to 2018 were selected. Pre- and postoperative variables were prospectively collected. Univariate and multivariate analyses were done to identify independent risk factors associated with renal function outcomes and to create a model to predict the postoperative GFR. Correlation analyses were performed to evaluate the performance of various serum creatinine-based equations for GFR estimation compared with Cr-51-EDTA. Results: In total, 107 patients were evaluated. After univariate and multivariate analyses, older age (p = 0.008), higher split function of the operated kidney on dimercaptosuccinic acid (DMSA) scintigraphy (p < 0.001), and lower preoperative Cr-51-EDTA (p < 0.001) were independent risk factors for higher GFR decline. Correlation analyses showed that GFR estimated by CKD-EPI equation had the best concordance to GFR measured by Cr-51-EDTA. Conclusions: Based on our findings age, DMSA and lower preoperative Cr-51-EDTA are predictors of postoperative renal function after unilateral nephrectomy. For the assessment of estimated GFR, CKD-EPI equation appears to have the best concordance with Cr-51-EDTA.
  • conferenceObject
    PROSPECTIVE EVALUATION OF BILATERAL RIRS: IS IT REALLY SAFE?
    (2020) DANILOVIC, Alexandre; TORRICELLI, Fabio; MARCHINI, Giovanni; BATAGELLO, Carlos; VICENTINI, Fabio; TRAXER, Olivier; SROUGI, Miguel; NAHAS, William; MAZZUCCHI, Eduardo
  • article 7 Citação(ões) na Scopus
    The urologist's role in the fight of COVID-19 pandemic: mandatory mindset shift on the frontline
    (2020) ISCAIFE, Alexandre; MARCHINI, Giovanni S.; SROUGI, Victor; TORRICELLI, Fabio C. M.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; MACHADO, Marcos; HISANO, Marcelo; TISEO, Bruno C.; BISSOLI, Julio C.; COCUZZA, Marcello; HALLAK, Jorge; SROUGI, Miguel; NAHAS, William C.
  • article 8 Citação(ões) na Scopus
    Renal Stone Features Are More Important Than Renal Anatomy to Predict Shock Wave Lithotripsy Outcomes: Results from a Prospective Study with CT Follow-Up
    (2020) TORRICELLI, Fabio C. M.; MONGA, Manoj; YAMAUCHI, Fernando I.; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; BATAGELLO, Carlos A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, Eduardo
    Introduction: Lower pole kidney stones have been associated with poor shock wave lithotripsy (SWL) outcomes because of its location. However, the real impact of collecting system anatomy on stone clearance after SWL is uncertain. There is a lack of prospective well-controlled studies to determine whether lower pole kidney stones have inferior outcomes than nonlower pole kidney stones when treated with SWL. Methods: We prospectively evaluated patients with a single kidney stone of 5-15mm undergoing SWL from June 12 through January 19. All patients were subjected to computed tomography before and 3 months after the procedure. Demographic data (age, gender, and body mass index), stone features (stone size, stone area, stone density, and stone-skin distance-SSD), and collecting system anatomy (infundibular length and width, and infundibulopelvic angle) were recorded. Outcomes (fragmentation and stone clearance rates) were compared between lower pole and nonlower pole cases. Then, a multivariate analysis including all variables was performed to determinate which parameters significantly impact on SWL outcomes. Results: One hundred and twenty patients were included in the study. Mean stone size was 8.3mm and mean stone density was 805 Hounsfield units. Overall stone fragmentation, success, and stone-free rates were 84.1%, 64.1%, and 34.1%, respectively. There were no significant differences in stone fragmentation (76.0% vs 71.4%; p=0.624), success rate (57.6% vs 53.3%; p=0.435), and stone-free rate (40.2% vs 35.7%; p=0.422) in the lower vs nonlower pole groups, respectively. On multivariate analysis, only stone density (p<0.001) and SSD (p=0.006) significantly influenced fragmentation. Stone size (p=0.029), stone density (p=0.002), and SSD (p=0.049) significantly influenced kidney stone clearance. Conclusions: Stone size, stone density, and SSD impact on SWL outcomes. Lower pole kidney stones have similar fragmentation and stone clearance compared with nonlower pole kidney stones.