PEDRO FELIPE SILVA DE FREITAS
Índice h a partir de 2011
2
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
3 resultados
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- Severe urinary tract damage secondary to primary bladder neck obstruction in women(2021) FREITAS, Pedro F. S.; COELHO, Augusto Q.; BRUSCHINI, Homero; ROVNER, Eric S.; GOMES, Cristiano M.Objective To present the clinical and radiological characteristics of women with severe structural deterioration of the bladder and upper urinary tract secondary to Primary Bladder Neck Obstruction (PBNO), and their outcomes after bladder neck incision (BNI). Methods Retrospective evaluation of adult women who underwent BNI for PBNO at one institution. Patients were assessed for symptoms, renal function, structural abnormalities of the urinary tract and video-urodynamics. PBNO diagnosis was confirmed with video-urodynamics in all patients. BNI was performed at the 4-5 and/or 7-8 o'clock positions. Postoperative symptoms, PVR, uroflowmetry and renal function were evaluated and compared to baseline. Results Median patient age was 56.5 years (range 40-80). All presented with urinary retention-four were on clean intermittent Catheterization (CIC) and two with a Foley catheter. All patients had bladder wall thickening and diverticula. Four women had elevated creatinine levels, bilateral hydronephrosis was present in five (83.3%). After BNI, all patients resumed spontaneous voiding without the need for CIC. Median Qmax significantly improved from 2.0 [1.0-4.0] mL/s to 15 [10-22.7] mL/s (p = 0.031). Median PVR decreased from 150 to 46 [22-76] mL (p = 0.031). There were no postoperative complications. Creatinine levels returned to normal in 3/4 (75%) patients. Conclusion PBNO in women may result in severe damage to the bladder and upper urinary tract. Despite severe structural abnormalities of the bladder, BNI was effective in reducing symptoms and improving structural and functional abnormalities of the lower and upper urinary tract.
- 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.
- Validation of the TWIST score for testicular torsion in adults(2021) BARBOSA, Joao Arthur Brunhara Alves; FREITAS, Pedro Felipe Silva de; CARVALHO, Sergio Andurte Duarte; COELHO, Augusto Quaresma; YORIOKA, Marco Aurelio Watanabe; PEREIRA, Maykon William Aparecido; BORGES, Leonardo Lima; SROUGI, Miguel; NAHAS, William C.; ARAP, Marco AntonioPurpose The TWIST (Testicular Work-up for Ischemia and Suspected Torsion) score was developed to allow for expedited diagnosis of testicular torsion (TT) in children based on clinical variables: edema (2 points), hard mass (2), absent cremasteric reflex (1), high-riding testis (1) and nausea/vomiting (1). We sought to validate the TWIST Score applied by non-expert physicians for the diagnosis of testicular torsion in an adult population. Methods We prospectively analyzed all consecutive males presenting to a tertiary hospital with acute scrotum. Patients with previous scrotal pathology or trauma were excluded. Physical examination was performed by a general surgeon and variables of TWIST were recorded. All patients underwent Scrotal Doppler Ultrasound. Measures of accuracy of the TWIST score and ROC curves were generated to evaluate its performance in diagnosing TT in adults. Results Of 68 patients, 34 had TT (50%). Median age was 24.9 years. According to the original cutoffs of TWIST, 23 patients had a score <= 2 among which none had TT. Fifteen patients had a score of 3-4, among which seven had TT. Thirty patients had a score >= 5, among which 27 had TT. All 18 patients with a score of 6 or greater had TT (100% PPV). ROC curve revealed an AUC of 0.95. Conclusion The TWIST Score is valid for the diagnosis of Testicular Torsion in adults, presenting a PPV of 90% for a cutoff of 5 points and 100% for six points. In all patients with a score of 2 or less, the disease could be safely excluded (100% NPV).