Alexandre Fornari - Academia.edu (original) (raw)

Papers by Alexandre Fornari

International Urogynecology Journal

Introduction and hypothesis The objective was to characterize the impact of the COVID-19 pandemic... more Introduction and hypothesis The objective was to characterize the impact of the COVID-19 pandemic on the surgical treatment of female stress urinary incontinence (FSUI) in Brazil. Methods This study was conducted with population-based data from the Brazilian public health system database. We obtained data on the number of surgical procedures for FSUI in 2019 (before the coronavirus disease [COVID-19] pandemic), 2020, and 2021 (during the pandemic) in each of the 27 Brazilian states. We included official Brazilian Institute of Geography and Statistics (IBGE) data on the population, Human Development Index (HDI), and annual per capita income of each state. Results A total of 6,718 surgical procedures for FSUI were performed in the Brazilian public health system in 2019. The number of procedures was reduced by 56.2% in 2020, and an additional reduction of 7.2% was seen in 2021. The distribution of procedures by state showed important differences, ranging from 4.4 procedures/1,000,000 inhabitants in Paraíba and Sergipe to 67.6 procedures/1,000,000 inhabitants in Paraná (p<0.01) in 2019. The number of surgical procedures was higher in states with a higher HDI (p=0.0001) and per capita income (p=0.042). The decrease in the number of surgical procedures affected the whole country and its rate did not correlate with HDI (p=0.289) or per capita income (p=0.598). Conclusion The impact of the COVID-19 pandemic on the surgical treatment of FSUI in Brazil was significant in 2020 and persisted in 2021. Access to surgical treatment of FSUI varied according to geographic region, HDI, and per capita income, even before COVID-19.

Pancreatic Cancer, 2010

Despite the growing interest in cystic neoplasms of the pancreas, their diagnosis, treatment and ... more Despite the growing interest in cystic neoplasms of the pancreas, their diagnosis, treatment and prognosis are still obscure and controversial. We studied, from September 1989 to July 1999, 21 patients (18 women) with an average age of 54.3 years who were submitted to surgical treatment for cystic neoplasms of the pancreas. Ultrasonography and computed tomography were performed in all patients. The treatment performed was surgical resection: cephalic gastroduodenopancreatectomy, 4 patients; body and tail pancreatectomy, 11 patients; only tail pancreatectomy, 2 patients; and two other patients were submitted to enucleation of one small lesion in the head of the pancreas. Internal drainage, through cystogastrostomy or cystojejunostomy, was performed in 3 cases. Site of tumor: body and tail region, 14 cases; head of the pancreas, 7 cases. Three patients had postoperative complications (respiratory tract infection, surgical wound infection, abdominal abscess). Three patients developed diabetes mellitus during the late postoperative period. One patient died 45 days after surgical procedure. Patients who present pancreatic cystic lesions should be submitted to surgery when local and medical conditions allow it and when intraoperative frozen biopsy excludes a pancreatic pseudocyst. If the nature of the lesion cannot be determined, it is better to err resecting a pseudocyst than by leaving or draining a cystic neoplasm, since these lesions are potentially curable.

Hypothesis / aims of study The prevalence of micturition disorders is high, and so is the burden ... more Hypothesis / aims of study The prevalence of micturition disorders is high, and so is the burden of the disease to their patients. Hoping to improve diagnostics made and the treatments offered to these people, a specific outpatient clinic was created. There are few studies on this topic, so the purpose of this article is to review demographic characteristics, associated diseases, the signed diagnoses and the treatments offered to patients referred to this specific service, as well as identify the successes and failures in treating these patients.

Hypothesis / aims of study Incidence rates of urinary incontinence (UI) after radical prostatecto... more Hypothesis / aims of study Incidence rates of urinary incontinence (UI) after radical prostatectomy (RP) has been reported between 0.5 and 87%. This discrepancy between incidences is partly due to the variability of definitions for UI, as well as the postoperative period in which this evaluation was done. Some studies have shown that training of the pelvic floor muscles pre and/or postoperative period may improve early and late urinary continence rates after PR. Few studies have used pelvic floor training associated with biofeedback or assessed quality of life (QoL) and rates of erectile dysfunction (ED). We decided to evaluate the effects of pelvic physiotherapy pre and postoperative associated with the use of biofeedback for urinary continence, QoL and DE in the third month after PR.

A hiperplasia benigna da prostata (HBP) e uma condicao muito prevalente em homens a partir dos 40... more A hiperplasia benigna da prostata (HBP) e uma condicao muito prevalente em homens a partir dos 40 anos, atingindo mais da metade da populacao masculina na setima decada e a quase totalidade na oitava decada. Os sintomas a ela relacionados podem causar grande prejuizo a qualidade de vida desses pacientes. O objetivo da presente revisao e resumir a literatura atual sobre a patologia, focando na sua epidemiologia, diagnostico e manejo. A avaliacao inicial do paciente com HBP deve compreender a anamnese com aplicacao do escore de sintomas prostaticos (IPSS), exame fisico com toque retal, avaliacao laboratorial (PSA serico, exame de urina e funcao renal), alem de metodos de imagem e urodinâmica para casos selecionados. O tratamento inicial para casos leves e moderados e medicamentoso, com o uso de alfa-bloqueadores ou inibidores da 5-alfaredutase, ou ainda a combinacao desses. Pacientes que nao respondem ao tratamento medicamentoso, com sintomas graves, ou que desenvolvem complicacoes da...

Hypothesis / aims of study Prostatic benign hyperplasia (PBH) is being recognized as a growing he... more Hypothesis / aims of study Prostatic benign hyperplasia (PBH) is being recognized as a growing health problem worldwide. The incidence of Benign Prostatic Hyperplasia (BPH) has rapidly increased as life expectancy has risen and is now the most common disease in the aging male. Association between PBH and overactive bladder is not uncommon. Patients may present with urgency and urgeincontinence. Quantification of symptoms using the IPSS should be carried out during the initial evaluation. A safe and effective method to evaluate the deleterious effects of bladder outlet obstruction is not yet known. The thickness of the bladder wall measured sonographically has been advocated as a minimally invasive technique and has been widely discussed (1,2). In the present study, we analyzed variables as bladder wall thickness (BWT), post-void residual volume, prostate volume, IPSS and OAB-V8 questionnaire in men who underwent transrectal ultrasound.

e descrito o caso de uma paciente de 45 anos portadora de neoplasia endocrina cistica nao-funcion... more e descrito o caso de uma paciente de 45 anos portadora de neoplasia endocrina cistica nao-funcionante de pâncreas. Apresentava dor abdominal, exames laboratoriais normais e metodos de imagem que demonstraram lesao cistica na cauda pancreatica. O tratamento cpnsistiu em pancreateectomia caudal esplenectomia, sendo o pos-operatorio sem complicacoes. A paciente permanece assintomatica apos 2 anos de acompanhamento. Apesar da onfrequencia dessa forma de apresentacao das neoplasias endocrinas pancreaticas, ela deve ser incluida no diagnostico diferencial das neoplasias cisticas do pâncreas

Neurourology and Urodynamics

Os autores apresentam uma serie de 12 casos, consecutivos, de colangite obstrutiva supurativa agu... more Os autores apresentam uma serie de 12 casos, consecutivos, de colangite obstrutiva supurativa aguda (COSA), tratados cirurgicamente. A etiologia mais frequente foi a coledocolitiase observada em 75 por cento dos casos. Fatores de risco como idade avancada, ictericia e comprometimento da funcao renal foram os principais indicadores prognosticos. Cinco (41,67 por cento) pacientes evoluiram ao obito. O diagnostico precoce com descompressao imediata da via biliar associado a medidas de suporte e antibioticoterapia sao as unicas alternativas de sucesso no tratamento de tal afeccao.

UroToday International Journal, 2008

International braz j urol

International braz j urol

Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction... more Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic fl oor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not signifi cantly improve urinary continence or erectile function at 3 months after RP.

The Journal of Obstetrics and Gynecology of India

International Urogynecology Journal

International Journal of Impotence Research

International braz j urol : official journal of the Brazilian Society of Urology

Surgical treatment of urinary incontinence progressed significantly with the introduction of synt... more Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (p<0.001)). Cost was significantly lower in patients submitted to sling in all items, except for time spent in recovery war...

The Journal of Sexual Medicine

International Urogynecology Journal

Introduction and hypothesis The objective was to characterize the impact of the COVID-19 pandemic... more Introduction and hypothesis The objective was to characterize the impact of the COVID-19 pandemic on the surgical treatment of female stress urinary incontinence (FSUI) in Brazil. Methods This study was conducted with population-based data from the Brazilian public health system database. We obtained data on the number of surgical procedures for FSUI in 2019 (before the coronavirus disease [COVID-19] pandemic), 2020, and 2021 (during the pandemic) in each of the 27 Brazilian states. We included official Brazilian Institute of Geography and Statistics (IBGE) data on the population, Human Development Index (HDI), and annual per capita income of each state. Results A total of 6,718 surgical procedures for FSUI were performed in the Brazilian public health system in 2019. The number of procedures was reduced by 56.2% in 2020, and an additional reduction of 7.2% was seen in 2021. The distribution of procedures by state showed important differences, ranging from 4.4 procedures/1,000,000 inhabitants in Paraíba and Sergipe to 67.6 procedures/1,000,000 inhabitants in Paraná (p<0.01) in 2019. The number of surgical procedures was higher in states with a higher HDI (p=0.0001) and per capita income (p=0.042). The decrease in the number of surgical procedures affected the whole country and its rate did not correlate with HDI (p=0.289) or per capita income (p=0.598). Conclusion The impact of the COVID-19 pandemic on the surgical treatment of FSUI in Brazil was significant in 2020 and persisted in 2021. Access to surgical treatment of FSUI varied according to geographic region, HDI, and per capita income, even before COVID-19.

Pancreatic Cancer, 2010

Despite the growing interest in cystic neoplasms of the pancreas, their diagnosis, treatment and ... more Despite the growing interest in cystic neoplasms of the pancreas, their diagnosis, treatment and prognosis are still obscure and controversial. We studied, from September 1989 to July 1999, 21 patients (18 women) with an average age of 54.3 years who were submitted to surgical treatment for cystic neoplasms of the pancreas. Ultrasonography and computed tomography were performed in all patients. The treatment performed was surgical resection: cephalic gastroduodenopancreatectomy, 4 patients; body and tail pancreatectomy, 11 patients; only tail pancreatectomy, 2 patients; and two other patients were submitted to enucleation of one small lesion in the head of the pancreas. Internal drainage, through cystogastrostomy or cystojejunostomy, was performed in 3 cases. Site of tumor: body and tail region, 14 cases; head of the pancreas, 7 cases. Three patients had postoperative complications (respiratory tract infection, surgical wound infection, abdominal abscess). Three patients developed diabetes mellitus during the late postoperative period. One patient died 45 days after surgical procedure. Patients who present pancreatic cystic lesions should be submitted to surgery when local and medical conditions allow it and when intraoperative frozen biopsy excludes a pancreatic pseudocyst. If the nature of the lesion cannot be determined, it is better to err resecting a pseudocyst than by leaving or draining a cystic neoplasm, since these lesions are potentially curable.

Hypothesis / aims of study The prevalence of micturition disorders is high, and so is the burden ... more Hypothesis / aims of study The prevalence of micturition disorders is high, and so is the burden of the disease to their patients. Hoping to improve diagnostics made and the treatments offered to these people, a specific outpatient clinic was created. There are few studies on this topic, so the purpose of this article is to review demographic characteristics, associated diseases, the signed diagnoses and the treatments offered to patients referred to this specific service, as well as identify the successes and failures in treating these patients.

Hypothesis / aims of study Incidence rates of urinary incontinence (UI) after radical prostatecto... more Hypothesis / aims of study Incidence rates of urinary incontinence (UI) after radical prostatectomy (RP) has been reported between 0.5 and 87%. This discrepancy between incidences is partly due to the variability of definitions for UI, as well as the postoperative period in which this evaluation was done. Some studies have shown that training of the pelvic floor muscles pre and/or postoperative period may improve early and late urinary continence rates after PR. Few studies have used pelvic floor training associated with biofeedback or assessed quality of life (QoL) and rates of erectile dysfunction (ED). We decided to evaluate the effects of pelvic physiotherapy pre and postoperative associated with the use of biofeedback for urinary continence, QoL and DE in the third month after PR.

A hiperplasia benigna da prostata (HBP) e uma condicao muito prevalente em homens a partir dos 40... more A hiperplasia benigna da prostata (HBP) e uma condicao muito prevalente em homens a partir dos 40 anos, atingindo mais da metade da populacao masculina na setima decada e a quase totalidade na oitava decada. Os sintomas a ela relacionados podem causar grande prejuizo a qualidade de vida desses pacientes. O objetivo da presente revisao e resumir a literatura atual sobre a patologia, focando na sua epidemiologia, diagnostico e manejo. A avaliacao inicial do paciente com HBP deve compreender a anamnese com aplicacao do escore de sintomas prostaticos (IPSS), exame fisico com toque retal, avaliacao laboratorial (PSA serico, exame de urina e funcao renal), alem de metodos de imagem e urodinâmica para casos selecionados. O tratamento inicial para casos leves e moderados e medicamentoso, com o uso de alfa-bloqueadores ou inibidores da 5-alfaredutase, ou ainda a combinacao desses. Pacientes que nao respondem ao tratamento medicamentoso, com sintomas graves, ou que desenvolvem complicacoes da...

Hypothesis / aims of study Prostatic benign hyperplasia (PBH) is being recognized as a growing he... more Hypothesis / aims of study Prostatic benign hyperplasia (PBH) is being recognized as a growing health problem worldwide. The incidence of Benign Prostatic Hyperplasia (BPH) has rapidly increased as life expectancy has risen and is now the most common disease in the aging male. Association between PBH and overactive bladder is not uncommon. Patients may present with urgency and urgeincontinence. Quantification of symptoms using the IPSS should be carried out during the initial evaluation. A safe and effective method to evaluate the deleterious effects of bladder outlet obstruction is not yet known. The thickness of the bladder wall measured sonographically has been advocated as a minimally invasive technique and has been widely discussed (1,2). In the present study, we analyzed variables as bladder wall thickness (BWT), post-void residual volume, prostate volume, IPSS and OAB-V8 questionnaire in men who underwent transrectal ultrasound.

e descrito o caso de uma paciente de 45 anos portadora de neoplasia endocrina cistica nao-funcion... more e descrito o caso de uma paciente de 45 anos portadora de neoplasia endocrina cistica nao-funcionante de pâncreas. Apresentava dor abdominal, exames laboratoriais normais e metodos de imagem que demonstraram lesao cistica na cauda pancreatica. O tratamento cpnsistiu em pancreateectomia caudal esplenectomia, sendo o pos-operatorio sem complicacoes. A paciente permanece assintomatica apos 2 anos de acompanhamento. Apesar da onfrequencia dessa forma de apresentacao das neoplasias endocrinas pancreaticas, ela deve ser incluida no diagnostico diferencial das neoplasias cisticas do pâncreas

Neurourology and Urodynamics

Os autores apresentam uma serie de 12 casos, consecutivos, de colangite obstrutiva supurativa agu... more Os autores apresentam uma serie de 12 casos, consecutivos, de colangite obstrutiva supurativa aguda (COSA), tratados cirurgicamente. A etiologia mais frequente foi a coledocolitiase observada em 75 por cento dos casos. Fatores de risco como idade avancada, ictericia e comprometimento da funcao renal foram os principais indicadores prognosticos. Cinco (41,67 por cento) pacientes evoluiram ao obito. O diagnostico precoce com descompressao imediata da via biliar associado a medidas de suporte e antibioticoterapia sao as unicas alternativas de sucesso no tratamento de tal afeccao.

UroToday International Journal, 2008

International braz j urol

International braz j urol

Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction... more Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic fl oor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not signifi cantly improve urinary continence or erectile function at 3 months after RP.

The Journal of Obstetrics and Gynecology of India

International Urogynecology Journal

International Journal of Impotence Research

International braz j urol : official journal of the Brazilian Society of Urology

Surgical treatment of urinary incontinence progressed significantly with the introduction of synt... more Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (p<0.001)). Cost was significantly lower in patients submitted to sling in all items, except for time spent in recovery war...

The Journal of Sexual Medicine