Wagner Matheus - Academia.edu (original) (raw)

Papers by Wagner Matheus

Brazilian Journal of Case Reports, Dec 18, 2023

This study describes a case of symptomatic arteriovenous fistula after Transurethral Resection of... more This study describes a case of symptomatic arteriovenous fistula after Transurethral Resection of the Prostate diagnosed by urethrocystoscopy and confirmed by imaging tests. The patient presented lower urinary tract symptoms associated with hematuria twenty years after being submitted to a TURP. Arterial and venous tomography angiography of the pelvis visualized a hypervascularized lesion involving the membranous urethra and aneurysm of the right external iliac artery. The patient underwent embolization of bilateral prostatic arteries with good post-embolization recovery and complete remission of urinary symptoms. Arteriovenous fistula after transurethral resection of the prostate is a rare pathology that must be considered in the differential diagnosis of persistent hematuria and infravesical obstruction without significant prostatic enlargement. In cases like this, embolization has become a new therapeutic option with excellent obliteration rates and minimal morbidity.

INTRODUCAO: O câncer de prostata representa um problema de saude publica por sua elevada incidenc... more INTRODUCAO: O câncer de prostata representa um problema de saude publica por sua elevada incidencia entre os homens com idade superior a 50 anos. Apos a confirmacao diagnostica por biopsia guiada por ultrassonografia, uma serie de exames de imagem tem sido usada para complementacao diagnostica e estadiamento local. Nao obstante a ressonância magnetica com bobina endorretal seja o metodo de imagem mais largamente utilizado para tal avaliacao, ainda ha duvidas sobre sua aplicabilidade e necessidade na pratica clinica rotineira. OBJETIVOS: Fazer uma revisao sistematica da literatura com metanalise para avaliar os resultados da ressonância magnetica com bobina endorretal de 1,5T com imagens convencionais no diagnostico e estadiamento local do câncer de prostata, em comparacao com resultados histopatologicos dos especimes da prostatectomia radical. MATERIAS E METODOS: Pesquisadas fontes de dados informatizados PUBMED, MEDLINE, EMBASE e LILACS usando-se termos especificos e trabalhos publicados a partir de 2008. Os dados foram coletados por instrumento qualitativo especifico. A metanalise foi feita pelos programas RevMan versao 6 (Cochrane) e Meta DiSc 1.4. A apresentacao dos dados foi realizada por florest plot, teste de homogeneidade, curva sROC e funnel plot. RESULTADOS: Foram encontrados sete trabalhos que compararam resultados da ressonância magnetica com anatomopatologico em pacientes com câncer de prostata. Para diagnostico da neoplasia, a sensibilidade e a especificidade foram de 0,65 (IC de 95%: 0,61- 0,68) e 0,58 (IC de 95%: 0,51-0,64) respectivamente, com heterogeneidade significativa entre os estudos. Tres estudos avaliaram extensao extra prostatica, com sensibilidade de 0,49 (IC de 95%: 0,40 - 0,58) e a especificidade de 0,82 (IC de 95%: 0,77 -0,86). Tres trabalhos avaliaram invasao de vesiculas seminais, sendo a sensibilidade de 0,45 (IC de 95%: 0,31 - 0,60) e a especificidade de 0,96 (IC de 95%: 0,93 - 0,98). Foi detectada heterogeneidade significativa entre os resultados dos estudos primarios em todas as analises. CONCLUSOES: A ressonância magnetica de 1,5 T com bobina endoretal demonstrou baixos valores de sensibilidade e especificidade para diagnostico e estadiamento do câncer de prostata. Os estudos analisados mostraram heterogeneidade significativa entre os trabalhos. O melhor resultado observado foi a especificidade da ressonância magnetica na invasao de vesiculas seminais. Mais estudos avaliando novas tecnicas e parâmetros sao necessarios, antes de se recomendar a utilizacao da RM rotineiramente na pratica clinica. Abstract

Título em inglês: Primary invasive versus progressive invasive transitional cell bladder câncer: ... more Título em inglês: Primary invasive versus progressive invasive transitional cell bladder câncer: Multicentric study of overall survival rate

Introducao: Os androgenos, alem de desempenhar um papel importante no desenvolvimento e no cresci... more Introducao: Os androgenos, alem de desempenhar um papel importante no desenvolvimento e no crescimento da prostata, tambem sao responsaveis pelo surgimento e progressao de lesoes prostaticas. Portanto, as acoes desses hormonios podem ser antagonizadas impedindo a conversao irreversivel de testosterona em dihidrotestosterona, por meio da inibicao da 5a-redutase. Neste contexto, os objetivos deste estudo foram caracterizar os efeitos clinicos e morfofuncionais da dutasterida, um inibidor de 5a-redutase, em receptores de hormonios esteroides no tecido da prostata humana normal, bem como para verificar a viabilidade desses receptores como potenciais marcadores para o manejo clinico dos pacientes em uso de dutasterida. Metodos: estudo prospectivo, duplo-cego e randomizado que avaliou 49 homens com idades entre 45 e 70 anos, sem alteracoes no exame de toque retal e com dosagens de PSA entre 2,5 e 4,0 ng/ml. Estes pacientes foram submetidos a biopsia de prostata guiada pelo ultrassom transretal, e apos ter sido descartada neoplasia de prostata, foram divididos em dois grupos recebendo dutasterida (n=25) ou placebo (n=24). Os pacientes foram avaliados clinicamente a cada trimestre e, ao final de 12 meses, submetidos a novos testes laboratoriais e analise histopatologica por nova biopsia da prostata. Resultados: Os resultados nao mostraram variacoes significativas nos niveis de estrogeno, testosterona sericos e indice de massa corporal em ambos os grupos, bem como de ER? (receptor estrogenico ?). No entanto, a imunorreatividade para AR (receptor androgenico) e ER? (receptor estrogenico beta) foram significativamente maiores no grupo dutasterida em relacao ao grupo placebo, acompanhado por uma reducao significativa do volume da prostata e dos niveis de PSA sericos no grupo dutasterida. Alem disso, ambos os indices de proliferacao e apoptose tambem foram significativamente maiores no grupo dutasterida, porem a razao proliferacao/apoptose foi significativamente menor neste grupo, indicando assim predominância de apoptose. Conclusao: O tratamento com dutasterida mostrou distintas reatividades no tecido prostatico normal, apontando a importância da ativacao de ER? no mecanismo apoptotico, propiciando efeito protetor no tecido prostatico normal, indicando ser este receptor um importante mediador para o seguimento clinico de pacientes em uso de dutasterida. Abstract

Atualmente existem diferentes agentes para o tratamento do câncer renal avancado. O objetivo prin... more Atualmente existem diferentes agentes para o tratamento do câncer renal avancado. O objetivo principal desse trabalho foi realizar revisao sistematica com meta-analise dos estudos clinicos randomizados que compararam: sorafenibe, sunitinibe, bevacizumabe, temsirolimus e everolimus ao interferon-α. Para isto foi realizada revisao sistematica da literatura em diferentes bancos de dados: EMBASE, LILACS e PUBMED, identificando estudos clinicos randomizados que compararam as terapias alvo moleculares (TAM) disponiveis versus interferon-alfa para tratamento de pacientes com câncer renal avancado. Para o tratamento de 1a linha foram encontrados 10 estudos que avaliaram as terapias com sunitinibe, sorafenibe, bevacizumabe e temsirolimus; e tres estudos que avaliaram o sorafenibe e everolimus como tratamento de 2a linha. O Risco Relativo (RR) da sobrevida livre de progressao (SLP) dos estudos de 1a linha foi de 0.83, intervalo de confianca (IC) [0.78-0.87] com I2= 94% e p<0.00001. Os melhores resultados foram: o estudo do sunitinibe, 0.38, IC [0.25-0.58], do bevacizumabe com RR de 0.62, IC [0.47-0.83] e do temsirolimus, 0.78, IC [0.70-0.87]. A meta-analise nao demonstrou beneficio quanto a sobrevida global (SG), no tratamento de 1a linha com sunitinibe e temsirolimus. Os tratamentos de 1a linha com sorafenibe e bevacizumabe nao associaram beneficios clinicos significativos. Nao foi possivel realizar meta-analise nos estudos do tratamento de 2a linha, pois, as populacoes eram diferentes. Logo, para o tratamento de 1a linha, sunitinibe e temsirolimus foram a terapias mais efetivas, quanto a SLP. No tratamento de 2a linha, o sorafenibe e everolimus foram relacionados a melhora da SLP. Em todos os estudos de 1a linha os pacientes nao apresentaram melhora de SG e a qualidade metodologica nao foram adequadas, portanto esses resultados devem ser analisados com cautela. Abstr

JBRA Assisted Reproduction, 2021

TESE-ICSI (testicular sperm extraction associated with intracytoplasmic sperm injection) represen... more TESE-ICSI (testicular sperm extraction associated with intracytoplasmic sperm injection) represents a technique to attain pregnancy in couples with non-obstructive azoospermia (NOA) and other unlikely situations. Because of the poor pregnancy outcomes obtained by this procedure, we need new sperm selection techniques to improve the livebirth rate of NOA patients. Here we describe a successful micro TESE-ICSI cycle performed with sperm selected through high magnification and polarized light microscopy in a couple with two previous ICSI failures.

Resumo. Neste trabalho, dois modelos matemáticos são elaborados para auxiliar especialista na tom... more Resumo. Neste trabalho, dois modelos matemáticos são elaborados para auxiliar especialista na tomada de decisão. A ferramenta utilizada foi a Teoria dos Conjuntos Fuzzy, por sua capacidade em lidar com incertezas inerentes aos conceitos médicos. No primeiro modelo, o Estádio, Grau e Tamanho do tumor são combinados para obter o Risco de Recidiva de um tumor superficial de bexiga. Já no segundo modelo, foram combinados o Estádio, Grau, Tamanho do tumor e Carcinoma in situ para obter o Risco de Progressão de tumores superficiais. Para cada modelo, foram feitas simulações com dados de pacientes. A partir do banco de dados e das possibilidades encontradas pelos SBRF, após a transformação possibilidade-probabilidade, pudemos gerar a probabilidade do caso real de cada conjunto fuzzy de saída.

International braz j urol, Dec 1, 2017

Revista Do Colegio Brasileiro De Cirurgioes, 1992

Journal of Clinical Oncology, Feb 20, 2020

Between 1954 and 1978, 148 patients underwent radical perineal prostatectomy for adenocarcinoma c... more Between 1954 and 1978, 148 patients underwent radical perineal prostatectomy for adenocarcinoma clinically confined to the prostate gland. This report is based on 45 of these patients with microscopic extension of disease beyond the gland and a minimum 5-year followup. Of the patients 22 received adjuvant external beam radiation therapy and 23 did not. The groups were comparable with regard to significant prognostic variables. Patient selection was by surgeon preference. Local recurrences were seen in 1 of 22 patients (5 per cent) receiving adjuvant radiotherapy and 7 of 23 (30 per cent) undergoing an operation alone (p less than 0.05). Of 8 patients with local recurrence 7 died of the disease. Delayed radiotherapy of a local recurrence generally was not effective in controlling the disease. Of the 11 patients who died of prostatic cancer with a mean followup of 9.2 years 3 received adjuvant radiotherapy and 8 did not. Severe but nonfatal long-term complications were seen in 14 per cent of the irradiated patients and 6 per cent of those treated with an operation alone. Most of the complications occurred in the earlier years of the study in patients who received 60 cobalt radiotherapy. When clinical stage B cancer of the prostate is found to be pathological stage C following radical perineal prostatectomy, adjuvant radiotherapy can decrease the incidence of subsequent local recurrence. The potential risk of adjuvant radiation therapy should be weighed and its use considered, particularly in patients whose tumor extends to the surgical margins or who have seminal vesicle invasion.

The Journal of Sexual Medicine, May 1, 2023

Introduction The penile cancer is a rare neoplasia affecting mostly the lower income and scholars... more Introduction The penile cancer is a rare neoplasia affecting mostly the lower income and scholarship socioeconomic levels. Patients with penile cancer live for several months, even years, with the symptoms before seeking a urologist. The delay of seeking medical assistance is mainly due to the fact of poor own recognition of having a serious disease, fear of treatment and surgery. Delayed treatment affects the severity of prognostic and quality of life of patients. For the advanced stages, penectomy is still the best available treatment. Objective This study aims to comprehend the meaning of the experience of patients with penile cancer who underwent partial or total penectomy. Methods The medical records of patients who were surgically treated due to this neoplasia were reviewed using the hospital database. After reviewing the data, the researchers contacted the patients and offered an interview with the psychologist of the Oncology Urology outpatient clinic. On the scheduled return day, patients met with the same psychologist, which applied semi-structured interviews seeking the meaning of the lived experience. After conducting the interview, the literal transcription and subsequent synthesis of what was transcribed was carried out. From the collected data, two more syntheses were made in search of the units of meaning and then analysis of the collected speeches, seeking to understand the meaning of the lived experience of each of the intervewees. The final step is to seek the shared experience of the studied phenomenom, in this case the penile cancer. After completion of the process, the syntheses were submitted to 2 independent psychologist colleagues for a better understanding of the described phenomena. Results Were interviewed 7 men who had penile cancer and underwent treatment, with total or partial penectomy. The average age of participants is 57,3 years. Of the interviewed patients, 4 are married, 2 are single but in a relationship, and 1 is divorced. All patients reported unfavorable sociocultural and socioeconomic aspects, lacking basic information on self-care and on who cared for them. The results are in a qualitative analysis. There are indications of significant themes, such as: Doubts about own masculinity and virility; Denial of pain and discomfort caused by symptoms of the penile cancer; Refusal of care; Resignation towards fate, lack of meaning in life; Sadness of having lost what makes a man normal; Ambivalence between the concern to remain a man and the concern for survival; Indiscriminate feelings, cultural precariousness; “Lack of care and waiting for the problem to go away”: characteristic culturally attributed to men. Conclusions The integrative look allows the scientific community to approach how the person feels when going through the experience and caring for the patient with a broader and more attentive look. It can be seen, even with the preliminary results, that this is an extremely painful experience that affects deep layers of human experience, and that access to information, culture and sex education could be of great help in preventing the disease. Disclosure No

The Journal of Sexual Medicine, May 1, 2023

Introduction Testicular cancer (TC) primarily affects men aged 15 to 40 years, and the incidence ... more Introduction Testicular cancer (TC) primarily affects men aged 15 to 40 years, and the incidence is around 5/100000. Tumors are usually aggressive and have a great psychological impact on patients. Penile cancer (PC) represents 2 of all types of tumors that affect men in Brazil Most of the affected population are elderly men. Usually, the tumor is identified at an advanced stage, when the only treatment available is total or partial penectomy, causing a great emotional impact. Objective This work aims to evaluate the impact of psychotherapy, in an open group, on Health Related Quality of Life (HRQOL) and Sexuality in patients with TC and PC who have been diagnosed, are undergoing treatment - surgery, radiotherapy, chemotherapy or hormone therapy - or who are being followed up after treatment Methods Data is been collected through an initial interview (Identification, Anamnesis, Health Anamnesis, Degree of Satisfaction with Life and Sexuality, Affective Emotional Assessment and Treatment Data), SF 36 short form and IIEF 5 short form questionnaire, in patients who are diagnosed, who have undergone treatment - surgery, radiotherapy or supervised monitoring - or who are being monitored at the clinic, and reapplication after 12 sessions At each session 5 questions related to the perception of the previous session will be answered. The group will be available for 2 years, once a week, and the patient will attend 12 sessions. The sessions last 90 minutes, conducted by the same psychologist. The research will be developed considering the ethical principles of secrecy, privacy, confidentiality and non identification of the interviewees' data. The study will not pose risks to the subjects and invasive techniques of the body or psychological suffering will not be used Before starting the process, the Informed Consent Form (will be delivered, as well as the provision of all details regarding the research It will also be explained that participation is voluntary and that the participant can leave the research at any time, without prejudice to their treatment and monitoring. Only patients who meet all these criteria will be included, after signing the informed consent. Results Currently, the screening of patients is being carried out to offer the possibility of participating in the open group. The project was on hold due to developments related to the COVID-19 pandemic. Conclusions As the work is at the beginning of development, there are still no preliminary conclusions. Disclosure No

The Journal of Urology, Apr 1, 2006

The Aging Male, Jul 24, 2018

The aim of this study was to evaluate the relationship between quality of life, erectile function... more The aim of this study was to evaluate the relationship between quality of life, erectile function and group psychotherapy in patients with prostate cancer undergoing radical prostatectomy. Sixty patients were evaluated for erectile function (IIEF-5), quality of life (SF-36SF), urinary incontinence (ICQI-SF and ICQI-OAB). Thirty of them had group psychotherapy two weeks before and 12 weeks after surgery. Patients who underwent group psychotherapy had better scores in IIEF-5, satisfaction with life in general, satisfaction with sexual life and in partner relationship; better results of SF-36SF, excepting two domains: bodily pain and role emotional. There were significant correlations between IIEF-5 and perception of discomfort (p ¼ .030), physical functioning (p ¼ .021), physical component (p ¼ .005) and role emotional (p ¼ .009) in patients undergoing group psychotherapy. In patients who didn't have group psychotherapy there were significant correlations between ICQI-OAB and perception of discomfort (p ¼ .025), social functioning (p ¼ .052) and role emotional (p ¼ .034); between ICQI-SF and perception of discomfort (p ¼ .0001). Group psychotherapy has a positive impact in quality of life and erectile function. There was no difference in the urinary function of the two groups. Further studies are necessary to identify the impact of self-perception and self-knowledge in the postoperative management of radical prostatectomy.

Actas urológicas españolas, 2010

Cis-platinum based chemotherapy agents are widely used in treatment of testicular cancer and its ... more Cis-platinum based chemotherapy agents are widely used in treatment of testicular cancer and its deleterious effects on spermatogenesis are well known. Therefore an extensive survey was undertaken to evaluate the effects of antioxidants in combination with Cis-platinum in an attempt to minimize its effects upon spermatogenic function of adult rats. Methods: A short-term prospective study (thirteen days) including twenty-four adult male Wistar rats was performed. Animals were assigned into one of three groups (eight per group): GI-control, GII-Cis-platinum treated and GIII-Cis-platinum plus superoxide dismutase and catalase. Histological analyses included germ cell counts, germ to Sertoli cell ratios and estimation of volume density components as well as the determination of the sperm reserves. Data was examined through one-way analysis of variance at 5% level of significance. Results: Germ cell numbers, germ cell to Sertoli cell ratios, organ weights (except body weight) and sperm reserves presented no differences among groups. However, the volumetric proportion of some components (tubular epithelium, tunica propria, Leydig cell nuclei and stroma) were affected (p<0.05) by treatment. The most prominent testicular component, the seminiferous epithelium was reduced (p<0.05) in Cis-platinum treated animals (GII). Conclusion: The use of antioxidant in association with Cis-platinum did not affect sperm production (germ cell numbers, germ to Sertoli cell ratios and sperm reserves) of adult rats. However, the deleterious effect of Cis-platinum on the seminiferous tubule epithelium was minimized by antioxidants.

The Journal of Sexual Medicine, Sep 1, 2020

The Journal of Urology, Apr 1, 2004

International Braz J Urol, Apr 1, 2019

Purpose: The 8 th edition of the TNM has been updated and improved in order to ensure a high degr... more Purpose: The 8 th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ-confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change. Materials and Methods: Prostates were step-sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan-Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model. Results: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery. Conclusions: Pathologic sub-staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage.

The Journal of Sexual Medicine, May 1, 2022

Brazilian Journal of Case Reports, Dec 18, 2023

This study describes a case of symptomatic arteriovenous fistula after Transurethral Resection of... more This study describes a case of symptomatic arteriovenous fistula after Transurethral Resection of the Prostate diagnosed by urethrocystoscopy and confirmed by imaging tests. The patient presented lower urinary tract symptoms associated with hematuria twenty years after being submitted to a TURP. Arterial and venous tomography angiography of the pelvis visualized a hypervascularized lesion involving the membranous urethra and aneurysm of the right external iliac artery. The patient underwent embolization of bilateral prostatic arteries with good post-embolization recovery and complete remission of urinary symptoms. Arteriovenous fistula after transurethral resection of the prostate is a rare pathology that must be considered in the differential diagnosis of persistent hematuria and infravesical obstruction without significant prostatic enlargement. In cases like this, embolization has become a new therapeutic option with excellent obliteration rates and minimal morbidity.

INTRODUCAO: O câncer de prostata representa um problema de saude publica por sua elevada incidenc... more INTRODUCAO: O câncer de prostata representa um problema de saude publica por sua elevada incidencia entre os homens com idade superior a 50 anos. Apos a confirmacao diagnostica por biopsia guiada por ultrassonografia, uma serie de exames de imagem tem sido usada para complementacao diagnostica e estadiamento local. Nao obstante a ressonância magnetica com bobina endorretal seja o metodo de imagem mais largamente utilizado para tal avaliacao, ainda ha duvidas sobre sua aplicabilidade e necessidade na pratica clinica rotineira. OBJETIVOS: Fazer uma revisao sistematica da literatura com metanalise para avaliar os resultados da ressonância magnetica com bobina endorretal de 1,5T com imagens convencionais no diagnostico e estadiamento local do câncer de prostata, em comparacao com resultados histopatologicos dos especimes da prostatectomia radical. MATERIAS E METODOS: Pesquisadas fontes de dados informatizados PUBMED, MEDLINE, EMBASE e LILACS usando-se termos especificos e trabalhos publicados a partir de 2008. Os dados foram coletados por instrumento qualitativo especifico. A metanalise foi feita pelos programas RevMan versao 6 (Cochrane) e Meta DiSc 1.4. A apresentacao dos dados foi realizada por florest plot, teste de homogeneidade, curva sROC e funnel plot. RESULTADOS: Foram encontrados sete trabalhos que compararam resultados da ressonância magnetica com anatomopatologico em pacientes com câncer de prostata. Para diagnostico da neoplasia, a sensibilidade e a especificidade foram de 0,65 (IC de 95%: 0,61- 0,68) e 0,58 (IC de 95%: 0,51-0,64) respectivamente, com heterogeneidade significativa entre os estudos. Tres estudos avaliaram extensao extra prostatica, com sensibilidade de 0,49 (IC de 95%: 0,40 - 0,58) e a especificidade de 0,82 (IC de 95%: 0,77 -0,86). Tres trabalhos avaliaram invasao de vesiculas seminais, sendo a sensibilidade de 0,45 (IC de 95%: 0,31 - 0,60) e a especificidade de 0,96 (IC de 95%: 0,93 - 0,98). Foi detectada heterogeneidade significativa entre os resultados dos estudos primarios em todas as analises. CONCLUSOES: A ressonância magnetica de 1,5 T com bobina endoretal demonstrou baixos valores de sensibilidade e especificidade para diagnostico e estadiamento do câncer de prostata. Os estudos analisados mostraram heterogeneidade significativa entre os trabalhos. O melhor resultado observado foi a especificidade da ressonância magnetica na invasao de vesiculas seminais. Mais estudos avaliando novas tecnicas e parâmetros sao necessarios, antes de se recomendar a utilizacao da RM rotineiramente na pratica clinica. Abstract

Título em inglês: Primary invasive versus progressive invasive transitional cell bladder câncer: ... more Título em inglês: Primary invasive versus progressive invasive transitional cell bladder câncer: Multicentric study of overall survival rate

Introducao: Os androgenos, alem de desempenhar um papel importante no desenvolvimento e no cresci... more Introducao: Os androgenos, alem de desempenhar um papel importante no desenvolvimento e no crescimento da prostata, tambem sao responsaveis pelo surgimento e progressao de lesoes prostaticas. Portanto, as acoes desses hormonios podem ser antagonizadas impedindo a conversao irreversivel de testosterona em dihidrotestosterona, por meio da inibicao da 5a-redutase. Neste contexto, os objetivos deste estudo foram caracterizar os efeitos clinicos e morfofuncionais da dutasterida, um inibidor de 5a-redutase, em receptores de hormonios esteroides no tecido da prostata humana normal, bem como para verificar a viabilidade desses receptores como potenciais marcadores para o manejo clinico dos pacientes em uso de dutasterida. Metodos: estudo prospectivo, duplo-cego e randomizado que avaliou 49 homens com idades entre 45 e 70 anos, sem alteracoes no exame de toque retal e com dosagens de PSA entre 2,5 e 4,0 ng/ml. Estes pacientes foram submetidos a biopsia de prostata guiada pelo ultrassom transretal, e apos ter sido descartada neoplasia de prostata, foram divididos em dois grupos recebendo dutasterida (n=25) ou placebo (n=24). Os pacientes foram avaliados clinicamente a cada trimestre e, ao final de 12 meses, submetidos a novos testes laboratoriais e analise histopatologica por nova biopsia da prostata. Resultados: Os resultados nao mostraram variacoes significativas nos niveis de estrogeno, testosterona sericos e indice de massa corporal em ambos os grupos, bem como de ER? (receptor estrogenico ?). No entanto, a imunorreatividade para AR (receptor androgenico) e ER? (receptor estrogenico beta) foram significativamente maiores no grupo dutasterida em relacao ao grupo placebo, acompanhado por uma reducao significativa do volume da prostata e dos niveis de PSA sericos no grupo dutasterida. Alem disso, ambos os indices de proliferacao e apoptose tambem foram significativamente maiores no grupo dutasterida, porem a razao proliferacao/apoptose foi significativamente menor neste grupo, indicando assim predominância de apoptose. Conclusao: O tratamento com dutasterida mostrou distintas reatividades no tecido prostatico normal, apontando a importância da ativacao de ER? no mecanismo apoptotico, propiciando efeito protetor no tecido prostatico normal, indicando ser este receptor um importante mediador para o seguimento clinico de pacientes em uso de dutasterida. Abstract

Atualmente existem diferentes agentes para o tratamento do câncer renal avancado. O objetivo prin... more Atualmente existem diferentes agentes para o tratamento do câncer renal avancado. O objetivo principal desse trabalho foi realizar revisao sistematica com meta-analise dos estudos clinicos randomizados que compararam: sorafenibe, sunitinibe, bevacizumabe, temsirolimus e everolimus ao interferon-α. Para isto foi realizada revisao sistematica da literatura em diferentes bancos de dados: EMBASE, LILACS e PUBMED, identificando estudos clinicos randomizados que compararam as terapias alvo moleculares (TAM) disponiveis versus interferon-alfa para tratamento de pacientes com câncer renal avancado. Para o tratamento de 1a linha foram encontrados 10 estudos que avaliaram as terapias com sunitinibe, sorafenibe, bevacizumabe e temsirolimus; e tres estudos que avaliaram o sorafenibe e everolimus como tratamento de 2a linha. O Risco Relativo (RR) da sobrevida livre de progressao (SLP) dos estudos de 1a linha foi de 0.83, intervalo de confianca (IC) [0.78-0.87] com I2= 94% e p<0.00001. Os melhores resultados foram: o estudo do sunitinibe, 0.38, IC [0.25-0.58], do bevacizumabe com RR de 0.62, IC [0.47-0.83] e do temsirolimus, 0.78, IC [0.70-0.87]. A meta-analise nao demonstrou beneficio quanto a sobrevida global (SG), no tratamento de 1a linha com sunitinibe e temsirolimus. Os tratamentos de 1a linha com sorafenibe e bevacizumabe nao associaram beneficios clinicos significativos. Nao foi possivel realizar meta-analise nos estudos do tratamento de 2a linha, pois, as populacoes eram diferentes. Logo, para o tratamento de 1a linha, sunitinibe e temsirolimus foram a terapias mais efetivas, quanto a SLP. No tratamento de 2a linha, o sorafenibe e everolimus foram relacionados a melhora da SLP. Em todos os estudos de 1a linha os pacientes nao apresentaram melhora de SG e a qualidade metodologica nao foram adequadas, portanto esses resultados devem ser analisados com cautela. Abstr

JBRA Assisted Reproduction, 2021

TESE-ICSI (testicular sperm extraction associated with intracytoplasmic sperm injection) represen... more TESE-ICSI (testicular sperm extraction associated with intracytoplasmic sperm injection) represents a technique to attain pregnancy in couples with non-obstructive azoospermia (NOA) and other unlikely situations. Because of the poor pregnancy outcomes obtained by this procedure, we need new sperm selection techniques to improve the livebirth rate of NOA patients. Here we describe a successful micro TESE-ICSI cycle performed with sperm selected through high magnification and polarized light microscopy in a couple with two previous ICSI failures.

Resumo. Neste trabalho, dois modelos matemáticos são elaborados para auxiliar especialista na tom... more Resumo. Neste trabalho, dois modelos matemáticos são elaborados para auxiliar especialista na tomada de decisão. A ferramenta utilizada foi a Teoria dos Conjuntos Fuzzy, por sua capacidade em lidar com incertezas inerentes aos conceitos médicos. No primeiro modelo, o Estádio, Grau e Tamanho do tumor são combinados para obter o Risco de Recidiva de um tumor superficial de bexiga. Já no segundo modelo, foram combinados o Estádio, Grau, Tamanho do tumor e Carcinoma in situ para obter o Risco de Progressão de tumores superficiais. Para cada modelo, foram feitas simulações com dados de pacientes. A partir do banco de dados e das possibilidades encontradas pelos SBRF, após a transformação possibilidade-probabilidade, pudemos gerar a probabilidade do caso real de cada conjunto fuzzy de saída.

International braz j urol, Dec 1, 2017

Revista Do Colegio Brasileiro De Cirurgioes, 1992

Journal of Clinical Oncology, Feb 20, 2020

Between 1954 and 1978, 148 patients underwent radical perineal prostatectomy for adenocarcinoma c... more Between 1954 and 1978, 148 patients underwent radical perineal prostatectomy for adenocarcinoma clinically confined to the prostate gland. This report is based on 45 of these patients with microscopic extension of disease beyond the gland and a minimum 5-year followup. Of the patients 22 received adjuvant external beam radiation therapy and 23 did not. The groups were comparable with regard to significant prognostic variables. Patient selection was by surgeon preference. Local recurrences were seen in 1 of 22 patients (5 per cent) receiving adjuvant radiotherapy and 7 of 23 (30 per cent) undergoing an operation alone (p less than 0.05). Of 8 patients with local recurrence 7 died of the disease. Delayed radiotherapy of a local recurrence generally was not effective in controlling the disease. Of the 11 patients who died of prostatic cancer with a mean followup of 9.2 years 3 received adjuvant radiotherapy and 8 did not. Severe but nonfatal long-term complications were seen in 14 per cent of the irradiated patients and 6 per cent of those treated with an operation alone. Most of the complications occurred in the earlier years of the study in patients who received 60 cobalt radiotherapy. When clinical stage B cancer of the prostate is found to be pathological stage C following radical perineal prostatectomy, adjuvant radiotherapy can decrease the incidence of subsequent local recurrence. The potential risk of adjuvant radiation therapy should be weighed and its use considered, particularly in patients whose tumor extends to the surgical margins or who have seminal vesicle invasion.

The Journal of Sexual Medicine, May 1, 2023

Introduction The penile cancer is a rare neoplasia affecting mostly the lower income and scholars... more Introduction The penile cancer is a rare neoplasia affecting mostly the lower income and scholarship socioeconomic levels. Patients with penile cancer live for several months, even years, with the symptoms before seeking a urologist. The delay of seeking medical assistance is mainly due to the fact of poor own recognition of having a serious disease, fear of treatment and surgery. Delayed treatment affects the severity of prognostic and quality of life of patients. For the advanced stages, penectomy is still the best available treatment. Objective This study aims to comprehend the meaning of the experience of patients with penile cancer who underwent partial or total penectomy. Methods The medical records of patients who were surgically treated due to this neoplasia were reviewed using the hospital database. After reviewing the data, the researchers contacted the patients and offered an interview with the psychologist of the Oncology Urology outpatient clinic. On the scheduled return day, patients met with the same psychologist, which applied semi-structured interviews seeking the meaning of the lived experience. After conducting the interview, the literal transcription and subsequent synthesis of what was transcribed was carried out. From the collected data, two more syntheses were made in search of the units of meaning and then analysis of the collected speeches, seeking to understand the meaning of the lived experience of each of the intervewees. The final step is to seek the shared experience of the studied phenomenom, in this case the penile cancer. After completion of the process, the syntheses were submitted to 2 independent psychologist colleagues for a better understanding of the described phenomena. Results Were interviewed 7 men who had penile cancer and underwent treatment, with total or partial penectomy. The average age of participants is 57,3 years. Of the interviewed patients, 4 are married, 2 are single but in a relationship, and 1 is divorced. All patients reported unfavorable sociocultural and socioeconomic aspects, lacking basic information on self-care and on who cared for them. The results are in a qualitative analysis. There are indications of significant themes, such as: Doubts about own masculinity and virility; Denial of pain and discomfort caused by symptoms of the penile cancer; Refusal of care; Resignation towards fate, lack of meaning in life; Sadness of having lost what makes a man normal; Ambivalence between the concern to remain a man and the concern for survival; Indiscriminate feelings, cultural precariousness; “Lack of care and waiting for the problem to go away”: characteristic culturally attributed to men. Conclusions The integrative look allows the scientific community to approach how the person feels when going through the experience and caring for the patient with a broader and more attentive look. It can be seen, even with the preliminary results, that this is an extremely painful experience that affects deep layers of human experience, and that access to information, culture and sex education could be of great help in preventing the disease. Disclosure No

The Journal of Sexual Medicine, May 1, 2023

Introduction Testicular cancer (TC) primarily affects men aged 15 to 40 years, and the incidence ... more Introduction Testicular cancer (TC) primarily affects men aged 15 to 40 years, and the incidence is around 5/100000. Tumors are usually aggressive and have a great psychological impact on patients. Penile cancer (PC) represents 2 of all types of tumors that affect men in Brazil Most of the affected population are elderly men. Usually, the tumor is identified at an advanced stage, when the only treatment available is total or partial penectomy, causing a great emotional impact. Objective This work aims to evaluate the impact of psychotherapy, in an open group, on Health Related Quality of Life (HRQOL) and Sexuality in patients with TC and PC who have been diagnosed, are undergoing treatment - surgery, radiotherapy, chemotherapy or hormone therapy - or who are being followed up after treatment Methods Data is been collected through an initial interview (Identification, Anamnesis, Health Anamnesis, Degree of Satisfaction with Life and Sexuality, Affective Emotional Assessment and Treatment Data), SF 36 short form and IIEF 5 short form questionnaire, in patients who are diagnosed, who have undergone treatment - surgery, radiotherapy or supervised monitoring - or who are being monitored at the clinic, and reapplication after 12 sessions At each session 5 questions related to the perception of the previous session will be answered. The group will be available for 2 years, once a week, and the patient will attend 12 sessions. The sessions last 90 minutes, conducted by the same psychologist. The research will be developed considering the ethical principles of secrecy, privacy, confidentiality and non identification of the interviewees' data. The study will not pose risks to the subjects and invasive techniques of the body or psychological suffering will not be used Before starting the process, the Informed Consent Form (will be delivered, as well as the provision of all details regarding the research It will also be explained that participation is voluntary and that the participant can leave the research at any time, without prejudice to their treatment and monitoring. Only patients who meet all these criteria will be included, after signing the informed consent. Results Currently, the screening of patients is being carried out to offer the possibility of participating in the open group. The project was on hold due to developments related to the COVID-19 pandemic. Conclusions As the work is at the beginning of development, there are still no preliminary conclusions. Disclosure No

The Journal of Urology, Apr 1, 2006

The Aging Male, Jul 24, 2018

The aim of this study was to evaluate the relationship between quality of life, erectile function... more The aim of this study was to evaluate the relationship between quality of life, erectile function and group psychotherapy in patients with prostate cancer undergoing radical prostatectomy. Sixty patients were evaluated for erectile function (IIEF-5), quality of life (SF-36SF), urinary incontinence (ICQI-SF and ICQI-OAB). Thirty of them had group psychotherapy two weeks before and 12 weeks after surgery. Patients who underwent group psychotherapy had better scores in IIEF-5, satisfaction with life in general, satisfaction with sexual life and in partner relationship; better results of SF-36SF, excepting two domains: bodily pain and role emotional. There were significant correlations between IIEF-5 and perception of discomfort (p ¼ .030), physical functioning (p ¼ .021), physical component (p ¼ .005) and role emotional (p ¼ .009) in patients undergoing group psychotherapy. In patients who didn't have group psychotherapy there were significant correlations between ICQI-OAB and perception of discomfort (p ¼ .025), social functioning (p ¼ .052) and role emotional (p ¼ .034); between ICQI-SF and perception of discomfort (p ¼ .0001). Group psychotherapy has a positive impact in quality of life and erectile function. There was no difference in the urinary function of the two groups. Further studies are necessary to identify the impact of self-perception and self-knowledge in the postoperative management of radical prostatectomy.

Actas urológicas españolas, 2010

Cis-platinum based chemotherapy agents are widely used in treatment of testicular cancer and its ... more Cis-platinum based chemotherapy agents are widely used in treatment of testicular cancer and its deleterious effects on spermatogenesis are well known. Therefore an extensive survey was undertaken to evaluate the effects of antioxidants in combination with Cis-platinum in an attempt to minimize its effects upon spermatogenic function of adult rats. Methods: A short-term prospective study (thirteen days) including twenty-four adult male Wistar rats was performed. Animals were assigned into one of three groups (eight per group): GI-control, GII-Cis-platinum treated and GIII-Cis-platinum plus superoxide dismutase and catalase. Histological analyses included germ cell counts, germ to Sertoli cell ratios and estimation of volume density components as well as the determination of the sperm reserves. Data was examined through one-way analysis of variance at 5% level of significance. Results: Germ cell numbers, germ cell to Sertoli cell ratios, organ weights (except body weight) and sperm reserves presented no differences among groups. However, the volumetric proportion of some components (tubular epithelium, tunica propria, Leydig cell nuclei and stroma) were affected (p<0.05) by treatment. The most prominent testicular component, the seminiferous epithelium was reduced (p<0.05) in Cis-platinum treated animals (GII). Conclusion: The use of antioxidant in association with Cis-platinum did not affect sperm production (germ cell numbers, germ to Sertoli cell ratios and sperm reserves) of adult rats. However, the deleterious effect of Cis-platinum on the seminiferous tubule epithelium was minimized by antioxidants.

The Journal of Sexual Medicine, Sep 1, 2020

The Journal of Urology, Apr 1, 2004

International Braz J Urol, Apr 1, 2019

Purpose: The 8 th edition of the TNM has been updated and improved in order to ensure a high degr... more Purpose: The 8 th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ-confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change. Materials and Methods: Prostates were step-sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan-Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model. Results: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery. Conclusions: Pathologic sub-staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage.

The Journal of Sexual Medicine, May 1, 2022