Gustavo Bechara | UERJ - Universidade do Estado do Rio de Janeiro / Rio de Janeiro State University (original) (raw)

Papers by Gustavo Bechara

Urology case reports, Jul 1, 2020

Appendiceal carcinoma is a rare disorder. Although imaging exams can suggest carcinoma of the app... more Appendiceal carcinoma is a rare disorder. Although imaging exams can suggest carcinoma of the appendix simulating as a primary bladder cancer a transurethral biopsy is essential for diagnosis. We reported a case of a 27-year-old man, presented with hypogastric pain associated with recurrent gross hematuria and dysuria but without any intestinal symptoms such as pain, obstruction or melena. MRI revealed an enlarged appendix contiguous with the bladder. An en-bloc resection was performed and revealed appendiceal mucinous adenocarcinoma. Carcinoma of the appendix is an important differential diagnosis to other lesions and allow a good chance of cure by en bloc resection.

Journal of pediatric surgery case reports, Jun 1, 2019

Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare immune-complex small vessel sy... more Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare immune-complex small vessel systemic vasculitis involving kidney in about 50% of patients. Characteristic clinical features are recurrent urticaria, decreased serum complement, skin vasculitis, arthritis, eye inflammation, abdominal pain, glomerulonephritis and positive anti-C1q antibodies. We report a 36-year-old woman with a 12-year history of recurrent urticaria and 2 years of urticarial vasculitis. On admission, she also had arthritis, pleuritis and pericarditis, abdominal pain, pathologic urinalysis, low serum values of C3, C4 and CH50. All immunoserology was negative except for ANA 1:80 and anti-C1q 620 IU. 'Full-house' immune complex vasculitis was demonstrated in skin and lung biopsies. A kidney biopsy showed diffuse proliferative segmental active and sclerosing glomerulonephritis with mesangial and endocapillary proliferation, neutrophil exudation, necrosis, extracapillary crescents and segmental and global glomerulosclerosis. 'Full-house' glomerular and extensive extraglomerular vascular and tubulointerstitial immune deposits with dominant IgG, C3 and C1q were noted by immunofluorescence. Electron microscopy revealed electron dense deposits with an ultrastructural 'fingerprint' pattern in the glomerular mesangium, transmembranous in capillary walls and in the arteriolar wall. Our patient fulfilled the criteria for HUVS and SLE, in accordance with the not infrequent clinical and immunoserological overlapping of the two diseases.

Urology case reports, Sep 1, 2019

Tuberculosis (TB) is a secular disease caused by a bacillus, highly prevalent in Brazil. The geni... more Tuberculosis (TB) is a secular disease caused by a bacillus, highly prevalent in Brazil. The genito-urinary tract involvement is rare, with the epididymis the most affected location. Treatment usually involves the combination of 3-4 drugs for TB for 6 months and surgery can be useful in complications.

Urology Case Reports, 2018

Journal of Urology, 2015

We will provide journalists and editors with full-text copies of the articles in question prior t... more We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date. Questions regarding embargo should be directed to

The Journal of Urology, 2013

Open Journal of Urology, 2012

The clear cell carcinoma is a relatively rare tumor, represented approximately 85% by renal cell ... more The clear cell carcinoma is a relatively rare tumor, represented approximately 85% by renal cell carcinoma (RCC), but has a characteristic of early metastatic, which sometimes spread to unusual places. Metastatic tumors in the paranasal sinuses are very rare. This case report a 65 years-old patient who presented sinusitis and epitaxis as a first sign of renal cell carcinoma with metastasis to the right maxillary sinus, which was opereted at Lagoa Hospital-RJ and strengthen the inclusion of this disease in the differential diagnosis of sinus disease. The renal cell carcinoma is a relatively rare tumor, representing approximately 3% of malignant tumors. About a third of patients with renal cell carcinoma have metastasis at diagnosis. The sinuses are a rare location of metastasis. The maxillary sinuses and the paranasal sinuses are most commonly affected by metastatic tumors to the sinuses region. The most frequent primary tumor to metastasis to paranasal sinuses is the renal cell carcinoma. This report highlights the rarity of the case and the importance in the differential diagnosis of sinus disease.

Introduction: The first open pyeloplasty was performed by Kuster in 1891. For many decades open p... more Introduction: The first open pyeloplasty was performed by Kuster in 1891. For many decades open pyeloplasty was considered the treatment of choice for stenosis of the PUJ. Anterograde or retrograde endoscopic incisions emerged as alternative treatments with success rates ranging from 70% to 89%. In 1993 Shussler and Gune performed the first laparoscopic dismembered pyeloplasty, and since then success rates have been comparable to those of the open technique, but with less morbidity. Objectives: A review of patients undergoing laparoscopic pyeloplasty by the AndersonHynes technique at the federal Lagoa Hospital, Rio de Janeiro, Brazil. Materials and Methods: Between June 2008 and July 2011, twenty-four patients with PUJ stenosis underwent laparoscopic dismembered pyeloplasty at our institution. The diagnosis of PUJ stenosis was determined by history, clinical examination and imaging studies (CT, IVP or renal scintigraphy). Laparoscopic dismembered pyeloplasty was performed by the tra...

Introduction: The retrocaval ureter, also known as circuncaval ureter, was first reported by Hoch... more Introduction: The retrocaval ureter, also known as circuncaval ureter, was first reported by Hochestetter in 1893. This rare anomaly is caused by an error in the embryonic development of the inferior vena cava. Congenital abnormalities that result in obstruction of the ureter are uncommon; however, the ureter retrocaval is the most common malformation arising from a venous abnormality. Propose: The aim of this article is to report our experience in laparoscopic treatment of obstructive uropathy due to retrocaval ureter, and perform a review of the literature. Methods: A PubMed search was performed for studies published between 1990-2013, on the surgical treatment of obstructive uropathy due to the presence of retrocaval ureter. A 42 years old male patient with symptoms of back and right flank pain associated with repeated urinary infection was diagnosed with retrocaval ureter. CT imaging revealed the middle segment of the right ureter in a retrocaval position, explaining the obstruc...

Urology Case Reports, 2021

Approximately 15% of cases of renal cell carcinoma (RCC) can invade the inferior vena cava, leadi... more Approximately 15% of cases of renal cell carcinoma (RCC) can invade the inferior vena cava, leading to the formation of a thrombus inside it, which can reach the cardiac chambers in up to 1% of cases. This article reports a case of RCC with venous thrombus that reached the right atrium. The patient underwent radical nephrectomy with lymphadenectomy and tumor thrombectomy with extracorporeal circulation associated with hypothermia, without total cardiac arrest. The surgical success of this case highlights the need to study new techniques that represent better operative approaches for solid kidney injuries.

European Urology Supplements

European Urology Supplements, 2015

European Urology Supplements, 2013

Journal of Endourology Case Reports

Background: Laparoscopic port-site metastases remain rare for urologic tumors, despite the increa... more Background: Laparoscopic port-site metastases remain rare for urologic tumors, despite the increasing use of laparoscopic techniques on the approach of urologic malignancy. Herein, we report a case of port-site mass after laparoscopic radical prostatectomy whose immunohistochemistry demonstrated metastasis from a pancreatic lesion. Case Presentation: A 62-year-old man presented to our ambulatory clinic with an elevated prostate-specific antigen (PSA) of 7.7 ng/mL. Transrectal biopsies revealed prostate cancer Gleason 6 (3 + 3) on the right side. He was subjected to a transperitoneal laparoscopic radical prostatectomy at our institution. The PSA on postoperative week 6 was 0.04 ng/mL. Three months after the surgery, he comes back to the emergency department complaining of an abdominal pain especially on the right flank. Our examination of the abdomen revealed a small palpable mass at the right upper port-site scar. Computed tomography of the abdomen and pelvis, with contrast, revealed a hypodense nodular lesion located on the abdominal wall near the upper port site and adjacent to the pancreatic tail. An excisional biopsy of the lesion confirmed the presence of metastatic adenocarcinoma. Immunohistochemistry demonstrated metastasis from a pancreatic lesion. Conclusion: Port-site mass after laparoscopic radical prostatectomy is uncommon especially in quite different tumors like this one with Gleason score 6 (3 + 3). Generally, port-site recurrences after a urologic laparoscopic surgery are uncommon and are not associated with diffused peritoneal carcinomatosis. Therefore, in this situation, another tumor site should be investigated as the primary source.

BMC urology, Jan 6, 2018

Mannitol has been employed to ameliorate renal warm ischemia damage during partial nephrectomy, h... more Mannitol has been employed to ameliorate renal warm ischemia damage during partial nephrectomy, however, there is limited scientific evidence to support the use of mannitol during partial nephrectomy. The objective of the present study was to investigate the glomerular number after renal warm ischemia, with and without the use of mannitol in a Pig Model. Twenty-four male pigs were assigned into three groups. Eight animals were allocated to the sham group that was subjected to laparoscopic dissection of the left renal hilum, without renal ischemia. Eight animals were allocated to the ischemia group that had the left renal hilum clamped for 30 min through laparoscopic access. Eight animals received mannitol (250 mg/kg) before the occlusion of renal hilum for 30 min. The kidneys were collected after the euthanasia of the pigs 21 days post surgery. The right kidney was utilized as a self-control for each animal. Serum creatinine, urea levels, the weight and volume of the kidneys were me...

Urology case reports, 2018

Acta cirurgica brasileira, 2017

To investigate the glomerular number after different warm ischemia times. Thirty two pigs were as... more To investigate the glomerular number after different warm ischemia times. Thirty two pigs were assigned into four groups. Three groups (G10, G20, and G30) were treated with 10, 20, and 30 minutes of left renal warm ischemia. The sham group underwent the same surgery without renal ischemia. The animals were euthanized after 3 weeks, and the kidneys were collected. Right kidneys were used as controls. The kidney weight, volume, cortical-medullar ratio, glomerular volumetric density, volume-weighted mean glomerular volume, and the total number of glomeruli per kidney were obtained. Serum creatinine levels were assessed pre and postoperatively. Serum creatinine levels did not differ among the groups. All parameters were similar for the sham, G10, and G20 groups upon comparison of the right and left organs. The G30 group pigs' left kidneys had lower weight, volume, and cortical-medullar ratio and 24.6% less glomeruli compared to the right kidney. A negative correlation was found betw...

Urologia internationalis, Jan 30, 2017

The study aimed to evaluate the ischemic and non-ischemic areas after selective arterial occlusio... more The study aimed to evaluate the ischemic and non-ischemic areas after selective arterial occlusion by using stereological analysis of glomeruli, and to compare them with main arterial clamping and sham-operated animals. Twenty-four male pigs were used in the study. The animals were divided into 3 groups with 8 animals in each as follows: group sham, submitted to laparoscopic dissection of the renal pedicle but not submitted to ischemia; group arterial (A), submitted to left renal artery clamping; and group selective (S), submitted to left renal artery caudal branch occlusion. Groups A and S underwent 30 min of warm ischemia. Left and right kidneys were collected after 21 days and renal fragments were processed for stereological evaluation. Glomerular volume density (Vv[glom]), mean glomerular volume (MGV), and glomerular density were measured. Serum creatinine and urea were assessed preoperatively, 10 days after surgery, and before euthanasia. There was no significant difference amo...

Acta Cirurgica Brasileira, 2016

Conception and design of the study, acquisition and interpretation of data, final approval of the... more Conception and design of the study, acquisition and interpretation of data, final approval of the manuscript.