Valdemar Ortiz | Universidade Federal de São Paulo (UNIFESP) (original) (raw)

Papers by Valdemar Ortiz

Research paper thumbnail of Comparison between ultrasound and noncontrast helical computed tomography for identification of acute ureterolithiasis in a teaching hospital setting

Sao Paulo Medical Journal, 2007

Recent studies have shown noncontrast computed tomography (NCT) to be more effective than ultraso... more Recent studies have shown noncontrast computed tomography (NCT) to be more effective than ultrasound (US) for imaging acute ureterolithiasis. However, to our knowledge, there are few studies directly comparing these techniques in an emergency teaching hospital setting. The objectives of this study were to compare the diagnostic accuracy of US and NCT performed by senior radiology residents for diagnosing acute ureterolithiasis; and to assess interobserver agreement on tomography interpretations by residents and experienced abdominal radiologists. Prospective study of 52 consecutive patients, who underwent both US and NCT within an interval of eight hours, at Hospital São Paulo. US scans were performed by senior residents and read by experienced radiologists. NCT scan images were read by senior residents, and subsequently by three abdominal radiologists. The interobserver variability was assessed using the kappa statistic. Ureteral calculi were found in 40 out of 52 patients (77%). US presented sensitivity of 22% and specificity of 100%. When collecting system dilatation was associated, US demonstrated 73% sensitivity, 82% specificity. The interobserver agreement in NCT analysis was very high with regard to identification of calculi, collecting system dilatation and stranding of perinephric fat. US has limited value for identifying ureteral calculi in comparison with NCT, even when collecting system dilatation is present. Residents and abdominal radiologists demonstrated excellent agreement rates for ureteral calculi, identification of collecting system dilatation and stranding of perinephric fat on NCT.

Research paper thumbnail of The Ochoa urofacial syndrome: recognize the peculiar smile and avoid severe urological and renal complications

Einstein (São Paulo), 2015

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facia... more Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients' medical records were reviewed and patients' urological status clinically reassessed. At last evaluation patients' mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.

Research paper thumbnail of 318 ROLE OF URINARY AND UROTHELIAL GLYCOSAMINOGLYCANS CONCENTRATIONS AND DMSO LOCAL INTERACTION IN AN EXPERIMENTAL RAT MODEL OF NON-BACTERIAL CYSTITIS

European Urology Supplements, 2007

During increase in abdominal pressure, urinary continence is maintained by urethral closure mecha... more During increase in abdominal pressure, urinary continence is maintained by urethral closure mechanisms. In rats and dogs, passive and active urethral closure mechanisms have been already described. The similarities in the effects of duloxetine on external urethral sphincter (EUS) activity in cat and human indicate that micturition in the cat may be a useful model for developing centrally acting serotonergic agents for the treatment of low urinary tract dysfunction (De Groat, Brit. J. Pharm. 2006). This study investigated urethral closure mechanisms under stress condition, sneezing, in anesthetized female cats.

Research paper thumbnail of Categorization of Bladder Dynamics and Treatment after Fetal Myelomeningocele Repair: First 50 Cases Prospectively Assessed

The Journal of urology, Jan 25, 2015

We categorized bladder patterns and principles of treatment applied to patients who underwent mye... more We categorized bladder patterns and principles of treatment applied to patients who underwent myelomeningocele repair during gestation in a prospective urological assessment. We performed urinary tract ultrasound, voiding cystourethrogram and urodynamic evaluation. We then categorized patients into 4 patterns, including normal, high risk (overactive bladder with detrusor leak point pressure greater than 40 cm H2O and high filling pressure also greater than 40 cm H2O), incontinent and underactive bladder. A total of 51 patients were enrolled in study at the first medical appointment. Urodynamic evaluation was done in 48 of these patients as the initial investigation, enabling attribution of a bladder pattern. The high risk pattern was found in 27 patients (56.2%), 18 were incontinent and 1 had an underactive bladder. Only 2 patients (4.2%) in this series had a normal bladder. Of patients who underwent myelomeningocele closure during gestation 93.7% had significant lower urinary tract...

Research paper thumbnail of Search and identification of spermatozoa and spermatids in the ejaculate of non-obstructive azoospermic patients

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

To search and to identify spermatozoa and spermatids, present in the ejaculate of non-obstructive... more To search and to identify spermatozoa and spermatids, present in the ejaculate of non-obstructive azoospermic patients. 27 patients, aged between 18 and 48 years, with initial diagnosis compatible with non-obstructive azoospermia, underwent up to 3 seminal samples, with assessment of macroscopic and microscopic parameters differentiated for each sample. In the first sample, 5 microL of semen were analyzed in a Horwell chamber in order to assess the presence or absence of spermatozoa. The procedure was repeated with 2 other aliquots. In the absence of spermatozoa, the entire sample was transferred to a conic tube and following centrifugation the sediment was freshly analyzed. The second seminal sample was collected only when no spermatozoa were found in the first sample and the research was performed in the same way. In cases where spermatozoa were not seen, the sample was centrifuged and the obtained sediment was stained by the panoptic method and observed under common light microsc...

Research paper thumbnail of Carcinoma de células renais incidentais e sintomáticos: fatores patológicos e sobrevida

Revista da Associação Médica Brasileira, 2004

RESUMO -OBJETIVOS. Pacientes com carcinoma de células renais (CCR) quando diagnosticados precocem... more RESUMO -OBJETIVOS. Pacientes com carcinoma de células renais (CCR) quando diagnosticados precocemente têm maior possibilidade de cura com o tratamento cirúrgico. Este estudo tem como objetivo analisar as características anatomopatológicas dos espécimes cirúrgicos que justificam a diferença da história natural dos pacientes com CCR incidental e sintomático.

Research paper thumbnail of Renal transplantation with and without bladder augmentation in children posterior urethral valve is there a difference in the long term?

THE JOURNAL OF UROLOGY ® 805 transplants, recipient gender, donor cause of death from CVA or anox... more THE JOURNAL OF UROLOGY ® 805 transplants, recipient gender, donor cause of death from CVA or anoxia, pretransplantation diabetes, previous blood transfusion, nonheart beating donor, and donor hypertension. ROC analysis was used to calculate the area under the curve and standard error using SPSS v16.0. The per course cost of changing from non-lymphocyte-depleting antibody to lymphocyte-depleting antibody was compared with that for lymphocyte-depleting antibody induction therapy alone. RESULTS: The nomogram predicted delayed graft function with area under the curve of 0.789 with a standard error of 0.049. Nonlymphocyte-depleting antibody therapy + lymphocyte-depleting antibody induction was $7104 more expensive per course than lymphocytedepleting antibody induction alone. CONCLUSIONS: A previously described nomogram to predict delayed graft function in kidney transplants was validated on data from our center. It can be used to predict delayed graft function and the need for possible pre-emptive lymphocyte-depleting antibody induction therapy.

Research paper thumbnail of Influence of oxidative stress and alpha tocopherol supplementation on urothelial cells of the urinary bladder in ovariectomised rats

The present study was designed to investigate whether vitamin E supplementation would influence t... more The present study was designed to investigate whether vitamin E supplementation would influence the levels of oxidative stress and the damage to urothelial cell DNA in the bladders of castrated rats. A total of 30 rats of the Wistar breed were divided into 3 groups of 10 animals each. Group 1 underwent a sham procedure and was killed after 30 days; group 2 underwent bilateral oophorectomy and was killed after 30 days without receiving vitamin E supplementation and group 3 underwent bilateral oophorectomy and received vitamin E supplementation at a dose of 1,000 IU/kg once a week intra-muscularly for 30 days. Four weeks after the procedure, the rats were anesthetised and their bladders were rapidly removed, frozen and stored at −70°C for Comet assaying, which was carried out on lymphocytes and vesicular urothelium cells. The 8-isoprostane concentration in plasma was also determined to confirm the presence of oxidative stress. The 8-isoprostane levels found were higher in oophorectomised rats that had not received vitamin E supplementation than in the sham group and the oophorectomised group with vitamin replacement. Tail moment analysis on the urothelial cells demonstrated that the oophorectomised group presented DNA damage that was statistically significant in comparison with the other groups. On the basis of the above data, vitamin E decreased the effects of oophorectomy on lipid peroxidation and avoided the DNA damage observed in urothelial cells.

Research paper thumbnail of A new nomogram to predict pathologic outcome following radical prostatectomy

International braz j urol, 2006

To develop a preoperative nomogram to predict pathologic outcome in patients submitted to radical... more To develop a preoperative nomogram to predict pathologic outcome in patients submitted to radical prostatectomy for clinical localized prostate cancer. Nine hundred and sixty patients with clinical stage T1 and T2 prostate cancer were evaluated following radical prostatectomy, and 898 were included in the study. Following a multivariate analysis, nomograms were developed incorporating serum PSA, biopsy Gleason score, and percentage of positive biopsy cores in order to predict the risks of extraprostatic tumor extension, and seminal vesicle involvement. In univariate analysis there was a significant association between percentage of positive biopsy cores (p < 0.001), serum PSA (p = 0.001) and biopsy Gleason score (p < 0.001) with extraprostatic tumor extension. A similar pathologic outcome was seen among tumors with Gleason score 7, and Gleason score 8 to 10. In multivariate analysis, the 3 preoperative variables showed independent significance to predict tumor extension. This allowed the development of nomogram-1 (using Gleason scores in 3 categories - 2 to 6, 7 and 8 to 10) and nomogram-2 (using Gleason scores in 2 categories - 2 to 6 and 7 to 10) to predict disease extension based on these 3 parameters. In the validation analysis, 87% and 91.1% of the time the nomograms-1 and 2, correctly predicted the probability of a pathological stage to within 10% respectively. Incorporating percent of positive biopsy cores to a nomogram that includes preoperative serum PSA and biopsy Gleason score, can accurately predict the presence of extraprostatic disease extension in patients with clinical localized prostate cancer.

Research paper thumbnail of Predictive value of PSA velocity over early clinical and pathological parameters in patients with localized prostate cancer who undergo radical retropubic prostatectomy

International braz j urol, 2004

Objectives: To analyze the behavior of the prostate specific antigen velocity (PSAV) in localized... more Objectives: To analyze the behavior of the prostate specific antigen velocity (PSAV) in localized prostate adenocarcinoma.

Research paper thumbnail of Avaliação da extensão da neoplasia em câncer da próstata: valor do PSA, da percentagem de fragmentos positivos e da escala de Gleason

Revista da Associação Médica Brasileira, 2003

Research paper thumbnail of PSA e medidas antropométricas em índios da Amazônia: avaliação da comunidade Parkatejê

Revista De Saude Publica, 2003

... físico simples e anotadas as medidas antropométricas para se obter o índice de massa corporal... more ... físico simples e anotadas as medidas antropométricas para se obter o índice de massa corporal (IMC), (normal <25 Kg/m²), ea relação cintura/quadril (RCQ), (normal <0,9). Fo-ram realizadas dosagens ... 8. Heshmat MY, Kaul L, Kori J, Jackson MA, Jackson AG, Jones GW et al. ...

Research paper thumbnail of Total urogenital mobilization by CAH: A step-by-step illustration of the technique

Journal of Pediatric Urology, 2015

Congenital adrenal hyperplasia (CAH) resulting from deficient 21-hydroxylase activity is an autos... more Congenital adrenal hyperplasia (CAH) resulting from deficient 21-hydroxylase activity is an autosomal recessive disorder with an incidence of 1:5000-25,000 in Caucasian populations. Despite various techniques to treat CAH, total urogenital mobilization (TUM) has gained popularity. This technique has low morbidity, and can be performed by the perineal route with the patient in the dorsal lithotomy position without the need to separate the urethra from the vagina. We aim to demonstrate in this video the TUM technique step by step. A 9-month-old child, born with ambiguous genitalia (Prader 3) with a 46XX karyotype and CAH diagnosis presented to our facility. Endoscopy showed a 2-cm common channel. The patient was treated as described in the video and she had an uneventful clinical outcome with complete healing. TUM is an excellent alternative for treating CAH.

Research paper thumbnail of GLYCOSAMINOGLYCANS' BEHAVIOUR FOLLOWING PROTAMINE - INDUCED CYSTITIS IN RATS

European Urology Supplements, 2006

Research paper thumbnail of Elective appendicovesicostomy in association with monfort abdominoplasty in the treatment of prune belly syndrome

International braz j urol, 2006

To evaluate the role of elective appendicovesicostomy in association with Monfort abdominoplasty ... more To evaluate the role of elective appendicovesicostomy in association with Monfort abdominoplasty to avoid urinary tract infection (UTI) and renal damage in the post-operative follow-up of patients with prune belly syndrome. We followed 4 patients operated in our institution (UNIFESP) (Monfort, orchidopexy and Mitrofanoff) and compared them to 2 patients treated similarly, but without an appendicovesicostomy, in a second institution (UFBA). We evaluated postoperative clinical complications, UTI and preservation of renal parenchyma. Patients were followed as outpatients with urinalysis, ultrasonography (US) and occasionally with renal scintigraphy. Mean follow-up was 23.5 months. Immediate post-operative course was uneventful. We observed that only one patient with the Mitrofanoff channel persisted with UTI, while the 2 patients used as controls persisted with recurrent pyelonephritis (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 UTI year). Our data suggest that no morbidity was added by the appendicovesicostomy to immediate postoperative surgical recovery and that this procedure may have a beneficial effect in reducing postoperative UTI events and their consequences by reducing the postvoid residuals in the early abdominoplasty follow-up. However, we recognize that the series is small and only a longer follow-up with a larger number of patients will allow us to confirm our suppositions. We could not make any statistically significant assumptions regarding differences in renal preservation due to the same limitations.

Research paper thumbnail of The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic rats

Acta Cirurgica Brasileira, 2007

The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic ra... more The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic rats The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic rats 1 A repetição de ondas de choque extracorpóreas e a lesão do parênquima renal em ratos normais e diabéticos ABSTRACT Purpose: To assess the effect of repeated extracorporeal shock waves (ESW) on renal parenchyma of normal and diabetic rats. Methods: 40 normal rats (A) and 40 diabetic rats (B) were assigned for ESW (Direx Tripter X1 ® -14 KVA) as follow: A1/B1 and A3/B3 no ESW; A2/B2 one ESW (2,000 SW); A4/B4 two ESW (4,000 SW) in an elapsed 14 days. All the animals were sacrificed 3 days after the ESW and samples of renal parenchyma were histological prepared, stained by H&E. For each animal the frequency of hemorrhage focus (HF) in the subcapasular, interstitial and glomerulus area was calculated (porcentage) on 20 randomly histological sections. Results: No one HF was identified in all normal or diabetic animals without ESW (A1, A3 and B1, B3). In the normal rats the HF frequency was similar to one ESW (subcapsular =15%; interstitial =20% and glomerular =10%) or repetead ESW (subcapsular =25%; interstitial =20%; glomerular=10%). In diabetic rats the occurence of HF with repetead ESW was more frequent (subcapsular =40%; interstitial =30% and glomerular =10%) than with a single ESW (subcapsular =25%; interstitial =15% and glomerular =15%). Conclusion: A single ESW or a repeated ESW caused a mild and similar damage on renal cortex of normal rats. In diabetic rats the repetead ESW may result in an accumulated damage, especially with focus of hemorrhage in subcapsular and interstitial tissue and glomerulus edema.

Research paper thumbnail of Complete female epispadia: The case for perineal approach

Journal of Pediatric Urology, 2015

Complete female epispadia (CFE) is a rare congenital anomaly occurring in 1 of 500,000 live birth... more Complete female epispadia (CFE) is a rare congenital anomaly occurring in 1 of 500,000 live births. The goals of CFE management include achieving continence, while protecting the kidneys, and creating functional, cosmetic external genitalia. We demonstrate in this video the steps of the surgery and present midterm follow-up of a 6-year-old child with CFE. The patient had an excellent cosmetic result, and reported continence of 3 h period with mild leakage. The perineal infrapubic approach offers the possibility of restoring cosmesis and providing resistance in one surgery precluding the need for abdominal bladder neck surgery.

Research paper thumbnail of Single nucleotide polymorphisms of the heat shock protein 90 gene in varicocele-associated infertility

International braz j urol, 2005

Purpose: Varicoceles are associated with impaired testicular function and male infertility, but t... more Purpose: Varicoceles are associated with impaired testicular function and male infertility, but the molecular mechanisms by which fertility is affected have not been satisfactorily explained. Spermatogenesis might be affected by increased scrotal temperature, such as that caused by varicocele. HSP90 is a molecular chaperone expressed in germ cells and is related to spermatogenesis, motility, and both heat and oxidative stress. Possible correlations between coding single region nucleotide polymorphisms (cSNPs) in the HSP90 gene in patients with varicocele associated with infertility were analyzed, and polymorphisms in these exons were characterized through DNA sequencing.

Research paper thumbnail of Is continent urinary diversion feasible in children under five years of age?

International braz j urol, 2009

To review our clinical experience with urinary continent catheterizable reservoir in children und... more To review our clinical experience with urinary continent catheterizable reservoir in children under five years of age. A total of 23 patients (16 males, 7 females) with a median age of 3.64 years were evaluated. Among these, 6 (26.08%) had a posterior urethral valve, 9 (39.13%) myelomeningocele, 4 (17.39%) bladder exstrophy, 2 (8.69%) genitourinary rabdomyosarcoma, 1 (4.34%) had spinal tumor and 1 (4.34%) an ano-rectal anomaly. Perioperative complications were observed in four patients consisting of one febrile urinary tract infection, one partial operative wound dehiscence, one partial stomal dehiscence and one vesico-cutaneous fistula after a secondary exstrophy repair. The overall long-term complications rate was 40.90% and consisted of two stomal stenoses (9.09%), one neobladder mucosal extrusion (4.54%), three neobladder calculi (13.63%) and persistence of urinary incontinence in three patients (13.63%). The overall surgical revision was 36.36% and final continence rate was 95.45% with mean follow-up of 39.95 months Continent urinary diversion is technically feasible even in small children, with acceptable rates of complications.

Research paper thumbnail of Value of various PSA parameters for diagnosing prostate cancer in men with normal digital rectal examination

International braz j urol, 2004

Objectives: The risks of identifying prostate cancer (PCa) in patients with serum total PSA (tPSA... more Objectives: The risks of identifying prostate cancer (PCa) in patients with serum total PSA (tPSA) between 4 and 10 ng/dl are between 25 and 35%. There are no data in Brazil showing the incidence of disease when all variables for PSA assessment are considered altogether, specifically tPSA, free fraction, PSA velocity and PSA stratified by age. The objective in this work was to define the incidence of disease in a population of men with abnormal values of PSA variables and normal digital rectal examination.

Research paper thumbnail of Comparison between ultrasound and noncontrast helical computed tomography for identification of acute ureterolithiasis in a teaching hospital setting

Sao Paulo Medical Journal, 2007

Recent studies have shown noncontrast computed tomography (NCT) to be more effective than ultraso... more Recent studies have shown noncontrast computed tomography (NCT) to be more effective than ultrasound (US) for imaging acute ureterolithiasis. However, to our knowledge, there are few studies directly comparing these techniques in an emergency teaching hospital setting. The objectives of this study were to compare the diagnostic accuracy of US and NCT performed by senior radiology residents for diagnosing acute ureterolithiasis; and to assess interobserver agreement on tomography interpretations by residents and experienced abdominal radiologists. Prospective study of 52 consecutive patients, who underwent both US and NCT within an interval of eight hours, at Hospital São Paulo. US scans were performed by senior residents and read by experienced radiologists. NCT scan images were read by senior residents, and subsequently by three abdominal radiologists. The interobserver variability was assessed using the kappa statistic. Ureteral calculi were found in 40 out of 52 patients (77%). US presented sensitivity of 22% and specificity of 100%. When collecting system dilatation was associated, US demonstrated 73% sensitivity, 82% specificity. The interobserver agreement in NCT analysis was very high with regard to identification of calculi, collecting system dilatation and stranding of perinephric fat. US has limited value for identifying ureteral calculi in comparison with NCT, even when collecting system dilatation is present. Residents and abdominal radiologists demonstrated excellent agreement rates for ureteral calculi, identification of collecting system dilatation and stranding of perinephric fat on NCT.

Research paper thumbnail of The Ochoa urofacial syndrome: recognize the peculiar smile and avoid severe urological and renal complications

Einstein (São Paulo), 2015

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facia... more Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients' medical records were reviewed and patients' urological status clinically reassessed. At last evaluation patients' mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.

Research paper thumbnail of 318 ROLE OF URINARY AND UROTHELIAL GLYCOSAMINOGLYCANS CONCENTRATIONS AND DMSO LOCAL INTERACTION IN AN EXPERIMENTAL RAT MODEL OF NON-BACTERIAL CYSTITIS

European Urology Supplements, 2007

During increase in abdominal pressure, urinary continence is maintained by urethral closure mecha... more During increase in abdominal pressure, urinary continence is maintained by urethral closure mechanisms. In rats and dogs, passive and active urethral closure mechanisms have been already described. The similarities in the effects of duloxetine on external urethral sphincter (EUS) activity in cat and human indicate that micturition in the cat may be a useful model for developing centrally acting serotonergic agents for the treatment of low urinary tract dysfunction (De Groat, Brit. J. Pharm. 2006). This study investigated urethral closure mechanisms under stress condition, sneezing, in anesthetized female cats.

Research paper thumbnail of Categorization of Bladder Dynamics and Treatment after Fetal Myelomeningocele Repair: First 50 Cases Prospectively Assessed

The Journal of urology, Jan 25, 2015

We categorized bladder patterns and principles of treatment applied to patients who underwent mye... more We categorized bladder patterns and principles of treatment applied to patients who underwent myelomeningocele repair during gestation in a prospective urological assessment. We performed urinary tract ultrasound, voiding cystourethrogram and urodynamic evaluation. We then categorized patients into 4 patterns, including normal, high risk (overactive bladder with detrusor leak point pressure greater than 40 cm H2O and high filling pressure also greater than 40 cm H2O), incontinent and underactive bladder. A total of 51 patients were enrolled in study at the first medical appointment. Urodynamic evaluation was done in 48 of these patients as the initial investigation, enabling attribution of a bladder pattern. The high risk pattern was found in 27 patients (56.2%), 18 were incontinent and 1 had an underactive bladder. Only 2 patients (4.2%) in this series had a normal bladder. Of patients who underwent myelomeningocele closure during gestation 93.7% had significant lower urinary tract...

Research paper thumbnail of Search and identification of spermatozoa and spermatids in the ejaculate of non-obstructive azoospermic patients

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

To search and to identify spermatozoa and spermatids, present in the ejaculate of non-obstructive... more To search and to identify spermatozoa and spermatids, present in the ejaculate of non-obstructive azoospermic patients. 27 patients, aged between 18 and 48 years, with initial diagnosis compatible with non-obstructive azoospermia, underwent up to 3 seminal samples, with assessment of macroscopic and microscopic parameters differentiated for each sample. In the first sample, 5 microL of semen were analyzed in a Horwell chamber in order to assess the presence or absence of spermatozoa. The procedure was repeated with 2 other aliquots. In the absence of spermatozoa, the entire sample was transferred to a conic tube and following centrifugation the sediment was freshly analyzed. The second seminal sample was collected only when no spermatozoa were found in the first sample and the research was performed in the same way. In cases where spermatozoa were not seen, the sample was centrifuged and the obtained sediment was stained by the panoptic method and observed under common light microsc...

Research paper thumbnail of Carcinoma de células renais incidentais e sintomáticos: fatores patológicos e sobrevida

Revista da Associação Médica Brasileira, 2004

RESUMO -OBJETIVOS. Pacientes com carcinoma de células renais (CCR) quando diagnosticados precocem... more RESUMO -OBJETIVOS. Pacientes com carcinoma de células renais (CCR) quando diagnosticados precocemente têm maior possibilidade de cura com o tratamento cirúrgico. Este estudo tem como objetivo analisar as características anatomopatológicas dos espécimes cirúrgicos que justificam a diferença da história natural dos pacientes com CCR incidental e sintomático.

Research paper thumbnail of Renal transplantation with and without bladder augmentation in children posterior urethral valve is there a difference in the long term?

THE JOURNAL OF UROLOGY ® 805 transplants, recipient gender, donor cause of death from CVA or anox... more THE JOURNAL OF UROLOGY ® 805 transplants, recipient gender, donor cause of death from CVA or anoxia, pretransplantation diabetes, previous blood transfusion, nonheart beating donor, and donor hypertension. ROC analysis was used to calculate the area under the curve and standard error using SPSS v16.0. The per course cost of changing from non-lymphocyte-depleting antibody to lymphocyte-depleting antibody was compared with that for lymphocyte-depleting antibody induction therapy alone. RESULTS: The nomogram predicted delayed graft function with area under the curve of 0.789 with a standard error of 0.049. Nonlymphocyte-depleting antibody therapy + lymphocyte-depleting antibody induction was $7104 more expensive per course than lymphocytedepleting antibody induction alone. CONCLUSIONS: A previously described nomogram to predict delayed graft function in kidney transplants was validated on data from our center. It can be used to predict delayed graft function and the need for possible pre-emptive lymphocyte-depleting antibody induction therapy.

Research paper thumbnail of Influence of oxidative stress and alpha tocopherol supplementation on urothelial cells of the urinary bladder in ovariectomised rats

The present study was designed to investigate whether vitamin E supplementation would influence t... more The present study was designed to investigate whether vitamin E supplementation would influence the levels of oxidative stress and the damage to urothelial cell DNA in the bladders of castrated rats. A total of 30 rats of the Wistar breed were divided into 3 groups of 10 animals each. Group 1 underwent a sham procedure and was killed after 30 days; group 2 underwent bilateral oophorectomy and was killed after 30 days without receiving vitamin E supplementation and group 3 underwent bilateral oophorectomy and received vitamin E supplementation at a dose of 1,000 IU/kg once a week intra-muscularly for 30 days. Four weeks after the procedure, the rats were anesthetised and their bladders were rapidly removed, frozen and stored at −70°C for Comet assaying, which was carried out on lymphocytes and vesicular urothelium cells. The 8-isoprostane concentration in plasma was also determined to confirm the presence of oxidative stress. The 8-isoprostane levels found were higher in oophorectomised rats that had not received vitamin E supplementation than in the sham group and the oophorectomised group with vitamin replacement. Tail moment analysis on the urothelial cells demonstrated that the oophorectomised group presented DNA damage that was statistically significant in comparison with the other groups. On the basis of the above data, vitamin E decreased the effects of oophorectomy on lipid peroxidation and avoided the DNA damage observed in urothelial cells.

Research paper thumbnail of A new nomogram to predict pathologic outcome following radical prostatectomy

International braz j urol, 2006

To develop a preoperative nomogram to predict pathologic outcome in patients submitted to radical... more To develop a preoperative nomogram to predict pathologic outcome in patients submitted to radical prostatectomy for clinical localized prostate cancer. Nine hundred and sixty patients with clinical stage T1 and T2 prostate cancer were evaluated following radical prostatectomy, and 898 were included in the study. Following a multivariate analysis, nomograms were developed incorporating serum PSA, biopsy Gleason score, and percentage of positive biopsy cores in order to predict the risks of extraprostatic tumor extension, and seminal vesicle involvement. In univariate analysis there was a significant association between percentage of positive biopsy cores (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), serum PSA (p = 0.001) and biopsy Gleason score (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) with extraprostatic tumor extension. A similar pathologic outcome was seen among tumors with Gleason score 7, and Gleason score 8 to 10. In multivariate analysis, the 3 preoperative variables showed independent significance to predict tumor extension. This allowed the development of nomogram-1 (using Gleason scores in 3 categories - 2 to 6, 7 and 8 to 10) and nomogram-2 (using Gleason scores in 2 categories - 2 to 6 and 7 to 10) to predict disease extension based on these 3 parameters. In the validation analysis, 87% and 91.1% of the time the nomograms-1 and 2, correctly predicted the probability of a pathological stage to within 10% respectively. Incorporating percent of positive biopsy cores to a nomogram that includes preoperative serum PSA and biopsy Gleason score, can accurately predict the presence of extraprostatic disease extension in patients with clinical localized prostate cancer.

Research paper thumbnail of Predictive value of PSA velocity over early clinical and pathological parameters in patients with localized prostate cancer who undergo radical retropubic prostatectomy

International braz j urol, 2004

Objectives: To analyze the behavior of the prostate specific antigen velocity (PSAV) in localized... more Objectives: To analyze the behavior of the prostate specific antigen velocity (PSAV) in localized prostate adenocarcinoma.

Research paper thumbnail of Avaliação da extensão da neoplasia em câncer da próstata: valor do PSA, da percentagem de fragmentos positivos e da escala de Gleason

Revista da Associação Médica Brasileira, 2003

Research paper thumbnail of PSA e medidas antropométricas em índios da Amazônia: avaliação da comunidade Parkatejê

Revista De Saude Publica, 2003

... físico simples e anotadas as medidas antropométricas para se obter o índice de massa corporal... more ... físico simples e anotadas as medidas antropométricas para se obter o índice de massa corporal (IMC), (normal <25 Kg/m²), ea relação cintura/quadril (RCQ), (normal <0,9). Fo-ram realizadas dosagens ... 8. Heshmat MY, Kaul L, Kori J, Jackson MA, Jackson AG, Jones GW et al. ...

Research paper thumbnail of Total urogenital mobilization by CAH: A step-by-step illustration of the technique

Journal of Pediatric Urology, 2015

Congenital adrenal hyperplasia (CAH) resulting from deficient 21-hydroxylase activity is an autos... more Congenital adrenal hyperplasia (CAH) resulting from deficient 21-hydroxylase activity is an autosomal recessive disorder with an incidence of 1:5000-25,000 in Caucasian populations. Despite various techniques to treat CAH, total urogenital mobilization (TUM) has gained popularity. This technique has low morbidity, and can be performed by the perineal route with the patient in the dorsal lithotomy position without the need to separate the urethra from the vagina. We aim to demonstrate in this video the TUM technique step by step. A 9-month-old child, born with ambiguous genitalia (Prader 3) with a 46XX karyotype and CAH diagnosis presented to our facility. Endoscopy showed a 2-cm common channel. The patient was treated as described in the video and she had an uneventful clinical outcome with complete healing. TUM is an excellent alternative for treating CAH.

Research paper thumbnail of GLYCOSAMINOGLYCANS' BEHAVIOUR FOLLOWING PROTAMINE - INDUCED CYSTITIS IN RATS

European Urology Supplements, 2006

Research paper thumbnail of Elective appendicovesicostomy in association with monfort abdominoplasty in the treatment of prune belly syndrome

International braz j urol, 2006

To evaluate the role of elective appendicovesicostomy in association with Monfort abdominoplasty ... more To evaluate the role of elective appendicovesicostomy in association with Monfort abdominoplasty to avoid urinary tract infection (UTI) and renal damage in the post-operative follow-up of patients with prune belly syndrome. We followed 4 patients operated in our institution (UNIFESP) (Monfort, orchidopexy and Mitrofanoff) and compared them to 2 patients treated similarly, but without an appendicovesicostomy, in a second institution (UFBA). We evaluated postoperative clinical complications, UTI and preservation of renal parenchyma. Patients were followed as outpatients with urinalysis, ultrasonography (US) and occasionally with renal scintigraphy. Mean follow-up was 23.5 months. Immediate post-operative course was uneventful. We observed that only one patient with the Mitrofanoff channel persisted with UTI, while the 2 patients used as controls persisted with recurrent pyelonephritis (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 UTI year). Our data suggest that no morbidity was added by the appendicovesicostomy to immediate postoperative surgical recovery and that this procedure may have a beneficial effect in reducing postoperative UTI events and their consequences by reducing the postvoid residuals in the early abdominoplasty follow-up. However, we recognize that the series is small and only a longer follow-up with a larger number of patients will allow us to confirm our suppositions. We could not make any statistically significant assumptions regarding differences in renal preservation due to the same limitations.

Research paper thumbnail of The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic rats

Acta Cirurgica Brasileira, 2007

The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic ra... more The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic rats The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic rats 1 A repetição de ondas de choque extracorpóreas e a lesão do parênquima renal em ratos normais e diabéticos ABSTRACT Purpose: To assess the effect of repeated extracorporeal shock waves (ESW) on renal parenchyma of normal and diabetic rats. Methods: 40 normal rats (A) and 40 diabetic rats (B) were assigned for ESW (Direx Tripter X1 ® -14 KVA) as follow: A1/B1 and A3/B3 no ESW; A2/B2 one ESW (2,000 SW); A4/B4 two ESW (4,000 SW) in an elapsed 14 days. All the animals were sacrificed 3 days after the ESW and samples of renal parenchyma were histological prepared, stained by H&E. For each animal the frequency of hemorrhage focus (HF) in the subcapasular, interstitial and glomerulus area was calculated (porcentage) on 20 randomly histological sections. Results: No one HF was identified in all normal or diabetic animals without ESW (A1, A3 and B1, B3). In the normal rats the HF frequency was similar to one ESW (subcapsular =15%; interstitial =20% and glomerular =10%) or repetead ESW (subcapsular =25%; interstitial =20%; glomerular=10%). In diabetic rats the occurence of HF with repetead ESW was more frequent (subcapsular =40%; interstitial =30% and glomerular =10%) than with a single ESW (subcapsular =25%; interstitial =15% and glomerular =15%). Conclusion: A single ESW or a repeated ESW caused a mild and similar damage on renal cortex of normal rats. In diabetic rats the repetead ESW may result in an accumulated damage, especially with focus of hemorrhage in subcapsular and interstitial tissue and glomerulus edema.

Research paper thumbnail of Complete female epispadia: The case for perineal approach

Journal of Pediatric Urology, 2015

Complete female epispadia (CFE) is a rare congenital anomaly occurring in 1 of 500,000 live birth... more Complete female epispadia (CFE) is a rare congenital anomaly occurring in 1 of 500,000 live births. The goals of CFE management include achieving continence, while protecting the kidneys, and creating functional, cosmetic external genitalia. We demonstrate in this video the steps of the surgery and present midterm follow-up of a 6-year-old child with CFE. The patient had an excellent cosmetic result, and reported continence of 3 h period with mild leakage. The perineal infrapubic approach offers the possibility of restoring cosmesis and providing resistance in one surgery precluding the need for abdominal bladder neck surgery.

Research paper thumbnail of Single nucleotide polymorphisms of the heat shock protein 90 gene in varicocele-associated infertility

International braz j urol, 2005

Purpose: Varicoceles are associated with impaired testicular function and male infertility, but t... more Purpose: Varicoceles are associated with impaired testicular function and male infertility, but the molecular mechanisms by which fertility is affected have not been satisfactorily explained. Spermatogenesis might be affected by increased scrotal temperature, such as that caused by varicocele. HSP90 is a molecular chaperone expressed in germ cells and is related to spermatogenesis, motility, and both heat and oxidative stress. Possible correlations between coding single region nucleotide polymorphisms (cSNPs) in the HSP90 gene in patients with varicocele associated with infertility were analyzed, and polymorphisms in these exons were characterized through DNA sequencing.

Research paper thumbnail of Is continent urinary diversion feasible in children under five years of age?

International braz j urol, 2009

To review our clinical experience with urinary continent catheterizable reservoir in children und... more To review our clinical experience with urinary continent catheterizable reservoir in children under five years of age. A total of 23 patients (16 males, 7 females) with a median age of 3.64 years were evaluated. Among these, 6 (26.08%) had a posterior urethral valve, 9 (39.13%) myelomeningocele, 4 (17.39%) bladder exstrophy, 2 (8.69%) genitourinary rabdomyosarcoma, 1 (4.34%) had spinal tumor and 1 (4.34%) an ano-rectal anomaly. Perioperative complications were observed in four patients consisting of one febrile urinary tract infection, one partial operative wound dehiscence, one partial stomal dehiscence and one vesico-cutaneous fistula after a secondary exstrophy repair. The overall long-term complications rate was 40.90% and consisted of two stomal stenoses (9.09%), one neobladder mucosal extrusion (4.54%), three neobladder calculi (13.63%) and persistence of urinary incontinence in three patients (13.63%). The overall surgical revision was 36.36% and final continence rate was 95.45% with mean follow-up of 39.95 months Continent urinary diversion is technically feasible even in small children, with acceptable rates of complications.

Research paper thumbnail of Value of various PSA parameters for diagnosing prostate cancer in men with normal digital rectal examination

International braz j urol, 2004

Objectives: The risks of identifying prostate cancer (PCa) in patients with serum total PSA (tPSA... more Objectives: The risks of identifying prostate cancer (PCa) in patients with serum total PSA (tPSA) between 4 and 10 ng/dl are between 25 and 35%. There are no data in Brazil showing the incidence of disease when all variables for PSA assessment are considered altogether, specifically tPSA, free fraction, PSA velocity and PSA stratified by age. The objective in this work was to define the incidence of disease in a population of men with abnormal values of PSA variables and normal digital rectal examination.