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ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

https://doi.org/10.1590/s1677-5538.ibju.2023.0065

Radical prostatectomies for treatment of prostate cancer: trends in a ten-year period in public health services in the city of São Paulo, Brazil
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Takemura, Lucas Seiti

; Barbosa, Álan Roger Gomes

; Amaral, Breno Santos

; Bosco, Alvaro Alexandre Dias

; Lourenço, Danilo Budib

; Apezzato, Marcelo

; Barbosa, João Arthur Brunhara Alves

; Faria, Eliney Ferreira

; Bianco, Bianca

; Lemos, Gustavo Caserta

; Carneiro, Arie

einstein (São Paulo)

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2022, Volume 20 elocation eAO0049

Resumo: En | Texto: En | PDF: En

ABSTRACT Objective To analyze the characteristics of public health services related to radical prostatectomy, according to hospital volume of surgeries and stratified as academic and non-academic centers. Methods An ecological study was conducted using a database available in TabNet platform of the Unified Health System Department of Informatics. Number of surgeries, length of hospital stay, length of stay in intensive care unit, in-hospital mortality rate, and cost of hospitalization were evaluated. The hospitals were divided into three subgroups according to surgery volume (tercile), and results were compared. The same comparisons were made among academic and non-academic centers. We considered academic centers those providing Urology residency program. Results A total of 11,259 radical prostatectomies were performed in the city of São Paulo between 2008 and 2018. We observed a significant trend of increase in radical prostatectomies for treating prostate cancer over the years (p=0.007). The length of stay in intensive care unit, and number of deaths were not statistically different among centers with diverse surgery volume, nor between academic and non-academic centers. However, length of hospital stay was significantly shorter in academic centers (p=0.043), while cost of hospitalization was significantly higher in high-volume center compared to low- (p<0.001) and intermediate-volume centers (p<0.001). Conclusion Length of hospital stay for radical prostatectomies performed in public services in the city of São Paulo was shorter in academic centers, whereas hospitals with a high volume of surgeries showed greater cost of hospitalization.

https://doi.org/10.31744/einstein_journal/2022ao0049

Role of salvage lymph node dissection in patients previously treated for prostate cancer: systematic review
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Fantin, João Paulo Pretti

; Furst, Maria Claudia Bicudo

; Tobias-Machado, Marcos

; Muller, Roberto Lodeiro

; Machado, Roberto Dias

; Santos, Alexandre Cesar

; Magnabosco, Wesley Justino

; Alcantara-Quispe, Cinthia

; Faria, Eliney Ferreira

International braz j urol

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Jun 2021, Volume 47 Nº 3 Páginas 484 - 494

Resumo: En | Texto: En | PDF: En

ABSTRACT Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.

https://doi.org/10.1590/s1677-5538.ibju.2020.0051 450 downloads

Robotic parastomal hernia repair
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Tobias-Machado, Marcos

; Gomes, Daniel Coser

; Faria, Eliney Ferreira

; Zampolli, Hamilton de Campos

International braz j urol

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Mar 2021, Volume 47 Nº 2 Páginas 857 - 858

Resumo: En | Texto: En | PDF: En

ABSTRACT Introduction and Objective: Annually, more than one hundred thousand new stomas are created in the United States and near 30-50% of those will develop parastomal hernia (1). Occasionally parastomal hernias may result in life threatening complications such as bowel obstruction or strangulation requiring urgent surgical intervention (2). The minimally invasive surgery for these hernias are preferred, specially when the primary case was either laparoscopic or robot-assisted. Our objective is to demonstrate a step-by-step robotic approach with and without mesh placement and their outcomes in two different scenarios: elective and emergency. Materials and Methods: We present two cases, a 56-year-old male with three years prior robot-assisted radical cystectomy with ileal conduit and a 82-year-old male with five year post operation of laparoscopic radical cystectomy with bilateral ureterostomies. Both of them had parastomal hernia, the first case was an urgency due to bowel obstruction while the second case was an elective procedure. Using three portals, we choose the primary repair for the first case and placement of a biological mesh within the keyhole technique (3) for the second one. Results: In the first case we had an operative time of 110min, total blood loss of 40cc and for the second case an operative time of 140min with total blood loss of 20cc. Both patients were discharged within 24h and had a follow-up of 2 years with no recurrence. Conclusions: The capability for complex sutures and dissection of intracorporeal structures makes the robotic platform a powerful ally (4) and we believe in its superiority over conventional laparoscopy. Although further studies are required, our initial series suggests that the robotic parastomal hernia repair is feasible and reproducible, with or without mesh placement and could be demonstrated its use for either elective or emergency situations.

https://doi.org/10.1590/s1677-5538.ibju.2020.0347 397 downloads

Editorial Comment: Impact of Obesity on Perioperative Outcomes at Robotic-assisted and Open Radical Prostatectomy: Results From the National Inpatient Sample
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Faria, Eliney F.

International braz j urol

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Fev 2021, Volume 47 Nº 1 Páginas 198 - 199

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/s1677-5538.ibju.2021.01.07 338 downloads

Vaginal sparing in laparoscopic radical cystectomy for females: feasibility and technical notes
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Alcántara-Quispe, Cinthia

; Faria, Eliney Ferreira

; Santos, Alexandre Cesar

; Magnabosco, Wesley Justino

; Fantin, João

; Tobias-Machado, Marcos

; Machado, Roberto Dias

International braz j urol

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Dez 2020, Volume 46 Nº 6 Páginas 1109 - 1110

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/s1677-5538.ibju.2019.0021 343 downloads

Editorial Comment: Does the Use of a Robot Decrease the Complication Rate Adherent to Radical Cystectomy? A Systematic Review and Meta-Analysis of Studies Comparing Open with Robotic Counterparts
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Faria, Eliney F.

International braz j urol

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Ago 2020, Volume 46 Nº 4 Páginas 657 - 658

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/s1677-5538.ibju.2020.04.06 254 downloads

Editorial Comment: Overall survival prediction in metastatic castration-resistant prostate cancer treated with radium-223
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Reis, Rodolfo Borges dos

; Muglia, Valdair

; Faria, Eliney F.

International braz j urol

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Ago 2020, Volume 46 Nº 4 Páginas 612 - 613

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/s1677-5538.0343.1 260 downloads

Editorial Comment: Laparoscopy versus robotic-assisted pyeloplasty in children: preliminary results of a pilot prospective randomized controlled trial
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Faria, Eliney F.

International braz j urol

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Ago 2020, Volume 46 Nº 4 Páginas 655 - 656

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/s1677-5538.ibju.2020.04.05 259 downloads

10.

Editorial Comment: Does YouTube include high-quality resources for training on laparoscopic and robotic radical prostatectomy?
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Faria, Eliney F.

International braz j urol

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Mar 2020, Volume 46 Nº 2 Páginas 279 - 280

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/s1677-5538.ibju.2020.02.08 265 downloads

11.

Editorial Comment: Best practices in near-infrared fluorescence imaging with indocyanine green (NIRF/ICG)-guided robotic urologic surgery: a systematic review-based expert consensus
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Faria, Eliney F.

International braz j urol

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Mar 2020, Volume 46 Nº 2 Páginas 281 - 282

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/s1677-5538.ibju.2020.02.09 347 downloads

12.

Prostate cancer screening among elderly men in Brazil: should we diagnose or not?
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Mori, Rafael Ribeiro

; Faria, Eliney Ferreira

; Mauad, Edmundo Carvalho

; Rodrigues Jr., Antonio Antunes

; Reis, Rodolfo Borges dos

International braz j urol

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Fev 2020, Volume 46 Nº 1 Páginas 34 - 41

Resumo: En | Texto: En | PDF: En

ABSTRACT Purpose: Prostate cancer screening in the elderly is controversial. The Brazilian government and the National Cancer Institute (INCA) do not recommend systematic screening. Our purpose was to assess prevalence and aggressiveness of prostate cancer in men aged 70 years and above, on the first Latin American database to date. Materials and Methods: Cross-sectional study (n=17,571) from 231 municipalities, visited by Mobile Cancer Prevention Units of a prostate-specific antigen (PSA) based opportunistic screening program, between 2004 and 2007. The criteria for biopsy were: PSA>4.0ng/ml, or PSA 2.5-4.0ng/ml with free/total PSA ratio ≤15%, or suspicious digital rectal examination findings. The screened men were stratified in two age groups (45-69 years, and ≥70 years). These groups were compared regarding prostate cancer prevalence and aggressiveness criteria (PSA, Gleason score from biopsy and TNM staging). Results: The prevalence of prostate cancer found was 3.7%. When compared to men aged 45-69 years, individuals aged 70 years and above presented cancer prevalence about three times higher (prevalence ratio 2.9, p<0.01), and greater likelihood to present PSA level above 10.0ng/ml at diagnosis (odds ratio 2.63, p<0.01). The group of elderly men also presented prevalence of histologically aggressive disease (Gleason 8-10) 3.6 times higher (p<0.01), and 5-fold greater prevalence of metastases (PR 4.95, p<0.05). Conclusions: Prostate cancer screening in men aged over 70 may be relevant in Brazil, considering the absence of systematic screening, higher prevalence and higher probability of high-risk disease found in this age range of the population studied.

https://doi.org/10.1590/s1677-5538.ibju.2019.0022 816 downloads

13.

External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes
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Maciel, Carlos Vaz de Melo

; Machado, Roberto Dias

; Morini, Mariana Andozia

; Mattos, Pablo Aloisio Lima

; Reis, Ricardo dos

; Reis, Rodolfo Borges dos

; Guimarães, Gustavo Cardoso

; Cunha, Isabela Werneck da

; Faria, Eliney Ferreira

International braz j urol

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Ago 2019, Volume 45 Nº 4 Páginas 671 - 678

Resumo: En | Texto: En | PDF: En

ABSTRACT Introduction Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population. Materials and methods We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-one-out, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC. Results We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample. Conclusions In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.

https://doi.org/10.1590/s1677-5538.ibju.2018.0756 534 downloads

14.

Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder
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Quispe, Cinthia Alcántara

; Machado, Roberto Dias

; Magnabosco, Wesley Justino

; Santos, Alexandre Cesar

; Faria, Eliney Ferreira

International braz j urol

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Out 2018, Volume 44 Nº 5 Páginas 1036 - 1041

Resumo: En | Texto: En | PDF: En

ABSTRACT Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome. This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula. In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.

https://doi.org/10.1590/s1677-5538.ibju.2018.0005 1303 downloads

15.

Synchronous abdominal tumors: is combined laparoscopic surgery in a single approach a safe option?
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Cartapatti, Marcelo

; Machado, Roberto Dias

; Muller, Roberto Lodeiro

; Magnabosco, Wesley J.

; Santos, Alexandre César

; Chapin, Brian Francis

; Melani, Armando

; Talvane, Antonio

; Tobias-Machado, Marcos

; Faria, Eliney Ferreira

International braz j urol

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Jun 2018, Volume 44 Nº 3 Páginas 483 - 490

Resumo: En | Texto: En | PDF: En

ABSTRACT Background and Purpose: Recent advances in cancer treatment have resulted in bet- ter prognosis with impact on patient's survival, allowing an increase in incidence of a second primary neoplasm. The development of minimally invasive surgery has provided similar outcomes in comparison to open surgery with potentially less mor- bidity. Consequently, this technique has been used as a safe option to simultaneously treat synchronous abdominal malignancies during a single operating room visit. The objective of this study is to describe the experience of two tertiary cancer hospitals in Brazil, in the minimally invasive treatment of synchronous abdominal neoplasms and to evaluate its feasibility and peri-operative results. Materials and Methods: We retrospectively reviewed the data from patients who were submitted to combined laparoscopic procedures performed in two tertiary hospitals in Brazil from May 2009 to February 2015. Results: A total of 12 patients (9 males and 3 females) with a mean age of 58.83 years (range: 33 to 76 years) underwent combined laparoscopic surgeries for the treatment of at least one urological disease. The total average duration of surgery was 339.8 minutes (range: 210 to 480 min). The average amount of intraoperative bleeding was 276.6mL (range: 70 to 550mL) and length of hospitalization was 5.08 days (range: 3 to 10 days). Two patients suffered minor complications regarding Clavien system during the immediate postoperative period. Conclusions: Combined laparoscopic surgery for the treatment of synchronous tumors is feasible, viable and safe. In our study, there was a low risk of postoperative morbidity.

https://doi.org/10.1590/s1677-5538.ibju.2017.0429 501 downloads

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