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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

Will the advances in retrograde intrarenal surgery extinguish percutaneous nephrolithotomy for stones larger than 2 cm?
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Azal Neto, Wilmar

; de Salles, Lukas Costa

; di Domenico, Bruno

; Miyaoka, Ricardo

; Reis, Leonardo O.

International braz j urol

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feb 2023, Volume 49 N. 1 Pages 143 - 149

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/s1677-5538.ibju.2022.0533

Consensus on diagnosis and management of non-metastatic castration resistant prostate cancer in Brazil: focus on patient, selection, treatment efficacy, side effects and physician's perception according to patient comorbidities
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Maluf, Fernando

; Soares, Andrey

; Avanço, Guilherme

; Hada, Aline Lury

; Cardoso, Ana Paula Garcia

; Carneiro, Arie

; Herchenhorn, Daniel

; Jardim, Denis Leonardo Fontes

; Schutz, Fabio Augusto

; Kater, Fabio Roberto

; Pereira, Felipe Moraes Toledo

; Monteiro, Fernando Sabino Marques

; Morbeck, Igor Alexandre Protzner

; Reolon, João Francisco Navarro

; Trindade, Karine Martins da

; Andrade, Livia Maria Querino da Silvo

; Nogueira, Lucas Mendes

; Furoni, Renato

; Natel, Ricardo Azze

; Reis, Rodolfo Borges dos

; Fogace, Rodrigo Nogueira

; Souza, Vinicius Carrera

International braz j urol

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mar 2021, Volume 47 N. 2 Pages 359 - 373

Abstract: En | Text: En | PDF: En

ABSTRACT Background: Non-metastatic castration resistant prostate cancer (M0 CRPC) has seen important developments in drugs and diagnostic tools in the last two years. New hormonal agents have demonstrated improvement in metastasis free survival in M0 CRPC patients and have been approved by regulatory agencies in Brazil. Additionally, newer and more sensitive imaging tools are able to detect metastasis earlier than before, which will impact the percentage of patients staged as M0 CRPC. Based on the available international guidelines, a group of Brazilian urology and medical oncology experts developed and completed a survey on the diagnosis and treatment of M0 CRPC in Brazil. These results are reviewed and summarized and associated recommendations are provided. Objective: To present survey results on management of M0 CRPC in Brazil. Design, setting, and participants: A panel of six Brazilian prostate cancer experts determined 64 questions concerning the main areas of interest: 1) staging tools, 2) treatments, 3) side effects of systemic treatment/s, and 4) osteoclast-targeted therapy. A larger panel of 28 Brazilian prostate cancer experts answered these questions in order to create country-specific recommendations discussed in this manuscript. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on the predefined questions. These answers are the panelists' opinions, not a literature review or meta-analysis. Therapies not yet approved in Brazil were excluded from answer options. Each question had five to seven relevant answers including two non-answers. Results were tabulated in real time. Conclusions: The results and recommendations presented can be used by Brazilian physicians to support the management of M0 CRPC patients. Individual clinical decision making should be supported by available data, however, for Brazil, guidelines for diagnosis and management of M0 CRPC patients have not been developed. This document will serve as a point of reference when confronting this disease stage.

https://doi.org/10.1590/s1677-5538.ibju.2020.0249 789 downloads

Exploring Urological Experience in the COVID-19 Outbreak: American Confederation of Urology (CAU) Survey
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Autrán-Gómez, Ana María

; Tobia, Ignacio

; Molina, Ricardo Castillejos

; Covarrubias, Francisco Rodríguez

; Benzing, Frank

; Maruccia, Serena

; Reis, Leonardo de O.

; Lay, Ramón Rodríguez

; Reza, Marcelo Torrico De la

; Torres, Felix Santaella

; Porras, Andrés Hernández

; Rodríguez, Alejandro

International braz j urol

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jul 2020, Volume 46 Suppl. 1 Pages 156 - 164

Abstract: En | Text: En | PDF: En

ABSTRACT Purpose: To explore the current situation faced by Latin American urology departments during the COVID-19 Outbreak in terms of knowledge, actions, prioritization of urology practices, and implementation of internal clinical management protocols for inpatients and outpatients. Material and Methods: A non-validated, structured, self-administered, electronic survey with 35 closed multiple choice questions was conducted in Spanish, Portuguese, Italian, and English and Deutsch versions from April 1st to April 30th, 2020. The survey was distributed through social networks and the official American Confederation of Urology (CAU) website. It was anonymous, mainly addressed to Latin American urologists and urology residents. It included 35 questions exploring different aspects: 1) Personal Protective Equipment (PPE) and internal management protocols for healthcare providers; 2) Priority surgeries and urological urgencies and 3) Inpatient and outpatient care. Results: Of 864 surveys received, 846 had at least 70% valid responses and were included in the statistical analyses. Surveys corresponded to South America in 62% of the cases, Central America and North America in 29.7%. 12.7% were residents. Regarding to PPE and internal management protocols, 88% confirmed the implementation of specific protocols and 45.4% have not received training to perform a safe clinical practice; only 2.3% reported being infected with COVID-19. 60.9% attended urgent surgeries. The following major uro-oncologic surgeries were reported as high priority: Radical Nephrectomy (RN) 58.4%, and Radical Cystectomy (RC) 57.3%. When we associate the capacity of hospitalization (urologic beds available) and percentage of high-priority surgery performed, we observed that centers with fewer urological beds (10-20) compared to centers with more urological beds (31-40) performed more frequently major urologic cancer surgeries: RN 54.5% vs 60.8% (p=0.0003), RC 53.1% vs 64.9% (p=0.005) respectively. Conclusions: At the time of writing (May 13th 2020) our data represents a snapshot of COVID-19 outbreak in Latin American urological practices. Our findings have practical implications and should be contextualized considering many factors related to patients and urological care: The variability of health care scenarios, institutional capacity, heterogeneity and burden of urologic disease, impact of surgical indications and decision making when prioritizing and scheduling surgeries in times of COVID-19 pandemic.

https://doi.org/10.1590/s1677-5538.ibju.2020.s119 633 downloads

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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aug 2019, Volume 45 N. 4 Pages 671 - 678

Abstract: En | Text: 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

Second brazilian consensus on the treatment of advanced prostate cancer: a SBOC-SBU-SBRT panel review
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Sasse, Andre Deeke

; Reis, Rodolfo Borges dos

; Nogueira, Lucas Mendes

; Maluf, Fernando Cotait

; Herchenhorn, Daniel

; Smaletz, Oren

; Lima, Volney Soares

; Schutz, Fábio

; Bastos, Diogo

; Wiermann, Evanius Garcia

; Morbeck, Igor Alexandre Protzner

; Jardim, Leonardo Fontes

; Souza, Vinicius Carrera

; Carvalho, Icaro Thiago

; Leite, Elton Trigo Teixeira

; Nardozza Jr., Archimedes

; Pompeo, Antonio Carlos Lima

; Bretas, Francisco

; Leal, Marcos Lima de Oliveira

; Sadi, Marcus Vinicius

; Ponte, José Ricardo Tuma da

; Carvalhal, Gustavo F.

International braz j urol

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jun 2019, Volume 45 N. 3 Pages 449 - 458

Abstract: En | Text: En | PDF: En

ABSTRACT Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The first Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.

https://doi.org/10.1590/s1677-5538.ibju.2018.0798 885 downloads

Validation of Portuguese version of Quality of Erection Questionnaire (QEQ) and comparison to International Index of Erectile Function (IIEF) and RAND 36-Item Health Survey
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Reis, Ana Luiza

; Reis, Leonardo Oliveira

; Saade, Ricardo Destro

; Santos Jr., Carlos Alberto

; Lima, Marcelo Lopes de

; Fregonesi, Adriano

International braz j urol

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feb 2015, Volume 41 N. 1 Pages 155 - 167

Abstract: En | Text: En | PDF: En

Purpose To validate the Quality of Erection Questionnaire (QEQ) considering Brazilian social-cultural aspects. Materials and Methods To determine equivalence between the Portuguese and the English QEQ versions, the Portuguese version was back-translated by two professors who are native English speakers. After language equivalence had been determined, urologists considered the QEQ Portuguese version suitable. Men with self-reported erectile dysfunction (ED) and infertile men who had a stable sexual relationship for at least 6 months were invited to answer the QEQ, the International Index of Erectile Function (IIEF) and the RAND 36-Item Health Survey (RAND-36). The questionnaires were presented together and answered without help in a private room. Internal consistency (Cronbach’s α), test-retest reliability (Spearman), convergent validity (Spearman correlation) coefficients and known-groups validity (the ability of the QEQ Portuguese version to differentiate erectile dysfunction severity groups) were assessed. Results We recruited 197 men (167 ED patients and 30 non-ED patients), mean age of 53.3 and median of 55.5 years (23-82 years). The Portuguese version of the QEQ had high internal consistency (Cronbach α=0.93), high stability between test and retest (ICC 0.83, with IC 95%: 0.76-0.88, p<0.001) and Spearman correlation coefficient r=0.82 (p<0.001), which demonstrated the high correlation between the QEQ and IIEF results. The correlations between the QEQ and RAND-36 were significantly low in ED (r=0.20, p=0.01) and non-ED patients (r=0.37, p=0.04). Conclusion The QEQ Portuguese version presented good psychometric properties and high convergent validity in relation to IIEF. The low correlations between the QEQ and the RAND-36, as well as between the IIEF and the RAND-36 indicated IIEF and QEQ specificity, which may have resulted from the patients’ psychological adaptations that minimized the impact of ED on Quality of Life (QoL) and reestablished the well-being feeling.

https://doi.org/10.1590/S1677-5538.IBJU.2015.01.21 2871 downloads

Can the learning of laparoscopic skills be quantified by the measurements of skill parameters performed in a virtual reality simulator?
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Sandy, Natascha Silva

; Cruz, Jose Arnaldo Shiomi da

; Passerotti, Carlo Camargo

; Nguyen, Hiep

; Reis, Sabrina Thalita dos

; Gouveia, Eder Maxwell

; Duarte, Ricardo Jordao

; Bruschini, Homero

; Srougi, Miguel

International braz j urol

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jun 2013, Volume 39 N. 3 Pages 371 - 376

Abstract: En | Text: En | PDF: En

Purpose To ensure patient safety and surgical efficiency, much emphasis has been placed on the training of laparoscopic skills using virtual reality simulators. The purpose of this study was to determine whether laparoscopic skills can be objectively quantified by measuring specific skill parameters during training in a virtual reality surgical simulator (VRSS). Materials and Methods Ten medical students (with no laparoscopic experience) and ten urology residents (PGY3-5 with limited laparoscopic experience) were recruited to participate in a ten-week training course in basic laparoscopic skills (camera, cutting, peg transfer and clipping skills) on a VRSS. Data were collected from the training sessions. The time that individuals took to complete each task and the errors that they made were analyzed independently. Results The mean time that individuals took to complete tasks was significantly different between the groups (p < 0.05), with the residents being faster than the medical students. The residents' group also completed the tasks with fewer errors. The majority of the subjects in both groups exhibited a significant improvement in their task completion time and error rate. Conclusion The findings in this study demonstrate that laparoscopic skills can be objectively measured in a VRSS based on quantified skill parameters, including the time spent to complete skill tasks and the associated error rate. We conclude that a VRSS is a feasible tool for training and assessing basic laparoscopic skills.

https://doi.org/10.1590/S1677-5538.IBJU.2013.03.10 2562 downloads

Perfil da demanda atendida em ambulatório de doenças profissionais e a presença de lesões por esforços repetitivos
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Reis, Ricardo J

; Pinheiro, Tarcísio MM

; Navarro, Albert

; Martin M, Miguel

Revista de Saúde Pública

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jun 2000, Volume 34 N. 3 Pages 292 - 298

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Caracterizar o perfil do paciente atendido em ambulatório de doenças profissionais de um hospital geral e, em especial, o portador da condição patológica mais freqüente: as lesões por esforços repetitivos (LER). MÉTODOS: Foram analisadas as 565 fichas-resumo de atendimento ambulatorial em saúde do trabalhador, em 1996, em função de variáveis sociodemográficas, de características do trabalho e de diagnóstico. Foram adotados os seguintes procedimentos: descrição univariável de todas as variáveis; análise bivariada, utilizando-se o teste do qui-quadrado (chi²) para variáveis categóricas; comparação de médias ou amplitudes para variável categórica e outra quantitativa; análise multivariada por meio de modelos log-linear, com transformação logit, para detectar os grupos com maior proporção de LER. RESULTADOS: Houve predomínio no atendimento de pacientes do sexo feminino com menos de 40 anos, sendo que, nos casos de LER, esse predomínio mostrou-se mais acentuado. As ocupações agrupadas apareceram em ordem decrescente, na seqüência: administrativos, operários e prestadores de serviços, sendo 59,6% pertencentes ao ramo de atividade econômica de serviços. As LER corresponderam a 56% dos diagnósticos feitos nas primeiras consultas. CONCLUSÕES: Confirmou-se a tendência de mudança no perfil epidemiológico das demandas atendidas no ambulatório de doenças profissionais, no final da década de 80, quando emergiram as LER. Deslocaram-se para uma minoria as antigas doenças profissionais decorrentes da exposição a riscos químicos e físicos, em função daquelas relacionadas às condições ergonômicas inadequadas.

OBJECTIVE: To assess the profile of outpatients seen at an occupational disease clinic of a general and repetitive strain injury (RSI) patients by using multivariate analyze. METHODS: The first 565 visit registries for the year 1996 were assessed regarding their social and demographics aspects, work characteristics, and diagnosis. All the variables were analyzed by univariate analysis method. Bivariate data were analyzed using Chi square test (chi²) for categorical variables, comparison of means or ranges for quantitative and categorical variables. Multivariate data were analyzed using log-linear models with logit-transformation to identify the groups with a larger proportion of RSI. RESULTS: Women sought the occupational diseases clinic more frequently than men, and there was a predominance of RSI cases. The occupation distribution was in order of priority as following: office workers, factory workers, and service workers. Of them, 56.9% were from the economic sector of services. RSI was seen in 56% of the patients diagnosed at their first visit. CONCLUSIONS: The analysis confirms the trends seen in the 80s regarding the epidemiological changes in occupational diseases, when RSI started to be identified and displaced to a secondary position the other common diseases (due to physical and chemical hazards) because of inadequacy of ergonomics.

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Perfil da demanda atendida em ambulatório de doenças profissionais e a presença de lesões por esforços repetitivos
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Reis, Ricardo J

; Pinheiro, Tarcísio MM

; Navarro, Albert

; Martin M, Miguel

Revista de Saúde Pública

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jun 2000, Volume 34 N. 3 Pages 292 - 298

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

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