URO - Artigos
Permanent URI for this collection
Browse
Recent Submissions
- A Multinational Study of The Impact of Covid-19 On Urologic Surgery Residency and WellbeingPublication . Goldman, C; Pradere, B; Mete, M; Talso, M; Bernardino, R; Campi, R; Marchalik, DObjective: To assess changes to the experiences and wellbeing of urology trainees in the United States (US) and European Union (EU) during the COVID-19 pandemic. Methods: A 72-item anonymous online survey was distributed September 2020 to urology residents of Italy, France, Portugal, and the US. The survey assessed burnout, professional fulfillment, loneliness, depression and anxiety as well as 38 COVID specific questions. Results: Two hundred twenty-three urology residents responded to the survey. Surgical exposure was the main educational concern for 81% of US and 48% of EU residents. E-learning was utilized by 100% of US and 57% of EU residents with two-thirds finding it equally or more useful than traditional didactics. No significant differences were seen comparing burnout, professional fulfillment, depression, anxiety, or loneliness among US or EU residents, 73% of US and 71% of EU residents reported good to excellent quality of life during the pandemic. In the US and EU, significantly less time was spent in the hospital, clinic, and operating room (P <.001) and residents spent more time using telehealth and working from home during the pandemic and on research projects, didactic lectures, non-medical hobbies and reading. The majority of residents reported benefit from more schedule flexibility, improved work life balance, and increased time for family, hobbies, education, and research. Conclusion: The COVID-19 pandemic has resulted in significant restructuring of residents' educational experience around the globe. Preservation of beneficial changes such as reduction of work hours and online learning should be pursued within this pandemic and beyond it.
- Extracellular Vesicle Proteome in Prostate Cancer: A Comparative Analysis of Mass Spectrometry StudiesPublication . Bernardino, RM; Leão, R; Henrique, R; Pinheiro, LC; Kumar, P; Suravajhala, P; Beck, HC; Carvalho, AS; Matthiesen, RMolecular diagnostics based on discovery research holds the promise of improving screening methods for prostate cancer (PCa). Furthermore, the congregated information prompts the question whether the urinary extracellular vesicles (uEV) proteome has been thoroughly explored, especially at the proteome level. In fact, most extracellular vesicles (EV) based biomarker studies have mainly targeted plasma or serum. Therefore, in this study, we aim to inquire about possible strategies for urinary biomarker discovery particularly focused on the proteome of urine EVs. Proteomics data deposited in the PRIDE archive were reanalyzed to target identifications of potential PCa markers. Network analysis of the markers proposed by different prostate cancer studies revealed moderate overlap. The recent throughput improvements in mass spectrometry together with the network analysis performed in this study, suggest that a larger standardized cohort may provide potential biomarkers that are able to fully characterize the heterogeneity of PCa. According to our analysis PCa studies based on urinary EV proteome presents higher protein coverage compared to plasma, plasma EV, and voided urine proteome. This together with a direct interaction of the prostate gland and urethra makes uEVs an attractive option for protein biomarker studies. In addition, urinary proteome based PCa studies must also evaluate samples from bladder and renal cancers to assess specificity for PCa.
- Magnetic Resonance Imaging Target Fusion Biopsy vs. Transrectal Ultrasound-Guided Biopsy - A Comparative Study of ISUP Score Upgrading Risk in the Final Radical Prostatectomy SpecimenPublication . Guimarães, T; Gil, M; Medeiros, M; Andrade, V; Guerra, J; Pinheiro, H; Fernandes, F; Pina, J; Lopes Dias, J; Campos Pinheiro, LObjectives: The aim of this study was to com-pare the risk of International Society of Urological Pathology (ISUP) score upgrading between magnetic resonance imaging targeted fusion biopsy (MRI-TB) and tran-srectal ultrasound-guided biopsy (TRUS-B) in the final radical prostatectomy (RP) specimen pathological report. Materials and methods: This retrospective single center study included 51 patients with prostate cancer (PCa) diagnosed with MRI-TB and 83 patients diagnosed with TRUS-B between October/2019 and July/2021. We compared the rates of ISUP score upgrading between both groups after robotic-assisted radi-cal prostatectomy (RARP) and the specific transition of each ISUP score based on biopsy modality. The rate of ISUP score concordance and downgrading were also assessed. To define the intra and interobserver concordance for each ISUP score in biopsy and RP specimen for each biopsy modality, the Cohen's Kappa coefficient was calculated. ISUP scores and biopsy modal-ity were selected for multivariate analysis and a logistic regres-sion model was built to provide independent risk factors of ISUP score upgrading. Results: The difference of the rate of upgrading between MRI-TB group and TRUS-B group was statistically significant (p = 0.007) with 42.2% of patients of TRUS-B group experiencing an upgrade in their ISUP score while only 19.6% in MRI-TB group. Concordance and downgrading rates did not statistically differ between the two groups. Strength of concordance using Cohen's Kappa coefficient was fair in both groups but higher in MRI-TB group (TRUS-B group k = 0.230; p < 0.001; concordance: 47%vs. MRI/TB group k = 0.438; p < 0.001; concordance: 62.7%). Biopsy modality and ISUP 1 on biopsy were independent predic-tors of ISUP upgrading after RP. Conclusions: MRI-TB is highly accurate with lower risk of PCa upgrading after RP than TRUS-B. Patients with ISUP 1 on biopsy have greater susceptibility to upgrading their ISUP score.
- Bladder Cancer New Biomarkers in Liquid BiopsiesPublication . Falcão, G; Barreira, JV; Parmanande, A; Carneiro, C; Campos Pinheiro, LBladder cancer is one of the most common neoplasia in men in the developed countries. Diagnosis and surveillance are made by bladder examination through cystoscopy making this one of the most expensive on cost/patient. After tumor removal, clinical staging is important for prognosis and treatment decision as non-muscle invasive (Ta and T1) and invasive (T2+) are treated in a completely different way. Today no noninvasive method has enough sensitivity to substitute cystoscopy or histological examination for tumor clinical staging. Our aim is to identify and quantify in urine, proteins that can detect and classify bladder tumors. A biomarker study was conducted using urine samples from: individuals with bladder cancer; individuals with other genitourinary disorders and individuals without urological diseases. Several proteins were found to successfully help in the discrimination of the bladder cancer stages Ta, T1 and T2+. Two biomarkerpanels were developed, one capable of detecting bladder cancer presence and other able to distinguish Ta, T1 and T2+. Our results show a significant difference between urinary proteome in patients with different bladder cancer stages. This may allow through liquid biopsies predict patient’s cancer stage. A validation study is on progress to attest this biomarker panel’s accuracy.
- The Prostate Health Index (PHI) Density: Are There Advantages Over PHI or Over the Prostate-Specific Antigen Density?Publication . Garrido, M; Ribeiro, R; Campos Pinheiro, L; Holdenrieder, S; Guimarães, JBackground and aims: Overdiagnosis of prostate cancer (PCa) should be minimized. We wanted to evaluate the diagnostic performance of the prostate health index density (PHID) and compare it with that of the prostate health index (PHI) alone and of the prostate-specific antigen density (PSAD). Materials and methods: 232 men scheduled for a prostate biopsy (prostate-specific antigen level: 2-10 µg/L), were enrolled. PHI, PHID and PSAD were evaluated considering PCa and clinically significant PCa (csPCa) as the outcomes. Results: For PCa, the area under the curve (AUC) was higher for PHID (0.823) than for PHI (0.779) and PSAD (0.776). For csPCa, the AUC was also higher for PHID (0.851) but closer to that of PSAD (0.819) and PHI (0.813). For equal sensitivities (90%) for PCa, PHID and PSAD offered the highest specificities (37%), missing the same number of cancers (n = 11). Considering csPCa, PHI and PHID had similar specificities. PSAD reached the highest specificity (50.0%), sparing 32.8% of biopsies, while missing 9 cases of csPCa. Conclusions: PHID has a better diagnostic performance than PHI for overall PCa detection, but very close to the PSAD performance. Considering csPCa, PHI and PHID perform almost equally, but PSAD has a better diagnostic performance.
- Crescimento Rápido e Simultâneo de Múltiplos Nevos Melanocíticos Associado a SeminomaPublication . Laureano, A; Chaveiro, A; Correia, R; Afonso, A; Cardoso, JOs potenciais efeitos em nevos melanocíticos, de hormonas associadas à gravidez, assim como de outras hormonas endógenas ou exógenas, são conhecidos desde há anos. Os autores descrevem o caso de um doente do sexo masculino, 35 anos, observado pelo crescimento rápido e simultâneo, num período de 6 meses, de múltiplos nevos melanocíticos, previamente existentes, localizados no tronco, associado à elevação da gonadotrofina coriónica humana subunidade beta (β-HCG) produzida por seminoma testicular. Após orquidectomia radical e radioterapia adjuvante, verificou-se indetecção desse marcador tumoral. Sem evidência de recidiva ou de crescimento adicional dos nevos após 3 anos. Foi possível estabelecer uma relação, raramente descrita, entre β-HCG derivada do seminoma e o crescimento de nevos melanocíticos.
- A Gencitabina como Alternativa Terapêutica na Ausência de BCG: A Experiência do CHLC (Hospital S. José)Publication . Andrade, V; Medeiros, M; Guimarães, T; Bernardino, R; Falcão, G; Fernandes, F; Farinha, R; Calais da Silva, F; Campos Pinheiro, LIntrodução: Os tumores não músculo invasivos da bexiga devem ser estratificados em grupos de risco de forma a adequar o tratamento após cirurgia a cada doente. Nos tumores de alto risco deve ser realizada terapêutica adjuvante com bacilo de Calmette-Guérin (BCG) intravesical durante 1 a 3 anos. Têm sido reportadas roturas de stock de BCG intravesical, tendo sido o Centro Hospitalar de Lisboa Central (CHLC) afectado nos anos 2014 e 2015, o que obrigou a uma reformulação no tratamento dos doentes que tinham indicação para realização desta terapêutica. A gencitabina poderá ser uma alternativa válida, dado que alguns estudos mostram que poderá ter um papel nos doentes de risco intermédio, como alternativa à mitomicina C, e nos de alto risco, refractários à BCG, com um perfil de toxicidade mais favorável. Material e Métodos: Trata-se de um estudo retrospectivo descritivo que incluiu doentes com tumores da bexiga não musculo-invasivos de alto risco, com início da doença em 2013/2014, afectados pelo período de escassez de BCG no Centro Hospitalar. Resultados: No CHLC, 11 doentes com tumores de alto risco foram submetidos a terapêutica com gencitabina, apenas dois exclusivamente, os restantes sequencialmente com BCG. Apenas dois doentes, tratados com BCG e gencitabina, apresentaram recidiva tumoral. No entanto, um número significativo (6 em 11) sofreram efeitos adversos, dois dos quais que levaram à interrupção da terapêutica. Conclusão: Aparentemente, a gencitabina foi uma boa alternativa de terapêutica adjuvante na ausência do tratamento gold standard (BCG), dada a existência de baixo número de recidivais tumorais, apesar do elevado número de efeitos adversos reportados.
- Development and Validation of the Metric-Based Assessment of a Robotic Vessel Dissection, Vessel Loop Positioning, Clip Applying and Bipolar Coagulation Task on an Avian ModelPublication . Puliatti, S; Amato, M; Mazzone, E; Rosiello, G; De Groote, R; Piazza, P; Sarchi, L; Farinha, R; Mottrie, A; Gallagher, AGThe evolution of robotic technology and its diffusion does not seem to have been adequately accompanied by the development and implementation of surgeon training programs that ensure skilled and safe device use at the start of the learning curve. The objective of the study is to develop and validate performance metrics for vessel dissection, vessel loop positioning, clip applying and bipolar coagulation using an avian model. Three robotic surgeons and a behavioral scientist characterized the performance metrics of the task according to the proficiency-based progression methodology. Fourteen experienced robotic surgeons from different European countries participated in a modified online Delphi consensus. Eight experienced surgeons and eight novices performed the robotic task twice. In the Delphi meeting, 100% consensus was reached on the performance metrics. Novice surgeons took 26 min to complete the entire task on trial 1 and 20 min on trial 2. Experts took 10.1 min and 9.5 min. On average the Expert Group completed the task 137% faster than the Novice Group. The amount of time to reach the vessel part of the task was also calculated. Novice surgeons took 26 min on trial 1 and 20 min on trial 2. Experts took 5.5 min and 4.8 min. On average the experts reached the vessel 200% faster than the novices. The Expert Group made 155% fewer performance errors than the Novice Group. The mean IRR of video-recorded performance assessments for all metrics was 0.96 (95% confidence intervals (CI) lower = 0.94-upper = 0.98). We report the development and validation for a standard and replicable basic robotic vessel dissection, vessel loop positioning, clip applying and bipolar coagulation task on an avian model. The development of objective performance metrics, based on a transparent and fair methodology (i.e., PBP), is the first fundamental step toward quality assured training. This task developed on the avian model proved to have good results in the validation study.
- Serum Lipids and Prostate CancerPublication . Garrido, M; Marta, J; Ribeiro, R; Campos Pinheiro, L; Guimarães, JBackground: Conflicting results are found in the literature relating serum lipids levels and prostate cancer. Some results imply a relationship between them; others contradict this association. The purpose of this study was to investigate a possible association between serum lipids levels and prostate cancer, at time of diagnosis. Methods: We measured serum levels of total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides in 237 patients submitted to a prostate biopsy, with PSA between 2 and 10 ng/ml. Patients without cancer at biopsy were used as controls, and the others were considered as cases. No information about lipid-lowering therapy, including statins, was available neither in cases nor in controls. Cases were divided into risk groups, according to the disease severity, based on staging. Lipids levels were compared between groups, using parametric and nonparametric tests. Logistic regression analysis and odds ratios were calculated. Results: LDL and total cholesterol levels were lower in patients with cancer, with the difference being statistically significant for LDL cholesterol (p = 0.010) and borderline for total cholesterol (p = 0.050). No significant differences were found between the several risk groups. Odds ratios for low LDL cholesterol (<130 mg/dl) and low total cholesterol (<200 mg/dl), with prostate cancer as the outcome, were 1.983 and 1.703, respectively. There were no significant differences between cases and controls for the other lipids. Conclusion: Lower LDL cholesterol (<130 mg/dl) and lower total cholesterol (<200 mg/dl) serum levels seem to associate with prostate cancer, at time of diagnosis.
- The Impact of Multidisciplinary Team Conferences in Urologic Cancer in a Tertiary HospitalPublication . Gil, M; Guerra, J; Andrade, V; Medeiros, M; Guimarães, T; Bernardino, R; Falcão, G; Calais da Silva, F; Campos Pinheiro, LPurpose: Multidisciplinary team (MDT) conferences are currently the standard of care in cancer patients' management. Despite evidence supporting benefits to the majority of malignancies, a paucity of data exists examining the impact in urinary and male genital cancers. This study aims to evaluate the impact of MDT conferences in urologic cancer practice. Methods: Clinical plans discussed in urologic MDT conferences in Centro Hospitalar Universitário de Lisboa Central between January 2019 and December 2019 were retrospectively analysed. Clinical plans were categorized as accepted, changed, rejected (cases that had to be re-presented to the MDT because of insufficient staging or administrative issues) or no plan. MDT conferences' impact was assessed according to type of consultation, referral medical specialty and primary tumour type. Results: 710 clinical plans were discussed at the MDT conferences. 61.8% were accepted, 10.6% were changed, 16.5% were rejected and 11.1% of cases referred to MDT discussion had no defined clinical plan. First consultations had a higher rate of accepted clinical plans (63.4%) versus subsequent consultations (56.4%). Referrals by the urology specialty had the highest rate of acceptances (64.3%). On the stratification by primary tumour site, testicular cancer had the highest acceptance rate (70.3%), whereas bladder cancer had the lowest (47.8%). Conclusions: MDT conferences had an important impact in the management of 38.2% of cases. Therefore, all patients with urologic malignancies should be referred to MDT review to ensure optimal clinical care.