This paper proposes to discuss the training methodologies for young surgeons, considering the mod... more This paper proposes to discuss the training methodologies for young surgeons, considering the modern needs, by discussing their expectations and the reality of the surgeons' job market nowadays. Scientific and technological novelties, the huge amount of information imposed daily, managerial interventions and cost issues modified radically the activities of the surgeons, especially if compared to classical conceptions. Recent re-readings of the classical ethical postulates demand a new behavior of the doctors concerning the patients and the society per se. Contemporaneous social culture bring about individual expectations concerning quality of life and professional perspective issues. It becomes necessary to modify the training methods for surgeons to make them adequate to the need of continuous learning and adaptation to new technological instruments. They also should adapt to social interactions with the patients and the other health professionals that fit nowadays expectations. Those structural adaptations are fundamental to maintain the interest of the new professionals in the area of surgery.
Ureteroceles are cystic dilatations of the submucosal terminal ureter that present anatomical var... more Ureteroceles are cystic dilatations of the submucosal terminal ureter that present anatomical variations, with several possible combinations of clinical and radiological presentations (uni or bilateral, orthotopic or ectopic, related to single or duplicated systems). An important concept is that ectopic and extravesical ureteroceles are not synonyms: an ectopic ureterocele may be intravesical, as the definition of ectopic ureterocele refers to any ureterocele that does not correspond to the implantation of the distal ureter in the normal site (the lateral limit of the trigonal bar). As a consequence, a ureterocele inserted near the bladder neck, for example, is ectopic, but still intravesical. The misunderstanding of this concept may cause difficulties to compare research data about ureteroceles, due to equating intravesical to orthotopic ureteroceles or to excluding intravesical ureteroceles from analyses concerning ectopic ureteroceles.
Introduction There are many techniques to treat congenital concealed penis (CP). Skin resurfacing... more Introduction There are many techniques to treat congenital concealed penis (CP). Skin resurfacing is the most difficult step in severe cases. We aim to show medium-term results of coronal sulcus–based triangular ventral mucosal flap (CBVMF) as a treatment of prepubertal severe CP, a recently reported technique. We aim to determine whether results are durable and if the technique is associated with persistent mucosal redundancy or with a permanent unequal penile color pattern. Methods CP cases reconstructed with CBVMF were reviewed. Preoperative complaints, degree of motivation of the child/parent to surgery, satisfaction of parent/child with results, and surgical complications were described. Results Seven patients (6 months to 6 years old) were treated with CBVMP. Two patients showed megaprepuce and another was submitted to a limited postectomy 3 years before. One family was not fully satisfied (expected “bigger penis”), but acknowledged that the penis was now well exposed. No chil...
This paper proposes to discuss the training methodologies for young surgeons, considering the mod... more This paper proposes to discuss the training methodologies for young surgeons, considering the modern needs, by discussing their expectations and the reality of the surgeons' job market nowadays. Scientific and technological novelties, the huge amount of information imposed daily, managerial interventions and cost issues modified radically the activities of the surgeons, especially if compared to classical conceptions. Recent re-readings of the classical ethical postulates demand a new behavior of the doctors concerning the patients and the society per se. Contemporaneous social culture bring about individual expectations concerning quality of life and professional perspective issues. It becomes necessary to modify the training methods for surgeons to make them adequate to the need of continuous learning and adaptation to new technological instruments. They also should adapt to social interactions with the patients and the other health professionals that fit nowadays expectations. Those structural adaptations are fundamental to maintain the interest of the new professionals in the area of surgery.
Ureteroceles are cystic dilatations of the submucosal terminal ureter that present anatomical var... more Ureteroceles are cystic dilatations of the submucosal terminal ureter that present anatomical variations, with several possible combinations of clinical and radiological presentations (uni or bilateral, orthotopic or ectopic, related to single or duplicated systems). An important concept is that ectopic and extravesical ureteroceles are not synonyms: an ectopic ureterocele may be intravesical, as the definition of ectopic ureterocele refers to any ureterocele that does not correspond to the implantation of the distal ureter in the normal site (the lateral limit of the trigonal bar). As a consequence, a ureterocele inserted near the bladder neck, for example, is ectopic, but still intravesical. The misunderstanding of this concept may cause difficulties to compare research data about ureteroceles, due to equating intravesical to orthotopic ureteroceles or to excluding intravesical ureteroceles from analyses concerning ectopic ureteroceles.
Introduction There are many techniques to treat congenital concealed penis (CP). Skin resurfacing... more Introduction There are many techniques to treat congenital concealed penis (CP). Skin resurfacing is the most difficult step in severe cases. We aim to show medium-term results of coronal sulcus–based triangular ventral mucosal flap (CBVMF) as a treatment of prepubertal severe CP, a recently reported technique. We aim to determine whether results are durable and if the technique is associated with persistent mucosal redundancy or with a permanent unequal penile color pattern. Methods CP cases reconstructed with CBVMF were reviewed. Preoperative complaints, degree of motivation of the child/parent to surgery, satisfaction of parent/child with results, and surgical complications were described. Results Seven patients (6 months to 6 years old) were treated with CBVMP. Two patients showed megaprepuce and another was submitted to a limited postectomy 3 years before. One family was not fully satisfied (expected “bigger penis”), but acknowledged that the penis was now well exposed. No chil...
Trabalho apresentado no 35o Congresso Brasileiro de Cirurgia Pediátrica, discutindo complicação d... more Trabalho apresentado no 35o Congresso Brasileiro de Cirurgia Pediátrica, discutindo complicação do tratamento endoscópico do pseudocisto de pâncreas
Hyperplastic diffuse nephroblastomatosis (HDNBM) is a rare pre-malignant condition associated to ... more Hyperplastic diffuse nephroblastomatosis (HDNBM) is a rare pre-malignant condition associated to Wilms tumor (WT) in circa 50% of the cases. The disease typically attains children in their first year of life and is treated with chemotherapy (CT) and close follow-up. Histopathology usually cannot differentiate WT and NBM: differential diagnosis depends on clinical and by imaging data. Late diagnosis is common, as well as delay of CT. Uncertainty in the indications of resections, late detection of malignant degeneration or overaggressive nephrectomies under the presumed diagnosis of WT are frequent. Inadequate follow up leads to late detection of metachronic WT, dramatic in cases of anaplastic lineage. We report 2 cases treated in on a referral service of Pediatric Urology/Oncology.
Conferência sobre controvérsias no tratamento de extrofia vesical, no 35o Congresso Brasileiro de... more Conferência sobre controvérsias no tratamento de extrofia vesical, no 35o Congresso Brasileiro de Cirurgia Pediátrica
We aim herein to describe and to explore differential diagnosis of the main causes of acute scrot... more We aim herein to describe and to explore differential diagnosis of the main causes of acute scrotum. Acute scrotum is an umbrella description that includes different causes of acute scrotal pain that present different presentations, age incidences and clinical consequences. The main individual diagnoses related to acute scrotum syndrome are testicular torsion, testicular appendix torsion and orchiepididymitis. The most important clinical aspects are to diagnose early an episode of testicular torsion, so as to avoid gonadal loss and to explore causes of acute epididymitis related to urological malformations in childhood.
Posterior urethral valves (PUV) are the most common form of urethral obstruction. The disease occ... more Posterior urethral valves (PUV) are the most common form of urethral obstruction. The disease occurs in 1:5000–1:8000 live male neonates [1]. PUV are a significant cause of perinatal mortality and one of the most common causes of kidney failure in infancy and childhood (a third of the patients suffering from PUV progress to terminal kidney failure during life, and PUV constitute 15% of children undergoing renal transplantation). Grade 5 kidney failure is rare (7:1,000,000 neonates), but is determined almost exclusively by PUV/fetal urethral obstruction and bilateral renal hypoplasia/dysplasia. Survival of such neonates in dialysis is possible in modern referral centers: around 80% survive till preschool age [2], but at the cost of a very high morbidity and the need for renal transplantation in young children.
Operative Manual of Pediatric and Adolescent Reconstruction, 2019
Hypospadias is a common malformation, with an
estimated prevalence of 1:300 males. The disease do... more Hypospadias is a common malformation, with an estimated prevalence of 1:300 males. The disease does not risk life or cause dangerous symptoms but issues with self-image, urinating normally in public places and finding sexual and romantic partners are common and affect the quality of life of children or families or adolescent patients in many different ways. Postoperative complications requiring redo operations are common. The severity of complications varies from simple to complex problems such as urethrocutaneous fistulae (Fig. 1), urethral stenosis, diverticula (Fig. 2), glans dehiscence (Fig. 3) or recurrent curvatures. The number of previous operations and type of technique are factors that determine the kind and severity of complications, as well as the technical difficulties to be encountered.1 Recurrence of curvature is the single most important factor to determine the type and the number of redo procedures. The quality of the built neourethra is also an important aspect to consider in the decision making process....
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Papers by Lisieux de Jesus
estimated prevalence of 1:300 males. The disease does
not risk life or cause dangerous symptoms but issues with
self-image, urinating normally in public places and finding
sexual and romantic partners are common and affect the
quality of life of children or families or adolescent patients
in many different ways.
Postoperative complications requiring redo operations
are common. The severity of complications varies from
simple to complex problems such as urethrocutaneous
fistulae (Fig. 1), urethral stenosis, diverticula (Fig. 2), glans
dehiscence (Fig. 3) or recurrent curvatures. The number
of previous operations and type of technique are factors
that determine the kind and severity of complications,
as well as the technical difficulties to be encountered.1
Recurrence of curvature is the single most important factor
to determine the type and the number of redo procedures.
The quality of the built neourethra is also an important
aspect to consider in the decision making process....