Antonio Macedo

Antonio Macedo
Universidade Federal de São Paulo | UNIFESP · Departamento de Pediatria

Associate Professor (Professor livre-docente)
Associate Professor PG UNIFESP, President CACAU NGO, Pediatric Urologist Albert Einstein Hospital and Leforte

About

177
Publications
33,093
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Introduction
Graduated in Medicine from the University of São Paulo (1989) and PhD in Urology by Johannes Gutenberg Universität Mainz (1996), associate professor at UNIFESP (2001). Head Urology Department AACD-Hospital. Visiting Professor UCSF, Temple and Indiana University in USA and Hebrew University- Israel, `top-ten` reviewer of JPU in 2011. Assistant editor JPU 2012-18, now Associate editor, member of the editorial board Journal of Urology 2012-18. Trained 31 fellows in pediatric urology, mentored 4 masters and 21 doctors degree. President of CACAU (NGO to support pediatric urology). Developed 5 innovative surgeries named on him, among them the Macedo ileal reservoir and Macedo-Malone ACE.
Additional affiliations
September 2018 - October 2018
Indiana University School of Medicine
Position
  • Professor
November 2017 - November 2017
Temple University
Position
  • Professor
February 2017 - present
Education
March 1994 - March 1996
Johannes Gutenberg-Universität Mainz
Field of study
  • Urology/ pediatric urology
January 1990 - December 1993
University of São Paulo
Field of study
  • General surgery/ urology
January 1984 - December 1989
University of São Paulo
Field of study
  • Medicine

Publications

Publications (177)
Article
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Objectives: High-risk bladder pattern can be defined by Urodynamic Evaluation (UE) as overactive bladder with detrusor leak point pressure higher than 40 cmH2O and/or higher filling pressures also above 40 cmH2O. We wanted to evaluate response to treatment in myelomeningocele patients operated in utero in this subgroup. Patients and methods: Fro...
Article
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Combination of two grafts: dermal graft for corporoplasty and buccal mucosa for two-stage urethroplasty
Article
Introduction Diphallia is a rare anomaly. It has a range of appearances from a small accessory penile to complete duplication. Methods We present a 2 year-old boy with complete penile duplication. The left penile was the largest. NMR (Nuclear Magnetic Resonance) suggested one corporal body for each penile and VCUG (Voiding Cystourethrogram) showed...
Article
Introduction Antegrade continence enema (ACE) is recommended for patients with fecal incontinence/constipation refractory to conservative management. The Malone ACE utilizes the appendix as a catheterizable channel whereas the Macedo–Malone (MM) precludes the use of the appendix. We aimed to illustrate the MM procedure. Methods The left colon is b...
Article
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A critica review of In utero MMC repair and bladder function based on own experience and previous publications of the authors
Article
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Introduction The purpose of this study was to determine the incidence of lower urinary tract surgery in patients with myelomeningocele (MMC) operated in utero as well as in the subgroup of patients with a minimum age of 5 years. Methods We use a previously published protocol to categorize bladder patterns and propose the treatment: high risk patte...
Article
INTRODUCTION Distal hypospadias represent the most frequent clinical presentation of hypospadias. In spite of more than 300 techniques available, there is not an ideal approach. We have proposed an alternative procedure based on the combination of minor urethral mobilization and major glans deconstruction and partial disassembly from the corpora, t...
Article
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INTRODUCTION We present a different salvage procedure for penile prosthesis implantation in a De Castro neophallus. METHODS A patient with congenital aphallia had been operated at the age of 11. Ten years later he had two non successful attempts of prosthesis implantation. Surgery consisted of adapting the implants into the aortic graft and foldin...
Article
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Objective: To assess the reliability and validity of the Quality of Life Assessment in Spina Bifida (QUALAS), children and teenager's versions (QUALAS C and T, respectively). This is the first self-applicable quality of life assessment tool for patients under 13 years of age, which also addresses the issue of urinary and fecal incontinence. Metho...
Preprint
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authors describe and present a simple way to treat penile concealment
Preprint
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Introduction: Vesicostomy should be considered in children with neuropathic bladder in case first-line therapies fail. This simple and reversible procedure can reduce febrile urinary tract infections and protect the upper urinary tract (¹) until more definitive alternatives can be proposed. We describe in this video how we approach patients that un...
Article
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Introduction: Since 2011 we have been following prospectively myelomeningocele patients treated in utero with particular interest to patients with sphincter weakness/deficiency. We investigated the changes of bladder pattern and upper urinary tract with time in children who underwent in utero repair and had low-pressure incontinence based on urody...
Article
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Introduction Prostatic utricle cysts result from incomplete regression of Mullerian duct structures and occur most frequently in males with perineal or peno-scrotal hypospadias. Utricular cysts may present with various signs and symptoms including urinary tract infection, pain and post-void incontinence, a palpable abdominal mass or recurrent epidi...
Article
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Introduction: The Renin-Angiotensin-Aldosterone System (RAAS) has been suggested as a possible marker of renal injury in chronic diseases. This study proposes to analyze the serum and urinary markers of the RAAS in myelomeningocele patients with renal function abnormalities detected on DMSA. Material and methods: Seventeen patients followed in o...
Article
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INTRODUCTION Bladder exstrophy remains one of the most challenging abnormalities in pediatric urology. We propose bladder neck transection and bladder augmentation with a catheterizable reservoir technique to achieve continence after previous anatomic reconstruction in stages. METHODS At the age of 5-6 years, we offer the transection of bladder ne...
Article
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Introduction: We present an alternative procedure for distal hypospadias consisting of urethral mobilization and partial glandar disassembly, namely GUD (glandar urethral disassembly) technique. Materials and methods: A subcoronal circumcision exposes distal dysplastic urethra. We incise the Buck´s fascia on both sides of urethra releasing it pa...
Article
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Introduction We present an alternative procedure for distal hypospadias consisting of urethral mobilization and glandular disassembly, named GUD-technique. Material and Methods After circumcision and exposure of distal dysplastic urethra, it is entirely mobilized from corpora and glans. Glans is deconstructed and incised in midline producing two w...
Article
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Purpose: In utero myelomeningocele (MMC) closure is a valid alternative to postnatal repair with unclear benefits to bladder function. We compared the bladder status in patients that underwent fetal MMC surgery and postnatal repair. Materials and methods: We retrospectively reviewed our database: Group 1 consisted of in utero surgery and group 2...
Chapter
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This chapter present in details the step-by-step procedure of Macedo ideal catheterizable reservoir
Article
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Introduction: After the successful results of in utero myelomeningocele (MMC) repair presented by the Management of Myelomeningocele Study, the concept of fetal surgery was introduced in our institution in 2011. Since then, we have been able to follow prospectively a group of patients with attention to urological care. In the present study, we wer...
Article
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INTRODUCTION: Fetal MMC repair has shown advantages towards postnatal repair procedure in regards to less ventriculoperitoneal shunt need and better motor status as suggested by the MOMS study. The urological fate of the patient, with particular attention to bladder function is not yet thoroughly understood. Herein we systematically evaluate the ef...
Chapter
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This is the presentation of a new technique for distal hypospadias based on urethral mobilization and grandad urethral disassembly
Article
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Objectives To evaluate the first one hundred cases of in utero myelomeningocele repair and urological outcome in a prospective analysis aiming to define possible improvement in bladder function. Patients and Methods We used a protocol consisting of detailed medical history, urinary tract ultrasound (US), voiding cystourethrography (VCUG) and urody...
Article
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We report a case of secondary urinary reconstruction of previously separated conjoined twins with exstrophic bladder and urinary incontinence. Patients were male and aged 13-year-old. Twin one had a history of failed enterocystoplasty that extruded and was visible like an exstrophic neobladder. He underwent a procedure to close bladder neck and rec...
Article
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Introduction: Y-type urethral duplication describes the condition in which a functional urethra is implanted in the rectum, and there is also a dysplastic topic urethra which produces mostly urinary dribbling. These patients are at risk of urinary tract complications and UTI. We aimed to present the surgical steps of a case treated by ASTRA approa...
Article
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Introduction and objective: Urethral duplication is a rare congenital anomaly, with roughly 200 cases reported in the literature (1). It is more frequent in males, with few cases reported in females. The clinical presentation differs according to the anatomical variant present. The duplication most commonly occurs in the sagittal plane with one ur...
Article
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Introduction: Severe genital abnormalities such as urogenital sinus and urethral duplication with ectopic urethra in the rectum represent a major challenge in reconstructive urology. Objective: We aimed to review our cases presenting with functional ectopic urethra implanted in the rectum that were treated through an ASTRA approach. Methods: W...
Article
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Purpose To develop a rabbit experimental study to test the hypothesis that surgical repair of hypospadias with severe ventral curvatures might be completed in one stage, if a graft, such as buccal mucosa, could be placed over the tunica vaginalis flap used in corporoplasty for ventral lengthening, with the addition of an onlay preputial island flap...
Article
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Purpose: A major complication of in utero myelomeningocele (MMC) repair is premature delivery. The prematurity rate in MOMS study was 79%, with a mean gestational age (GA) at birth of 34 weeks. Considering this particular aspect of prenatal surgery group, we speculated if prematurity could also influence the urological outcome. Material and metho...
Article
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Objective: Aphallia is a rare penile congenital abnormality. The aim of this systematic review was to assess all available literature on neophalloplasty in infancy with an interest in technical alternatives and clinical outcome. Materials and methods: We performed a Pubmed search using the terms: neophalloplasty, neophallus, and phalloplasty, an...
Article
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Introduction: Some patients with myelomeningocele need bladder augmentation (augmentation cystoplasty). The aim of this study was to evaluate the relationship between the bladder augmentation and the rectoanal inhibitory reflex (RAIR) modulation in patients with myelomeningocele. The modulation of the anorectal inhibitory reflex in accord the use...
Article
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Aims: We evaluated the long-term results with a left antegrade continence enema (LACE) approach: "Macedo-Malone (MM) procedure" to define parameters such as clinical durability of the technique and patients' compliance with the method. Methods: We reviewed the medical records of all patients that underwent the MM procedure in our institution sin...
Article
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Penile agenesis is a rare congenital abnormality with an incidence of 1 in 30 million births. We want to demonstrate in this video a new technique of neophalloplasty based on two transverse skin flaps from lower abdominal wall. The patient was placed into a prone position; the urethral meatus was found inside the rectum, 2 cm from the anal border....
Article
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Aphallia is a rare congenital abnormality with an incidence of 1 in 30 million births. In this video, we demonstrate implantation of a penile prosthesis in a neophallus performed 10 years previously in a patient aged 21. Through a midline perineal incision aiming to reach the inferior surface of the pubic arch, we created a 16-cm tunnel for prosthe...
Article
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In severe hypospadias, urethral plate division is necessary for curvature correction. To configure the new urethra, an approach has been described using a foreskin flap directly anastomosed in an 'onlay' fashion to the tunica albuginea of the corpora cavernosa. Results suggest that it is possible to use the corpus cavernosum albuginea as the poster...
Article
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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...
Article
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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 (overactiv...
Article
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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 wi...
Article
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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 perine...
Chapter
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The tunica vaginalis has been used in hypospadias repair in different ways, either as a graft or a flap. The potential benefits of using a virgin source of tissue in genital area but away from the main surgical field (urethra) confirm its versatile role as a barrier layer, part ofurethroplasty and as a way to restore corpora integrity after corporo...
Article
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Aims: To assess whether crossing rectus abdominis muscle strips, as proposed by Yachia, would change urinary catheterizable conduit's pressure profilometry, in static and dynamic conditions. Methods: Non-randomized selection of 20 continent patients that underwent Macedo's ileum-based reservoir, 10 including Yachia's technique (Study Group) and...
Article
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AimsTo report our data on initial urological presentation after in utero myelomeningocele (MMC) closure.MethodsA prospective urological assessment at first presentation was designed for patients that had undergone in utero MMC closure and referred to our urological facility. The protocol consisted of detailed medical history, renal sonography, void...
Chapter
Full-text available
The tunica vaginalis has been used in hypospadias repair in different ways, either as a graft or a flap. The potential benefits of using a virgin source of tissue in genital area but away from the main surgical field (urethra) confirm its versatile role as a barrier layer, part of urethroplasty and as a way to restore corpora integrity after corpor...
Article
Full-text available
Purpose: To compare the histological characteristics of keratinized versus non-keratinized onlay island flaps in an experimental rabbit model. Materials and methods: Sixteen male rabbits were randomly allocated into two experimental groups: keratinized and non-keratinized onlay island flaps. A defect was created in the ventral aspect of the peni...
Article
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Introduction: Cloacal exstrophy is a rare occurrence with an incidence of 1:200,000 to 1:400,000 live births. It represents one of the most challenging reconstructive endeavors faced by pediatric surgeons and urologists. Aside from the genitourinary defects, there are other associated anomalies of the gastrointestinal, musculoskeletal and neurolog...
Article
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Objective: To demonstrate ventral corporoplasty, with tunica vaginalis flap to reconstruct the corpora cavernosa, in a two-stage strategy for proximal hypospadias surgery. Methods: Assessment of residual curvature after complete urethral plate division and transverse superficial cuts in albuginea. Ventral incision of tunica albuginea to elongate...
Article
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To use anthropometric measurements to compare nutritional status in children with neurogenic bladder dysfunction secondary to meningomyelocele who underwent enterocystoplasty and those who did not undergo surgery. A case-control study was conducted in 20 children, divided into two groups: those who had enterocystoplasty (Group A) and those who did...
Article
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Objective: To conduct a systematic review on single scrotal incision orchiopexy. Materials and methods: A search was performed using Pubmed, through which 16 articles were selected out of a total of 133. The following conditions were considered exclusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic approach, r...
Article
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Objective: To evaluate in a rabbit experimental model a mechanism of continence of catheterizable urinary conduits (CUC), focusing on the behavior of intersected rectal muscle fibers in relation to the channel by histological and histochemical analysis, and secondarily to register conduit continence rates from clinical and urodynamic data. Materi...
Article
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Objective: The total urogenital mobilization (TUM) technique avoids dissection of the vagina from the urinary tract. However, in the case of a long common channel, bowel interposition for vaginal replacement may be necessary. We present a video of the TUM technique in cloacal repair with ileal neovaginoplasty. Methods: An 8-month-old female pati...
Article
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Objective: New concepts in ambiguous genitalia have questioned the strategy of female gender reassignment in cases of penile agenesis. Hence, we present a video of the construction of a phallus according to the De Castro technique as an alternative approach for this devastating condition. Methods: A 12-year-old boy with congenital penile agenesi...
Article
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Objective: To histologically evaluate, in an experimental study in rabbits, the integration process of the buccal mucosa fenestrated graft applied in the corpora cavernosa for Bracka first stage urethroplasty. Materials and methods: A urethral defect was surgically created in 16 male rabbits of the New Zealand breed through the excision of the p...
Article
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Hypospadias is one of the most common congenital anomalies in men. We searched the recent literature (since 1 January 2011) using the following keywords in the title or abstract: hypospadia or hypospadias, in order to provide the reader with an updated view of the subject. Early repair is recommended; distal forms are mainly treated by the tubulari...
Article
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Introduction: Urethral duplication is a rare congenital anomaly affecting mainly boys. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. We present a patient with urethral duplication in which the orthotopic urethra was patent in the penile segment but atresic in t...