ALEXANDRE DANILOVIC
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- Single-use flexible ureteroscopes: update and perspective in developing countries. A narrative review(2022) MAZZUCCHI, Eduardo; MARCHINI, Giovanni Scala; BERTO, Fernanda Christina Gabrigna; DENSTEDT, John; DANILOVIC, Alexandre; VICENTINI, Fabio Carvalho; TORRICELLI, Fabio Cesar Miranda; BATTAGELLO, Carlos Alfredo; SROUGI, Miguel; NAHAS, William CarlosFlexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital flexible ureteroscopes a great evolution has occurred. The first single-use flexible ureteroscope was launched in 2011 and new models are coming to the market. The aim of this article is to review the characteristics of these devices, compare their results with the reusable devices and evaluate the cost-benefits of adopting single-use flexible ureteroscopes in developing countries. Materials and Methods: an extensive review of articles listed at PubMed and published between 2000 and 2021 was performed. Results: Single-use flexible ureteroscopes have a shaft with 65 to 68cm length and weight between 119 and 277g. Their deflection goes up to 300 degrees. Their stone-free rates vary between 60 and 95% which is comparable to reusable scopes and operative times ranges from 54 to 86 minutes which are lower when compared to reusable flexible scopes. Their costs vary between 800 and 3180 US dollars. Conclusion: single-use flexible ureteroscopes are lighter and have superior quality of image when compared to fiberoptic ones. There are no definite data showing a higher stone-free rate or less complications with the use of single-use flexible ureteroscopes. Each institution must perform a cost-benefit analysis before making the decision of adopting or not such devices depending on the local circumstances.
- Deep learning is a promising technology and seems to be the future of the CT stone evaluation(2022) DANILOVIC, Alexandre
- Tranexamic acid in patients with complex stones undergoing percutaneous nephrolithotomy: a randomised, double-blinded, placebo-controlled trial(2022) BATAGELLO, Carlos A.; VICENTINI, Fabio C.; MONGA, Manoj; MILLER, Aaron W.; MARCHINI, Giovanni S.; TORRICELLI, Fabio C. M.; DANILOVIC, Alexandre; COELHO, Rafael F.; SROUGI, Miguel; NAHAS, Willian C.; MAZZUCCHI, EduardoObjectives To assess the efficacy and safety of single-dose tranexamic acid on the blood transfusion rate and outcomes of patients with complex kidney stones undergoing percutaneous nephrolithotomy (PCNL). Patients and Methods In a randomised, double-blinded, placebo-controlled trial, 192 patients with complex kidney stone (Guy's Stone Scores III-IV) were prospectively enrolled and randomised (1:1 ratio) to receive either one dose of tranexamic acid (1 g) or a placebo at the time of anaesthetic induction for PCNL. The primary outcome measure was the occurrence rate of perioperative blood transfusion. The secondary outcome measures included blood loss, operative time, stone-free rate (SFR), and complications. ClinicalTrials.gov identifier: NCT02966236. Results The overall risk of receiving a blood transfusion was reduced in the tranexamic acid group (2.2% vs 10.4%; relative risk, 0.21, 95% confidence interval [CI] 0.03-0.76, P = 0.033; number-needed-to-treat: 12). Patients randomised to the tranexamic acid group had a higher immediate and 3-month SFR compared with those in the placebo group (29% vs 14.7%, odds ratio [OR] 2.37, 95% CI 1.15-4.87, P = 0.019, and 46.2% vs 28.1%, OR 2.20, 95% CI 1.20-4.02, P = 0.011, respectively). Faster haemoglobin recovery occurred in patients in the tranexamic acid group (mean, 21.3 days; P = 0.001). No statistical differences were found in operative time and complications between groups. Conclusions Tranexamic acid administration is safe and reduces the need for blood transfusion by five-times in patients with complex kidney stones undergoing PCNL. Moreover, tranexamic acid may contribute to better stone clearance rate and faster haemoglobin recovery without increasing complications. A single dose of tranexamic acid at the time of anaesthetic induction could be considered standard clinical practice for patients with complex kidney stones undergoing PCNL.
- Treatment of renal lower pole stones: an update(2022) MAZZUCCHI, Eduardo; BERTO, Fernanda C. G.; DENSTEDT, John; DANILOVIC, Alexandre; BATAGELLO, Carlos Alfredo; TORRICELLI, Fabio C. M.; VICENTINI, Fabio C.; MARCHINI, Giovanni S.; SROUGI, Miguel
- Supine versus Prone Percutaneous Nephrolithotomy for Complex Stones: A Multicenter Randomized Controlled Trial(2022) PERRELLA, Rodrigo; VICENTINI, Fabio C.; PARO, Eliane D.; TORRICELLI, Fabio C. M.; MARCHINI, Giovani S.; DANILOVIC, Alexandre; BATAGELLO, Carlos A.; V, Priscila K. Mota; FERREIRA, Daniel B.; COHEN, David J.; MURTA, Claudio B.; CLARO, Joaquim F. A.; GIUSTI, Guido; MONGA, Manoj; NAHAS, William C.; SROUGI, Miguel; MAZZUCCHI, EduardoPurpose: High-quality evidence comparing supine to prone percutaneous nephrolithotomy (PCNL) for the treatment of complex stones is lacking. This study aimed to compare the outcomes of supine position (SUP) and prone position (PRO) PCNL. Materials and Method: A noninferior randomized controlled trial was per formed according to the CONSORT (Consolidated Standards for Reporting Trials) criteria. The inclusion criteria were patients over 18 years of age with complex stones. SUP was performed in the Barts flank-free modified position. Except for positioning, all the surgical parameters were identical. The primary outcome was the difference in the success rate on the first postoperative day (POD1) between groups. The secondary outcome was the difference in the stone-free rate (SFR) on the 90th postoperative day (final SFR). A non-inferiority margin of 15% was used. Demographic, operative, and safety variables were compared between the groups. Statistical significance was set at p <0.05. Results: Overall, 112 patients were randomized and their demographic characteristics were comparable. The success rates on POD1 were similar (SUP: 62.5% vs PRO: 57.1%, p = 0.563). The difference observed (-5.4%) was lower than the predefined limit. The final SFRs were also similar (SUP: 55.4% vs PRO: 50.0%, p =0.571). SUP had a shorter operative time (mean +/- SD 117.9 +/- 39.1 minutes vs 147.6 +/- 38.8 minutes, p <0.001) and PRO had a higher rate of Clavien >= 3 complications (14.3% vs 3.6%, p =0.045). Conclusions: Positioning during PCNL for complex kidney stones did not impact the success rates; consequently, both positions may be suitable. However, SUP might be associated with a lower high-grade complication rate.