GIOVANNI SCALA MARCHINI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina
74 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 74
- Percutaneous nephrolithotomy in patients with spinal cord injury: should all these patients be automatically assigned a Guy's stone score of 4?(2021) TORRICELLI, Fabio C. M.; VICENTINI, Fabio C.; ZANETTI, Lucas; PERRELLA, Rodrigo; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; BATAGELLO, Carlos A.; MURTA, Claudio B.; CLARO, Joaquim F. A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoPurpose To assess the complication and stone-free rates of PCNL in patients with spinal cord injury (SCI) and to evaluate whether this population should be assigned a Guy's stone score (GSS) of 4. Methods A case-control study was conducted, and electronic charts were reviewed to search for patients with SCI, bladder dysfunction, and kidney stones who had undergone PCNL. Control cases were randomly selected from among patients with complete staghorn calculus (GSS = 4). Results One hundred and seventeen patients were included. Patients with SCI had a significant shorter operative time (119 vs. 141 min;p = 0.018). There were no significant differences between the groups in terms of the patients' position, number of renal tracts, bleeding or transfusion rate; however, there was a significantly higher complication rate (23.1% vs. 7.8%;p = 0.009) and a longer hospital stay (5.8 vs. 3.1 days;p = 0.002) among patients with SCI. With regards to the stone-free rate in patients with different grades of GSS patients with SCI who had a GSS of 1 had a stone-free rate of 85.7%, while those with a GSS of 2, 3, or 4 had 50%, 50%, and 31.5%, respectively (p = 0.024). Only patients with a GSS of 4 in the SCI group had outcomes that were similar to those of control patients (31.5% vs. 31.6%). Conclusion Patients with SCI should not be automatically assigned GSS 4. Stone-free rate is related to stone burden in these patients, although they do show a higher complication rate and a longer hospital stay than non-neurological patients.
- Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones(2015) TORRICELLI, Fabio Cesar Miranda; DANILOVIC, Alexandre; VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scala; SROUGI, Miguel; MAZZUCCHI, EduardoThe use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed (R) database between January 1984 and October 2013 using ""shock wave lithotripsy"" and ""stone"" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.
conferenceObject FACTORS ASSOCIATED WITH SEVERE SEPTIC EVENTS AFTER SURGICAL DECOMPRESSION OF OBSTRUCTING URETERAL STONES: A PROSPECTIVE ANALYSIS(2016) MARCHINI, Giovanni; MOSCARDI, Paulo; SROUGI, Victor; VICENTINI, Fabio; TORRICELLI, Fabio; BRITO, Artur; CAMARA, Cesar; SROUGI, Miguel; MAZZUCCHI, Eduardo- Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function(2020) TORRICELLI, Fabio C. M.; CARVALHO, Regina S.; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; BATAGELLO, Carlos A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoINTRODUCTION: Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. METHODS: Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. RESULTS: Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien <= 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). CONCLUSION: sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stonefree rate.
- Irreversible Renal Function Impairment Due to Silent Ureteral Stones(2016) MARCHINI, Giovanni S.; VICENTINI, Fabio Carvalho; MONGA, Manoj; TORRICELLI, Fabio Cesar; DANILOVIC, Alexandre; BRITO, Artur Henrique; CAMARA, Cesar; SROUGI, Miguel; MAZZUCCHI, EduardoOBJECTIVE To evaluate if renal function loss and hydronephrosis due to a silent ureteral stone might be reversed. MATERIALS AND METHODS We prospectively selected patients with silent ureteral stones between January 2006 and January 2014. A silent case was considered if there were no specific or subjective symptoms related to the ureteral stone. Patient, stone, and kidney characteristics were evaluated preoperatively, 3 and 12 months postoperatively. Renal function was accessed in the same intervals with serum creatinine (SCr), glomerular filtration rate (GFR), and Tc-99m-dimercaptosuccinic acid. Patients without complete pre-and postoperative evaluation were excluded. Primary end point was midterm progress of global and ipsilateral renal function. Secondary end points included the evaluation of renal and collecting system anatomy from diagnosis to 12 months after treatment. Analysis of variance with repeated measures and marginal homogeneity test were used to evaluate renal function and hydronephrosis progression. RESULTS Twenty-six patients met our inclusion criteria. Mean preoperative SCr and GFR were 1.24 mg/dL and 72.5 mL/min, respectively. At initial scintigraphy, mean renal function was 33.4%. Laser ureterolithotripsy was performed in 84.6% of cases and all patients were rendered stone free. Two patients (8%) developed ureteral stenosis. There was no difference regarding SCr (P =.89), GFR (P =.48), and renal function at scintigraphy (P =.19) during follow-up. Hydronephrosis significantly improved from preoperatively to 3 months postoperatively (P < .0001), but not from 3 to 12 months (P =.065). CONCLUSION Patients with silent ureteral stones present with significant impairment of ipsilateral renal function and hydronephrosis at diagnosis. On midterm follow-up evaluation, renal function of the affected unit remains stable whereas hydronephrosis improves after treatment. (C) 2016 Elsevier Inc.
- Percutaneous nephrolithotomy in patients with solitary kidney: a critical outcome analysis(2015) TORRICELLI, Fabio C. M.; PADOVANI, Guilherme P.; MARCHINI, Giovanni S.; VICENTINI, Fabio C.; DANILOVIC, Alexandre; REIS, Sabrina T.; SROUGI, Miguel; MAZZUCCHI, EduardoPurpose: To describe our experience with percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys and analyze factors that can impact on intra-operative bleeding and postoperative complications. Materials and Methods: We reviewed our stone database searching for patients with solitary kidney who underwent PCNL from Jan-05 through Oct-13. Demographic data, stone characteristics, and intra-and postoperative outcomes were recorded. Spearman correlation was performed to assess which variables could impact on bleeding and surgical complications. Linear and logistic regressions were also performed. Results: Twenty-seven patients were enrolled in this study. The mean age and BMI were 45.6 years and 28.8Kg/m(2), respectively; 45% of cases were classified as Guys 3 (partial staghorn or multiple stones) or 4 (complete staghorn) - complex cases. Stone-free rate was 67%. Eight (29.6%) patients had postoperative complications (five of them were Clavien 2 and three were Clavien 3). On univariate analysis only number of tracts was associated with increased bleeding (p=0.033) and only operative time was associated with a higher complication rate (p=0.044). Linear regression confirmed number of access tracts as significantly related to bleeding (6.3, 95% CI 2.2-10.4; p=0.005), whereas logistic regression showed no correlation between variables in study and complications. Conclusions: PCNL in solitary kidneys provides a good stone-free rate with a low rate of significant complications. Multiple access tracts are associated with increased bleeding.
- Metabolic assessment in pure struvite stones formers: is it necessary?(2021) DANILOVIC, Alexandre; FERREIRA, Thiago Augusto Cunha; GOMES, Samirah Abreu; WEI, Isabela Akemi; VICENTINI, Fabio Carvalho; TORRICELLI, Fabio Cesar Miranda; MARCHINI, Giovanni Scala; MAZZUCCHI, Eduardo; SROUGI, Miguel; NAHAS, William CarlosAbstract Background and objective: Magnesium ammonium phosphate stones (MAP), also known as struvite stones, are associated with urinary infection and impairment of renal unit. The aim of this study is to evaluate the urinary metabolic risk factors for recurrence of renal calculi in patients submitted to nephrectomy due to MAP stones. Methods: We retrospectively reviewed the charts of patients > 18 years old submitted to total nephrectomy due to pure MAP stones and pure calcium oxalate (CaOx) stones from July 2006 to July 2016. Urinary metabolic parameters were assessed through 24-hour urine exams ≥ 3 months after nephrectomy. Urinary metabolic parameters and new event related to lithiasis were compared. Results: Twenty-eight and 39 patients were included in MAP and CaOx group, respectively. Abnormalities in 24-hour urine samples were similar between groups. Hypercalciuria occurred in 7.1 and 10.3% of patients in MAP and CaOx group, respectively (p = 0.66), whereas hypocitraturia was present in 65.2 and 59.0% of patients with MAP and CaOx group, respectively (p = 0.41). No significant difference in new events was found between MAP and CaOx groups (17.9 vs. 23.1%, respectively; p = 0.60). Conclusion: A 24-hour urine evaluation should be offered to patients submitted to nephrectomy due to pure MAP stones in order to detect metabolic risk, improve treatment, and prevent stone recurrence.
- Infrared Thermometer: an accurate tool for temperature measurement during renal surgery(2013) MARCHINI, Giovanni Scala; DUARTE, Ricardo Jordao; MITRE, Anuar Ibrahim; TISEO, Bruno Camargo; CASSAO, Valter Dell'Acqua; TORRICELLI, Fabio Cesar Miranda; ARAP, Marco Antonio; SROUGI, MiguelPurpose: To evaluate infrared thermometer (IRT) accuracy compared to standard digital thermometer in measuring kidney temperature during arterial clamping with and without renal cooling. Materials and Methods: 20 pigs weighting 20Kg underwent selective right renal arterial clamping, 10 with (Group 1 - Cold Ischemia with ice slush) and 10 without renal cooling (Group 2 - Warm Ischemia). Arterial clamping was performed without venous clamping. Renal temperature was serially measured following clamping of the main renal artery with the IRT and a digital contact thermometer (DT): immediate after clamping (T0), after 2 (T2), 5 (T5) and 10 minutes (T10). Temperature values were expressed in mean, standard deviation and range for each thermometer. We used the T student test to compare means and considered p < 0.05 to be statistically significant. Results: In Group 1, mean DT surface temperature decrease was 12.6 +/- 4.1 degrees C (5-19 degrees C) while deep DT temperature decrease was 15.8 +/- 1.5 degrees C (15- 18 degrees C). For the IRT, mean temperature decrease was 9.1 +/- 3.8 degrees C (3-14 degrees C). There was no statistically significant difference between thermometers. In Group 2, surface temperature decrease for DT was 2.7 +/- 1.8 \degrees C (0-4 degrees C) and mean deep temperature decrease was 0.5 +/- 1.0 degrees C (0-3 degrees C). For IRT, mean temperature decrease was 3.1 +/- 1.9 degrees C (0-6 degrees C). No statistically significant difference between thermometers was found at any time point. Conclusions: IRT proved to be an accurate non-invasive precise device for renal temperature monitoring during kidney surgery. External ice slush cooling confirmed to be fast and effective at cooling the pig model.
- Penile enlargement with methacrylate injection: is it safe?(2013) TORRICELLI, Fabio Cesar Miranda; ANDRADE, Enrico Martins de; MARCHINI, Giovanni Scala; LOPES, Roberto Iglesias; CLARO, Joaquim Francisco Almeida; CURY, Jose; SROUGI, MiguelCONTEXT: Penis size is a great concern for men in many cultures. Despite the great variety of methods for penile augmentation, none has gained unanimous acceptance among experts in the field. However, in this era of minimally invasive procedure, injection therapy for penile augmentation has become more popular. Here we report a case of methacrylate injection in the penis that evolved with penile deformity and sexual dysfunction. This work also reviews the investigation and management of this pathological condition. CASE REPORT: A 36-year-old male sought medical care with a complaint of penile deformity and sexual dysfunction after methacrylate injection. The treatment administered was surgical removal. Satisfactory cosmetic and functional results were reached after two months. CONCLUSIONS: There is a need for better structured scientific research to evaluate the outcomes and complication rates from all penile augmentation procedures.
- One week pre-operative oral antibiotics for percutaneous nephrolithotomy reduce risk of infection: a systematic review and meta-analysis(2023) DANILOVIC, Alexandre; TALIZIN, Thalita Bento; TORRICELLI, Fabio Cesar Miranda; MARCHINI, Giovanni S.; BATAGELLO, Carlos; VICENTINI, Fabio C.; NAHAS, Willaim C.; MAZZUCCHI, EduardoPurpose: The aim of this meta-analysis is to assess the efficacy of extended dose of preoperative antibiotics to reduce infectious risk in patients undergoing percutaneous nephrolithotomy (PCNL).Materials and Methods: A literature search for prospective case-control studies or randomized controlled trials was done. PICO framework was used.Population: adult patients that underwent to PCNL; Intervention: extended dose preoperative antibiotic prophylaxis before PCNL; Control: short dose preoperative antibiotic prophylaxis befo-re PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fe-ver after PCNL and positive intraoperative urine and stone culture. This meta-analysis was registered in PROSPERO database under the number: CRD42022359589.Results: Three RCT and two prospective studies (475 patients) were included. SIRS/ sepsis outcome was retrieved from all studies included. Seven days preoperative oral antibiotics for PCNL was a protective factor for developing SIRS/sepsis (OR 0.366, 95% CI 0.234 -0.527, p < 0.001). There was no statistical association between seven-day use of antibiotics and fever (OR 0.592, 95% CI 0.147 - 2.388, p = 0.462). Patients who received seven days preoperative antibiotics had lower positive intraoperative urine culture (OR 0.284, 95% CI 0.120 - 0.674, p = 0.004) and stone culture (OR 0.351, 95% CI 0.185 - 0.663, p = 0.001) than the control group.Conclusion: one week of prophylactic oral antibiotics based on local bacterial sensi-tivity pattern plus a dose of intravenous antibiotics at the time of surgery in patients undergoing PCNL reduces the risk of infection.