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
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conferenceObject THE GUY'S STONE SCORE: A VERY PRACTICAL AND USEFUL TOOL TO PREDICT THE OUTCOMES OF PERCUTANEOUS NEPHROLITHOTOMY (PCNL)(2012) VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scala; MAZZUCCHI, Eduardo; CHEDID NETO, Elias Assad; BRITO, Arthur Henrique; DANILOVIC, Alexandre; HISANO, Marcelo; CLARO, Joaquim Almeida; SROUGI, MiguelOBJECTIVE: To evaluate the applicability of the Guy’s stone score for complete supine PCNL. METHODS: 117 patients that underwent to complete supine PCNL were classified according the Guy’s stone score. The data were prospectively collected but the classification according to the score was done by review of the pre-operative CT scans. All patients were operated by the same surgeon and had a pre and post operative CT scan and at the final followup. The outcomes and complications were compared among the 4 groups. RESULTS: The table 1 shows the demographic and outcomes. The groups were similar except for the median stone diameter. The differences among groups were statistically different after stratification according to the Guy’s stone score in relation to operative time, hemoglobin drop, transfusions, complications, tubeless rate, immediate success, auxiliary procedures, PCNL revisions and final success rate. CONCLUSIONS: The Guy’s stone score showed to be a very practical and useful tool to predict the outcomes of PCNL.- Preoperative Planning with Noncontrast Computed Tomography in the Prone and Supine Position for Percutaneous Nephrolithotomy: A Practical Overview(2015) MARCHINI, Giovanni S.; BERTO, Fernanda Christina G.; VICENTINI, Fabio C.; SHAN, Chen Jen; SROUGI, Miguel; MAZZUCCHI, EduardoObjective: To evaluate kidney/adjacent organs positional changes in patients undergoing percutaneous nephrolithotomy (PCNL) using noncontrast computed tomography (NCCT) in prone and supine positions. Methods: Patients scheduled PCNL were prospectively enrolled in the study and underwent NCCT in supine and in prone position (with boosters). Two imaginary lines for the posterior calyx of upper/mid/lower poles of both kidneys in prone and supine decubitus were considered and compared. Line I (LI): drawn horizontally in the coronal plane in contact with the posterior edge of the kidney. Line II (LII): drawn from the antero-lateral edge of the vertebra through the middle of the posterior calyx (ideal puncture line). Renal depth (d) was measured from LI to the anterior extremity of the vertebra. The maximum access angle (a) considered the window available in the axial plane to perform a secure approach to each calyx. Results: Thirty-seven patients were analyzed; 56.7% were female; mean BMI was 28.3 +/- 4.9 kg/m(2). For the right kidney, prone position was associated with more organs crossed by LI (54.1% vs 18.9%; p<0.01) and LII (56.8% vs 27%; p=0.03) in the upper calyx. For the left kidney, LII crossed more organs in prone in the upper calyx (54.1% vs 29.7%; p=0.03). Both kidneys showed a tendency to be deeper in the supine position, which provided a wider access angle. Conclusions: Supine NCCT is not accurate to plan PCNL access in prone position. Prone decubitus is associated with more potential organ injuries in the upper pole. In supine, the kidney situates deeper in the abdomen but the access angle is wider than in prone.
- Low Dose Fluoroscopy During Ureteroscopy Does Not Compromise Surgical Outcomes(2019) DANILOVIC, Alexandre; NUNES, Eduardo; LIPKIN, Michael E.; FERREIRA, Thiago; TORRICELLI, Fabio C. M.; MARCHINI, Giovanni S.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoObjective: To evaluate whether reducing the dose of fluoroscopy to 1/4 of standard dose during unilateral ureteroscopy for ureteral stone treatment would impact in a reduction of total radiation emitted and whether this strategy would impact operation time, stone-free rate, and complication rate. Methods: From August 2016 to August 2017, patients over 18 years submitted to ureteroscopy for ureteral stone between 5 and 20 mm were prospectively randomized for 1/4 dose reduction or standard dose fluoroscopy. Patients with abnormal urinary anatomy such as horseshoe kidney, pelvic kidney, or duplex system were excluded from the study. Results: Ninety-four patients were enrolled. The fluoroscopic dose reduction strategy to 1/4 of the standard dose was able to significantly reduce the cumulative radiation emitted by C-arm fluoroscopy and the dose area product (3.6 +/- 4.5 mGy vs 16.2 +/- 19.3 mGy, p = 0.0001 and 0.23 +/- 0.52 mcGycm(2) vs 1.15 +/- 2.74 mcGycm(2), p = 0.02, respectively). Fluoroscopy time was similar between groups (74.5 +/- 84.8 seconds vs 88.3 +/- 90 seconds, p = 0.44). There was no need to increase the fluoroscopy dose during any of the procedures. Surgical outcomes were not affected by fluoroscopic dose reduction strategy. Conclusion: Low dose fluoroscopy reduces the emitted radiation during ureteroscopy without compromising surgical outcomes.
- RE: Srougi, et al., Editorial Comment on: Septic Shock Following Surgical Decompression of Obstructing Ureteral Stones: A Prospective Analysis by Yoo, et al. (From: Yoo KH, Min GE, Lee H-L, et al., J Endourol 2019 [Epub ahead of print]; DOI: 10.1089/end.2019.0128)(2019) SROUGI, Victor; BERJEAUT, Ricardo H.; MOSCARDI, Paulo R.; MARCHINI, Giovanni S.
- Renal Stone Features Are More Important Than Renal Anatomy to Predict Shock Wave Lithotripsy Outcomes: Results from a Prospective Study with CT Follow-Up(2020) TORRICELLI, Fabio C. M.; MONGA, Manoj; YAMAUCHI, Fernando I.; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; BATAGELLO, Carlos A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoIntroduction: Lower pole kidney stones have been associated with poor shock wave lithotripsy (SWL) outcomes because of its location. However, the real impact of collecting system anatomy on stone clearance after SWL is uncertain. There is a lack of prospective well-controlled studies to determine whether lower pole kidney stones have inferior outcomes than nonlower pole kidney stones when treated with SWL. Methods: We prospectively evaluated patients with a single kidney stone of 5-15mm undergoing SWL from June 12 through January 19. All patients were subjected to computed tomography before and 3 months after the procedure. Demographic data (age, gender, and body mass index), stone features (stone size, stone area, stone density, and stone-skin distance-SSD), and collecting system anatomy (infundibular length and width, and infundibulopelvic angle) were recorded. Outcomes (fragmentation and stone clearance rates) were compared between lower pole and nonlower pole cases. Then, a multivariate analysis including all variables was performed to determinate which parameters significantly impact on SWL outcomes. Results: One hundred and twenty patients were included in the study. Mean stone size was 8.3mm and mean stone density was 805 Hounsfield units. Overall stone fragmentation, success, and stone-free rates were 84.1%, 64.1%, and 34.1%, respectively. There were no significant differences in stone fragmentation (76.0% vs 71.4%; p=0.624), success rate (57.6% vs 53.3%; p=0.435), and stone-free rate (40.2% vs 35.7%; p=0.422) in the lower vs nonlower pole groups, respectively. On multivariate analysis, only stone density (p<0.001) and SSD (p=0.006) significantly influenced fragmentation. Stone size (p=0.029), stone density (p=0.002), and SSD (p=0.049) significantly influenced kidney stone clearance. Conclusions: Stone size, stone density, and SSD impact on SWL outcomes. Lower pole kidney stones have similar fragmentation and stone clearance compared with nonlower pole kidney stones.
- In Vitro Evaluation of Single-Use Digital Flexible Ureteroscopes: A Practical Comparison for a Patient-Centered Approach(2018) MARCHINI, Giovanni Scala; BATAGELLO, Carlos A.; MONGA, Manoj; TORRICELLI, Fabio Cesar Miranda; VICENTINI, Fabio C.; DANILOVIC, Alexandre; SROUGI, Miguel; NAHAS, Willian C.; MAZZUCCHI, EduardoObjective: To compare the manufacturing and in vitro performance characteristics of two single-use flexible ureteroscopes with a permanent optical flexible ureteroscope. Materials and Methods: Two single-use flexible ureteroscopes, LithoVue (Boston Scientific) and Pusen (1rs. generation; Zhuhai Pusen Medical Technology Company Limited, China), were tested and compared with a permanent Flex-X-2 ureteroscope (Karl Storz, Germany) in terms of technical characteristics, optics, deflection mechanism, and additional parameters which could potentially affect surgical technique. Results: Pusen was the lightest ureteroscope while the LithoVue had the longest working length. LithoVue had a higher resolution power than the other two ureteroscopes at all distances tested (p<0.001). Pusen showed higher resolution than Flex-X-2 (p<0.01). Field of view was wider for LithoVue (87 degrees), followed by Flex-X-2 (85 degrees) and Pusen (75 degrees). Color representation was superior for Flex-X-2 than LithoVue and then Pusen. LithoVue outperformed Pusen and Flex-X-2 for all settings with instruments in terms of deflection loss (p<0.01). Pusen had the highest irrigation flow (52mL/min) with an empty working channel (p<0.01). LithoVue and Pusen showed similar flow rates with a 200m (21mL/min) and 365m laser fiber (7mL/min) and 1.3F basket (18mL/min), being superior to Flex-X-2 (p<0.01). With the 1.9F basket, LithoVue had superior flow rate (7mL/min) than Pusen (3.5mL/min) and Flex-X-2 (4mL/min; p=0.01). Conclusion: LithoVue outperformed the other ureteroscopes in terms of optical resolution, field of view, deflection capacity, and irrigation flow with larger instruments. Pusen is the lighter scope and showed better results in terms of irrigation when no instruments are in place. Flex-X-2 was superior in terms of color representation.
- Low Dose Fluoroscopy During Ureteroscopy Does Not Compromise Surgical Outcomes (vol 33, pg 527, 2019)(2023) DANILOVIC, Alexandre; NUNES, E.; LIPKIN, M. E.; FERREIRA, T.; TORRICELLI, F. C. M.; MARCHINI, G. S.; SROUGI, M.; NAHAS, W. C.; MAZZUCCHI, E.
- Residual Stone Fragments After Percutaneous Nephrolithotomy: Shockwave Lithotripsy vs Retrograde Intrarenal Surgery(2021) DANILOVIC, Alexandre; TORRICELLI, Fabio Cesar Miranda; MARCHINI, Giovanni Scala; BATAGELLO, Carlos; VICENTINI, Fabio Carvalho; TRAXER, Olivier; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoBackground: Despite technology incorporation to percutaneous nephrolithotomy (PCNL), residual stone fragments (RSFs) may still persist after PCNL and need to be addressed to avoid regrowth or ureteral obstruction. The objective of this study was to compare the outcomes of retrograde intrarenal surgery (RIRS) to extracorporeal shockwave lithotripsy (SWL) for treating patients with RSFs after a previous standard PCNL. Materials and Methods: Adult patients with RSF after a standard PCNL submitted to RIRS or SWL in our Institution from January 2017 to January 2020 were retrospectively studied. Stone-free rate (SFR) was evaluated on postoperative day (POD) 90 by noncontrast CT (NCCT) or ultrasound and kidney, ureter, and bladder radiograph (KUB) for each renal unit. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. Sample size was calculated for a power of 80% and a significance level of 0.05, assuming SFR of 20% for SWL and 50% for RIRS. Results: Thirty-three patients treated by SWL were compared with 36 patients treated by RIRS. Hospitalization time was longer in the RIRS group (4.18 vs 12.33 hours, p = 0.001). SFR and success rate were lower in SWL than RIRS group (24.2% vs 58.3%, p = 0.007 and 30.3% vs 72.2%, p = 0.004, respectively), using POD 90 NCCT in 81.8% and ultrasound and KUB in 18.2% of the SWL group and using POD 90 NCCT in 100% of the RIRS group. Minor complications (Clavien-Dindo < III) occurred in 11 of 36 (30.6%) patients submitted to RIRS and in 2 of 33 (6.1%) patients submitted to SWL group (p = 0.025). Two patients (6.1%) of the SWL group had Clavien-Dindo IIIb complication owing to Steinstrasse and were submitted to ureteroscopy. Emergency room visits were similar between groups (6.1% vs 8.3%, p = 1.0). Conclusions: RIRS has better SFR, higher minor complications, and lower major complications than SWL for the treatment of RSFs after standard PCNL.
conferenceObject PERCUTANEOUS NEPHROLITHOTOMY IN OBESE PATIENTS: COMPARISON BETWEEN THE PRONE AND TOTAL SUPINE POSITION(2012) MAZZUCCHI, Eduardo; VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scalla; DANILOVIC, Alexandre; BRITO, Artur Henrique; SROUGI, MiguelOBJECTIVE: We compared the outcomes of obese patients(BMI > 30) submitted to Percutaneous Nephrolithotomy (PCNL) in the prone or in the complete supine position. METHODS: Patients were randomly divided and all had a non-contrast computed tomography (CT) before and after the procedure. Stones were graded according to the Guy’s score and complications according to the Clavien grading. The stone-free rates, operative time, hospital stay and surgical complications were evaluated. RESULTS: 56 PCNL were performed (24 in the prone and 32 in the supine position). Mean stone area was 11.28 cm2 and 10.2 cm2 for patients in the prone and supine position (p=0.43). Overall stone-free rate after one procedure and the final result were 54.2% and 83.3% in the prone and 68.8% and 78.1% in the supine position, respectively (p=0.28 and 0.64). Stone-free rate was 100 and 88.9% for Guy’s I (p=0.84), 62.5 and 62.5% for Guy’s II (p=1.0), 75 and 54.5% for Guy’s III (p=0.6) and 20 and 75% for Guy’s IV (p=0.09) in the prone and supine positions, respectively. Mean operative time was 164.6 and 120.3 minutes in the prone and supine position (p=0.0017) and hospital stay 4.38 and 2.68 days, respectively (p=0.01). The transfusion rate was 20.8% in the prone group and zero in the supine group (p=0.01). Surgical complications rates were 33.3% and 31.3 % in the prone and supine positions, respectively (p=0.77). CONCLUSIONS: PCNL in the complete supine position in obese patients achieved similar results but complete supine position requires less transfusion, shorter operative time and hospital stay.- Septic Shock Following Surgical Decompression of Obstructing Ureteral Stones: A Prospective Analysis(2018) SROUGI, Victor; MOSCARDI, Paulo R.; MARCHINI, Giovanni S.; BERJEAUT, Ricardo Haidar; TORRICELLI, Fabio C.; MESQUITA, Jose L. B.; SROUGI, Miguel; MAZZUCCHI, EduardoPurpose: To investigate risk factors for septic shock and death in patients with obstructive pyelonephritis due to ureteral stone, who underwent urinary tract decompression. Patients and Methods: We prospectively enrolled patients who presented at the emergency department of our institution with clinical signs of pyelonephritis, Systemic Inflammatory Response Syndrome (SIRS), and obstructive ureteral stone confirmed by computed tomography scan. Forty patients that underwent urinary tract decompression were included. Demographical, medical, and laboratorial characteristics were recorded; antibiotic regimen and time from presentation to decompression were compared between patients with septic complications. Results: Septic shock and death occurred in 6 (15%) and 2 (5%) patients, respectively. Gender, age, and comorbidities were not associated with septic complications. Urinary culture was negative in 40% of the cohort and the most prevalent pathogen was Escherichia coli. Administration of antibiotics other than third-generation cephalosporin was associated with septic shock (p=0.02). There was no difference between groups regarding the time of antibiotics use (p=0.63) and time from presentation to urinary tract decompression (p=0.07). Patients with leukocyte count above 15.6x10(3)/mu L had 2.2-fold greater risk of having septic shock (p=0.027). Conclusions: We failed to find an association between time of antibiotic use or delayed urinary tract decompression and occurrence of septic complications; antibiotic choice was determinant of prognosis. Elevated serum leukocytes could be used as a trigger to indicate prompt surgical intervention.