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
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- 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.
- Marchini et al.: Silent Ureteral Stones: Effect on Kidney Function-Can Treatment of Silent Ureteral Stones Preserve Kidney Function? (Urology 2012; 79: 304-308) Reply(2012) MARCHINI, Giovanni S.; VICENTINI, Fabio C.; MAZZUCCHI, Eduardo; BRITO, Arthur; EBAID, Gustavo; SROUGI, Miguel
- Predicting Urinary Stone Composition Based on Single-energy Noncontrast Computed Tomography: The Challenge of Cystine(2014) TORRICELLI, Fabio Cesar Miranda; MARCHINI, Giovanni Scala; DE, Shubha; YAMACAKE, Kleiton G. R.; MAZZUCCHI, Eduardo; MONGA, ManojOBJECTIVE To study several measurements from a single-energy noncontrast computed tomography (NCCT) that may distinguish calcium oxalate, uric acid, and cystine stones. METHODS Patients with pure urinary stones who had at least 1 single-energy NCCT before the stone composition analysis from January 2008 to December 2012 were enrolled in this study. The analyzed data comprised stone size, volume, core Hounsfield unit (HU), periphery HU, absolute and relative HU differences between core and periphery, and HU density. After these measurements, an NCCT bone window was subjectively evaluated to study the homogeneity of each stone from core to periphery. The Spearman correlation test was used to determine the correlation between HU values and stone size and volume for each group. RESULTS A total of 113 patients were found with pure urinary stones who also had a corresponding NCCT. There were 36, 47, and 30 patients in the calcium oxalate, uric acid, and cystine groups, respectively. The core HU, periphery HU, absolute and relative HU differences, and HU density were significantly different among the 3 groups (P <. 001). Stone size and volume had a positive correlation with core and periphery HUs only for calcium oxalate and cystine stones. The subjective evaluation of the urinary calculi revealed a different pattern for each stone composition. CONCLUSION Single-energy NCCT may predict calcium oxalate stones with a high degree of accuracy. There is an overlap in radiographic profiles of cystine and uric acid stones, making a definitive differentiation more challenging. (C) 2014 Elsevier Inc.
- Size is Not Everything That Matters: Preoperative CT Predictors of Stone Free After RIRS(2019) DANILOVIC, Alexandre; ROCHA, Bruno Aragao; TORRICELLI, Fabio Cesar Miranda; MARCHINI, Giovanni Scala; BATAGELLO, Carlos; VICENTINI, Fabio Carvalho; TRAXER, Olivier; VIANA, Publio Cesar Cavalcante; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoOBJECTIVE To define computed tomography (CT) predictors of residual fragments after retrograde intrarenal surgery (RIRS) for kidney stones up to 20 mm in patients never submitted to surgical procedures for stone removal. METHODS From August 2016 to August 2017, symptomatic adult patients with kidney stones less than 20 mm treated by RIRS had their pre- and postoperative CT prospectively evaluated in search for predictors of residual stone fragments. Stone size, stone volume, number of stones, stone density, and location were evaluated in preoperative CT and analyzed as predictors for residual stone fragments on 90 POD CT. Stone location was represented by the infundibulopelvic angle (IPA) measured for each stone on preoperative noncontrast CI using multiplanar reconstruction. RESULTS Ninety-two patients were successfully submitted to RIRS. Bilateral procedures were performed in 23 patients (25%) resulting in 115 renal units operated. Operative time was 54.5 +/- 26.7 minutes (mean +/- SD) and 96.7% (89/92) of the patients were discharged up to 12 hours after the procedure. Postoperative CI demonstrated stone-free in 86 of 115 (74.8%), 0-2 mm in 10 of 115 (8.7%), and > 2 mm residual fragments in 19 of 115 (16.5%) procedures. Logistic regression analysis revealed steep IPA was a predictor for any residual stone fragment after RIRS for kidney stones < 20 mm (P= .012). ROC curve showed that IPA < 41 degrees was associated with a higher chance of residual fragments after RIRS. CONCLUSION IPA < 41 degrees is associated with a higher chance of residual fragments after RIRS for kidney stones up to 20 mm. (C) 2019 Elsevier Inc.
- Utility of the Guy's Stone Score Based on Computed Tomographic Scan Findings for Predicting Percutaneous Nephrolithotomy Outcomes(2014) VICENTINI, Fabio C.; MARCHINI, Giovanni Scala; MAZZUCCHI, Eduardo; CLARO, Joaquim F. A.; SROUGI, MiguelOBJECTIVE To evaluate the ability of the Guy's stone score (GS) to predict the success rates and complications on the basis of the computed tomographic (CT) scan findings for renal stones treated with percutaneous nephrolithotomy (PCNL). METHODS From 2008 to 2012, a total of 147 consecutive patients (155 renal units) who underwent PCNL in a completely supine position were prospectively evaluated. All patients underwent a CT scan preoperatively, and the stones were classified according to the GS. All PCNLs were analyzed to determine the association between the GS and treatment outcomes on the basis of CT findings and complications, according to the Clavien criteria. RESULTS Of the 155 PCNLs, 27% were classified as GS1, 28.4% as GS2, 27% as GS3, and 17.6% as GS4. Only the largest diameter of the stones differed among the groups (GS1= 21.4, GS2= 26.5, GS3= 31.4, and GS4= 50.5 mm; P <. 001). After stratification according to the GS, the groups differed significantly regarding their operative times (GS1= 63 +/- 28.5, GS2= 101.4 +/- 40.8, GS3= 127.6 +/- 47.6, and GS4= 153.3 +/- 56 minutes; P <. 001), tubeless rates (GS1= 54.8%, GS2= 45.4%, GS3= 28.6%, and GS4= 7.4%; P <. 001), blood transfusion rates (GS1= 0%, GS2= 2.3%, GS3= 4.8%, and GS4= 22.2%; P=.01), complications (GS1= 4.8%, GS2= 9.1%, GS3= 26.2%, and GS4= 44.4%; P <. 001), immediate success rates (GS1= 95.2%, GS2= 79.5%, GS3= 59.5%, and GS4= 40.7%; P <. 001), and number of auxiliary procedures (GS1= 0.05 +/- 0.32, GS2= 0.28 +/- 0.6, GS3= 0.35 +/- 0.66, and GS4= 0.43 +/- 0.59; P=.031). The final success rates after the auxiliary procedures were similar among the groups (GS1= 97.6%, GS2= 86.4%, GS3= 90.5%, and GS4= 74.5%; P=.19). CONCLUSION The GS based on CT findings accurately predicted success rates and complications after PCNL for renal stones. (C) 2014 Elsevier Inc.
- Irreversible Renal Function Impairment Due to Silent Ureteral Stones REPLY(2016) MARCHINI, Giovanni S.
- Silent Ureteral Stones: Impact on Kidney Function-Can Treatment of Silent Ureteral Stones Preserve Kidney Function?(2012) MARCHINI, Giovanni S.; VICENTINI, Fabio C.; MAZZUCCHI, Eduardo; BRITO, Arthur; EBAID, Gustavo; SROUGI, MiguelOBJECTIVE To report our experience with silent ureteral stones and expose their true influence on renal function. METHODS We analyzed 506 patients who had undergone ureterolithotripsy from January 2005 to May 2010. Silent ureteral stones were calculi found in the absence of any specific or subjective ureteral stone-related symptoms. Of the 506 patients, 27 (5.3%) met these criteria (global cohort). All patients were assessed postoperatively with dimercaptosuccinic acid scintigraphy (DMSA). A difference in relative kidney function of >10% was considered abnormal. Pre- and postoperative comparative DMSA analyses were electively obtained for 9 patients (kidney function cohort). A t test was used to assess the numeric variables, and the chi-square test or Fisher's exact test was used for categorical variables. Two-tailed P < .05 was considered statistically significant. RESULTS Stones were diagnosed by radiologic abdominal evaluation for nonurologic diseases in 40% and after previous nephrolithiasis treatment in 33%. The primary therapy was ureterolithotripsy in 88%. The mean follow-up time was 23 months. The overall ureteral stone-free rate after 1 and 2 procedures was 96% and 100%, respectively. In the global cohort, the mean pre- and postoperative serum creatinine levels were similar (P = .39), and the mean postoperative function on DMSA was 31%. In the kidney function cohort, no difference was found between the pre-and postoperative DMSA findings (22% +/- 12.1% vs 20% +/- 11.8%; P = .83) and serum creatinine (0.8 +/- 0.13 mg/dL vs 1.0 +/- 0.21 mg/dL; P = .45). CONCLUSION Silent ureteral stones are associated with decreased kidney function present at the diagnosis. Hydronephrosis tends to diminish after stone removal, and kidney function remains unaltered. UROLOGY 79: 304-309, 2012. (C) 2012 Elsevier Inc.
- Silent Ureteral Stones: Impact on Kidney Function-Can Treatment of Silent Ureteral Stones Preserve Kidney Function? REPLY(2012) MARCHINI JR., Giovanni Scala
- Complete Calcified Ureteral Stent: A Combined 1-Session Approach(2017) TORRICELLI, Fabio C. M.; BERJEAUT, Ricardo H.; LAFFEIRA, Luccas; YAMAUCHI, Fernando I.; MARCHINI, Giovanni S.; NAHAS, William C.; SROUGI, Miguel; MAZZUCCHI, EduardoOBJECTIVE To demonstrate a successful 1-session approach to a complete calcified ureteral stent, preserving the affected kidney without complications. PATIENT AND METHODS A 33-year-old man presented at our service with an increased urinary frequency, afebrile urinary tract infection, and left lumbar pain. He underwent a ureterolithotripsy with ureteral stenting 3 years ago. After that intervention, he was lost to follow-up. A noncontrast computed tomography scan revealed a complete calcified ureteral stent (FECal V). After careful preoperative planning, the patient was submitted to a combined 1-step approach including left semirigid ureteroscopy, left percutaneous nephrolithotomy, and an open cystolithotomy in supine decubitus. This video demonstrates the surgical steps of the procedure for a FECal V (completely calcified) stent removal. RESULTS Operative time was 240 minutes. The calcified stent was completely removed. A 6 Fr ureteral catheter and a 16 Fr nephrostomy tube were left at the end of the procedure. No double-J stent was used to avoid the same kind of complication. The patient had no peri-or postoperative complications. A computed tomography scan was performed in the first postoperative day (POD) and revealed 2 small residual fragments (7 mm and 6 mm). The ureteral catheter was removed on the first POD, and the nephrostomy tube on the second POD. The patient was discharged from hospital on the third POD. The patient is now scheduled to a flexible ureteroscopy to treat the small residual fragments. CONCLUSION Forgotten ureteral stent is a surgical challenge, requiring multiple approaches and advanced urologic techniques. Our video illustrates that a less invasive and combined 1-step procedure to preserve the kidney is both safe and feasible, when performed by an experienced surgeon. (C) 2017 Elsevier Inc.