GIOVANNI SCALA MARCHINI

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 29 Citação(ões) na Scopus
    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, Eduardo
    The 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.
  • article 23 Citação(ões) na Scopus
    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, Manoj
    OBJECTIVE 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.
  • article 70 Citação(ões) na Scopus
    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, Miguel
    OBJECTIVE 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.
  • article 5 Citação(ões) na Scopus
    Current trends of percutaneous nephrolithotomy in a developing country
    (2018) BATAGELLO, Carlos A.; VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scala; TORRICELLI, Fabio Cesar Miranda; SROUGI, Miguel; NAHAS, Willian Carlos; MAZZUCCHI, Eduardo
    Introduction: To present the current practice patterns on percutaneous nephrolithotomy (PCNL) in a developing country. Materials and Methods: A survey was offered to Brazilian urologists during the II International Endourology Symposium held in Sao Paulo, in 2015. The first seven questions were related to demographic data while the 20 remaining were directed to urologists who performed PCNL. Results: From 250 participants, 100 replied to the survey, 81% performed PCNL and 60.4% of performers had been in practice for less than 15 years. Eighty-one percent were trained in the prone position and 64% in supine. PCNL was learned during the residency in 66.7% and 2.5% had fellowship training. Prone position was the preferred decubitus for simple or complex calculi, though for obese patients there was no difference. Younger surgeons prefer supine while older surgeons prefer prone. The access was obtained by the surgeon in all cases, 96.3% use fluoroscopy and 3.7% prefer ultrasonography. Forty-seven percent use ultrasonic lithotripters and 4.1% laser. For kidney drainage, 71.6% place a nephrostomy tube. Double J stent is left in 77%. The postoperative image method was CT for 50%. Colonic injury was reported by 25%, predominantly in the senior group without statistically difference between positions. Conclusions: From a selected group of urologists, we observe that Brazilian urologists usually gain their own access for PCNL guided by fluoroscopy. They predominantly prefer the prone position, use fascial dilators, ultrasonic lithotripters and place a nephrostomy tube when exiting the kidney. Fellowship programs, ultrasonography, flexible nephoscopy and tubeless procedures could be encouraged.
  • article 3 Citação(ões) na Scopus
    Endoscopic guided PCNL in the prone split-leg position versus supine PCNL: a comparative analysis stratified by Guy's stone score
    (2019) BATAGELLO, Carlos A.; SANTOS, Hugo D. Barone dos; NGUYEN, Andrew H.; ALSHARA, Luay; LI, Jianbo; MARCHINI, Giovanni Scala; VICENTINI, Fabio C.; TORRICELLI, Fabio Cesar Miranda; DANILOVIC, Alexandre; PEREIRA, Jessica Goulart; ROSE, Emily; SROUGI, Miguel; NAHAS, Willian C.; MAZZUCCHI, Eduardo; MONGA, Manoj
    Introduction: The optimal patient positioning for percutaneous nephrolithotomy (PCNL) based on the complexity of stone burden is not yet defined. Thus, we aimed to evaluate the intraoperative parameters, effectiveness and complications of patients undergoing PCNL between the endoscopic-guided prone split-leg PCNL (ePSL) and the supine PCNL by stratifying patients according to Guy's stone score (GSS). Materials and methods: A retrospective chart review was conducted of patients undergoing PCNL at two high-volume tertiary referral centers. At one center, patients underwent PCNL using the ePSL technique, while at the second center, patients underwent PCNL in supine. Patient demographics and stone characteristics, operative details, complications and effectiveness were compared between groups. The impact of obesity was also investigated. Results: Of 830 subjects, a total of 449 (54%) underwent PCNL in ePSL and 381 (46%) in supine. The ePSL group had a greater mean age and body mass index. No statistical differences were found in gender, serum chemistry and Charlson comorbidity index. After stratifying patients by GSS, the differences in baseline stone burden between PSL and supine lost significance and both groups could be compared. Complications were not statistically different between both groups. Univariate analysis demonstrated that multiple tracts and lower pole access were more prevalent in supine. In addition, for GSS1-3, ePSL was correlated with reduced operative time, radiation exposure, length of hospital stay and need for secondary procedure. Multivariate analysis correlated ePSL with lower radiation exposure and need for secondary procedures (p = 0.01). In comparison to the whole trial population, the same tendencies were appreciated for obese cohort. Conclusions: This is the first report focusing on the performance differences between ePSL and supine PCNL stratified by GSS. Both techniques are safe, with a low rate of complications. For GSS1-3, ePSL reduces radiation exposure and requires less need for both multiple access and secondary procedure.
  • article 13 Citação(ões) na Scopus
    Outcomes of surgical treatment of ureteral strictures after laser ureterolithotripsy for impacted stones
    (2015) SROUGI, Victor; PADOVANI, Guilherme P.; MARCHINI, Giovanni S.; VICENTINI, Fabio C.; MAZZUCCHI, Eduardo; SROUGI, Miguel
    Introduction: To evaluate the outcomes of ureteral strictures treatment after endoureterotomy using the holmium laser or open/laparoscopic surgery. Material and methods: From a database of 1101 patients that underwent semi-rigid holmium laser ureterolithotripsy from 2003 to 2013, we performed a search for patients treated for ureteral stricture. Parameters analyzed included patient demographic, stone burden, and ureteral stricture characteristics. Treatment included holmium laser endoureterotomy for stenosis cm and open/laparoscopic repair for stenosis >1 cm or for failed endoscopic treatment. Outcomes and complications were assessed. Success was defined as symptom improvement and radiographic obstruction resolution. Results: Of all the patients, 32 (2.8%) evolved with ureteral stenosis and all had impacted calculi at the time of surgery. Twenty-two patients with complete follow up were studied. After a mean follow up of 18.5 months (range 3-70), the success rates for endoureterotomy and open/laparoscopic stricture repair group were 50% and 82%, respectively. The hospitalization period was significantly shorter for patients who had undergone endoureterotomy (2.7 +/- 1.4 days versus 4.8 +/- 1.4 days; p = 0.003). Only minor complications occurred in both groups. Conclusion: The rate of ureteral stricture after holmium laser ureterolithotripsy for impacted calculi is higher than reported for non-impacted stones. Holmium laser endoureterotomy for stenosis shorter than 1 cm treated half of the cases. Open/laparoscopic repair had good outcomes in cases of longer stenosis.
  • article 45 Citação(ões) na Scopus
    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, Eduardo
    Objective: 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.
  • article 16 Citação(ões) na Scopus
    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, Miguel
    OBJECTIVE 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.
  • article 24 Citação(ões) na Scopus
    Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta - analysis of randomized controlled trials
    (2016) TORRICELLI, Fabio C. M.; MONGA, Manoj; MARCHINI, Giovanni S.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, Eduardo
    Introduction: To provide a systematic review and meta-analysis of randomized controlled trials (RCT) comparing semi-rigid ureteroscopic lithotripsy (URS) with laparo-scopic ureterolithotomy (LU) for the treatment of the large proximal ureteral stone. Materials and methods: A systematic literature review was performed in June 2015 using the PubMed, Scopus, and Web of Science databases to identify relevant studies. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. Results: Six RCT including 646 patients were analyzed, 325 URS cases (50.3%) and 321 LU cases (49.7%). URS provided a significantly shorter operative time (weighted mean difference [WMD] = -31.26 min; 95% CI -46.88 to -15.64; p< 0.0001) and length of hospital stay (WMD = - 1.48 days; 95% CI - 2.78 to -0.18; p= 0.03) than LU. There were no significant differences in terms of overall complications (OR = 0.78; 95% CI 0.21-2.92; p= 0.71) and major complications - Clavien = 3 - (OR = 1.79; 95% CI 0.59-5.42; p= 0.30). LU led to a significantly higher initial stone-free rate (OR = 8.65; 95% CI 4.18-17.91; p< 0.00001) and final stone-free rate (OR = 6.41; 95% CI 2.24-18.32; p >= 0.0005) than URS. There was a significantly higher need for auxiliary procedures in URS cases (OR = 6.58;95% CI 3.42-12.68; p< 0.00001). Conclusions: Outcomes with LU for larger proximal ureteral calculi are favorablecompared to semi-rigid URS and should be considered as a first-line alternative if flexible ureteroscopy is not available. Utilization of flexible ureteroscopy in conjunction with semi-rigid ureteroscopy may impact these outcomes, and deserves further systematic evaluation.
  • article 25 Citação(ões) na Scopus
    Impact of Renal Anatomy on Shock Wave Lithotripsy Outcomes for Lower Pole Kidney Stones: Results of a Prospective Multifactorial Analysis Controlled by Computerized Tomography
    (2015) TORRICELLI, Fabio C. M.; MARCHINI, Giovanni S.; YAMAUCHI, Fernando I.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; SROUGI, Miguel; MONGA, Manoj; MAZZUCCHI, Eduardo
    Purpose: We evaluated which variables impact fragmentation and clearance of lower pole calculi after shock wave lithotripsy. Materials and Methods: We prospectively evaluated patients undergoing shock wave lithotripsy for a solitary 5 to 20 mm lower pole kidney stone between June 2012 and August 2014. Patient body mass index and abdominal waist circumference were recorded. One radiologist blinded to shock wave lithotripsy outcomes measured stone size, area and density, stone-to-skin distance, infundibular length, width and height, and infundibulopelvic angle based on baseline noncontrast computerized tomography. Fragmentation, success (defined as residual fragments less than 4 mm in asymptomatic patients) and the stone-free rate were evaluated by noncontrast computerized tomography 12 weeks postoperatively. Univariate and multivariate analysis was performed. Results: A total of 100 patients were enrolled in the study. Mean stone size was 9.1 mm. Overall fragmentation, success and stone-free rates were 76%, 54% and 37%, respectively. On logistic regression body mass index (OR 1.27, 95% CI 1.11-1.49, p = 0.004) and stone density (OR 1.0026, 95% CI 1.0008-1.0046, p = 0.005) significantly impacted fragmentation. Stone size (OR 1.24, 95% CI 1.07-1.48, p = 0.039) and stone density (OR 1.0021, 95% CI 1.0007-1.0037, p = 0.012) impacted the success rate while stone size (OR 1.24, 95% CI 1.04-1.50, p = 0.029), stone density (OR 1.0015, 95% CI 1.0001-1.0032, p = 0.046) and infundibular length (OR 1.1035, 95% CI 1.015-1.217, p = 0.015) impacted the stone-free rate. The best outcomes were found in patients with a body mass index of 30 kg/m(2) or less, stones 10 mm or less and 900 HU or less, and an infundibular length of 25 mm or less. The coexistence of significant unfavorable variables led to a stone-free rate of less than 20%. Conclusions: Obese patients with higher than 10 mm density stones (greater than 900 HU) in the lower pole of the kidney with an infundibular length of greater than 25 mm should be discouraged from undergoing shock wave lithotripsy.