CLAUDIO BOVOLENTA MURTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, 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 COMPLETE SUPINE PERCUTANEOUS NEPHROLITHOTOMY - OUTCOMES OF A PROSPECTIVE SERIES OF A SINGLE SURGEON(2012) VICENTINI, Fabio Carvalho; HISANO, Marcelo; MAZZUCCHI, Eduardo; CLARO, Joaquim Almeida; MURTA, Claudio Bovolenta; SROUGI, MiguelOBJECTIVE: To describe our technique and results. METHODS: A total of 117 patients (120 renal units) were evaluated in a prospective manner. One surgeon operated all the cases. All patients had a CT scan pre-operatively and the stones were classified according the Guy’s score. We performed complete supine PCNL (csPCNL) with no rolled towel under the flank and no change of position. The ipsilateral arm was hung over the thorax and the patients were draped only once. A 6Fr ureteral catheter was placed without lithotomy position. The puncture was done always by the surgeon in the selected calix under fluoroscopic vision. The tract was dilated with a double shot technique and a 30Fr Amplatz sheath was placed. A 16Fr nephrostomy tube was inserted in cases of bleeding or residual stones. A ureteral catheter or a double J was always left. A CT scan was done in the first POD in all cases. Success was defined as the presence of ≤ 4 mm fragments at the end of follow up. RESULTS: The operative time ranged between 20 and 240 minutes (mean 105.5±50.8 min). The immediate success rate was 72.5% and the final rate was 90.4% after an average of 1.08 PCNL and 0.17 auxiliary procedures. Patients were left tubeless in 38.3% of the cases. The complication rate was 15.8% (11.6% of Clavien 1 or 2 and 4.2% of Clavien 3 or 4). The transfusion rate was 4.2%. No colon injuries or deaths occurred. CONCLUSIONS: The csPCNL is a very safe and effective procedure.conferenceObject Ureteral obstruction in advanced malignancies: Prognostic factors(2012) CORDEIRO, M. D.; OGLIO, M. F. Dall; SANTANA, A. Crippa; PESSOA, R. R.; CHADE, D.; MURTA, C. B.; SROUGI, M.INTRODUCTION & OBJECTIVES: Ureteral obstruction may occur as a secondary event in patients with end-stage abdominopelvic malignancies. Ureteral decompression procedures are performed in order to relief symptons and avoid progression to renal failure, however they may not result in patient increased survival. The objectives was to conduct a prospective study to assess the prognostic factors after ureteral decompression aiming to detect the patients who would benefit from such procedures. MATERIAL & METHODS: One hundred and twenty-three patients who underwent ureteral de sobstruction procedures by ureteral stent or nephrostomy, were analized in the Cancer Institute of the State of São Paulo from January 2009 to September 2010. The collected data included: sex, age , body mass index (BMI), type of primary tumor, clinical symptoms, events related to dissemination (metastases, ascites, pleural effusion), prior therapies (chemotherapy, radiotherapy and surgery), Charlson co-morbidity index, degree of hydronephrosis, type of ureteral desobstruction (ureteral stent or nephrostomy) and preoperative serum albumin, preoperative serum creatinine and preoperative hemoglobin. RESULTS: Univariate Analysis: With the clinical and laboratory data identified in the study, the Kaplan-Meier method was used to assess survival rates and the log-rank tests were performed to identified the relationship between clinical variables and survival time. We detected as significant prognostic associations preoperative serum albumin (<3mg/dL), degree of hydronephrosis (grade 1 and 2), presence of metastases, number of sites of metastases and the Charlson co-morbidity index (Charlson> 10 ). Multivariate Analysis: The Cox proportional hazards model detected that the preoperative serum albumin level, the degree of hydronephrosis and the Charlson index were significantly related to a poor survival. Patients were divided into four groups to create a model of risk stratification: favorable (0 risk factors), lower intermediate (1 risk factor), upper Intermediate (2 risk factors) unfavorable (3 risk factors). The 6-month survival rates were 83.3% for the favorable group, 59.4% for the lower intermediate group, 19% for upper intermediate group and 0% for unfavorable group. CONCLUSIONS: Our model of stratification may be a useful tool before deciding on ureteral desobstruction procedures since the survival of patients in the unfavorable group was 0% in 6 months. We hope that our study can modify the current approach of patients with advanced abdominopelvic malignancies complicated by ureteral obstruction.