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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- Impact of Obesity on Outcomes of Supine Percutaneous Nephrolithotomy(2020) FERREIRA, Thiago Augusto Cunha; DUTRA, Matheus Marques Guerra; VICENTINI, Fabio Carvalho; SZWARC, Marcelo; MOTA, Priscila Kuriki Vieira; EISNER, Brian; MURTA, Claudio Bovolenta; CLARO, Joaquim Francisco de AlmeidaObjectives:To determine whether obesity has an impact on the outcomes of supine percutaneous nephrolithotomy (PCNL). Patients and Methods:We retrospectively evaluated a prospectively created database of patients who underwent PCNL in the supine position from June 2009 to June 2014. The patients were divided into two groups according to their body mass index (BMI): <30 kg/m(2)(group 1, nonobese) and >= 30 kg/m(2)(group 2, obese). Pre, peri, and postoperative data were analyzed. Stone complexity was classified according to Guy's stone score. The primary endpoint was the absence of stone fragments of >= 4 mm on CT scans at postoperative day 1. Complications were graded according to the modified Clavien classification. Results:Of the 401 patients, 307 (76.6%) were nonobese and 94 (23.4%) were obese. Regarding demographic and stone characteristics, group 2 (BMI >= 30 kg/m(2)) had a higher percentage of female patients (67.3%vs50.4%,p = 0.002) and a higher mean BMI (34.8vs24.5 kg/m(2),p < 0.001) than group 1. Success rates were not statistically different between the groups (group 1 = 61.8%, group 2 = 51%,p = 0.08). There were no differences in the transfusion rate (group 1 = 2.9%, group 2 = 4.2%,p = NS) or total number of complications greater than Clavien grade 1 (group 1 = 13.6%, group 2 = 13.8%,p = NS). Conclusion:In a retrospective study of 400 patients undergoing PCNL, the outcomes were not different between nonobese and obese patients. To our knowledge, this is the first study evaluating these outcomes for PCNL performed in the supine position. Further multicenter and prospective studies are necessary to verify these findings.
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.