FABIO CESAR MIRANDA TORRICELLI
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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- Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function(2020) TORRICELLI, Fabio C. M.; CARVALHO, Regina S.; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; BATAGELLO, Carlos A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoINTRODUCTION: Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. METHODS: Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. RESULTS: Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien <= 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). CONCLUSION: sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stonefree rate.
conferenceObject PROSPECTIVE EVALUATION OF BILATERAL RIRS: IS IT REALLY SAFE?(2020) DANILOVIC, Alexandre; TORRICELLI, Fabio; MARCHINI, Giovanni; BATAGELLO, Carlos; VICENTINI, Fabio; TRAXER, Olivier; SROUGI, Miguel; NAHAS, William; MAZZUCCHI, Eduardo- The urologist's role in the fight of COVID-19 pandemic: mandatory mindset shift on the frontline(2020) ISCAIFE, Alexandre; MARCHINI, Giovanni S.; SROUGI, Victor; TORRICELLI, Fabio C. M.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; MACHADO, Marcos; HISANO, Marcelo; TISEO, Bruno C.; BISSOLI, Julio C.; COCUZZA, Marcello; HALLAK, Jorge; SROUGI, Miguel; NAHAS, William C.
- 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.
- Editorial Comment: Upper urinary tract stone compositions: the role of age and gender(2020) TORRICELLI, Fabio C. M.
- Retroperitoneoscopic ureterolithotomy to treat large ureteral stones in the proximal ureter(2020) SROUGI, Victor; TORRICELLI, Fabio C.; ANDRADE, Hiury S.; ARAP, Marco A.; I, Anuar Mitre; MAZZUCCHI, Eduardo; DUARTE, Ricardo J.; SROUGI, MiguelIntroduction: Retroperitoneoscopic ureterolithotomy emerged as an option for the extraction of large stones in the proximal ureter, offering short convalescence and low rates of residual fragments. Materials and methods: We describe the case of a 50-year-old male, who presented at our emergency department with right flank pain for 15 days without fever. He had a past medical history of nephrolithiasis. A non-contrast computed tomography (NCCT) evidenced a stone with 1.5cm and 1200HU in the right proximal ureter associated with ipsilateral hydronephrosis. A retroperitoneoscopic ureterolithotomy was planned. Results: The surgery was performed under general anesthesia, with the patient in 90o left lateral decubitus. Retroperitoneal space was created with blunt finger dissection. Three ports were used and the operative time was 60 minutes. Foley catheter was removed the morning after the procedure and the drain 8 hours later. The patient was discharged in the first postoperative day. Double J catheter withdrawal was done 4 weeks after surgery. No intraoperative or postoperative (90-days) complications were recorded. Control NCCT demonstrated the complete removal of the ureteral stone. Conclusion: The retroperitoneoscopic approach is an effective alternative to treat large proximal ureteral stones.
conferenceObject IMPACT OF THE PATIENT POSITION ON COMPLICATION RATES OF PERCUTANEOUS NEPHROLITHOTOMY FOR COMPLEX STONES: A RANDOMIZED STUDY(2020) PERRELLA, Rodrigo; VICENTINI, Fabio C.; PARO, Eliane D.; MARCHINI, Giovani S.; TORRICELLI, Fabio C. M.; DANILOVIC, Alexandre; BATAGELLO, Carlos; MURTA, Claudio B.; CLARO, Joaquim F. A.; NAHAS, Willian; MAZZUCCHI, EduardoconferenceObject IMPACT OF INTRAOPERATIVE USE OF TRANEXAMIC ACID IN PATIENTS WITH COMPLEX KIDNEY STONES UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY: PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED TRIAL(2020) CARLOS, Carlos Alfredo; VICENTINI, Fabio Carvalho; MONGA, Manoj; MARCHINI, Giovanni Scala; TORRICELLI, Fabio Cesar Miranda; DANILOVIC, Alexandre; BRITO, Artur; SROUGI, Miguel; NAHAS, Willian Carlos; MAZZUCCHI, Eduardo- Renal manifestations of sarcoidosis: from accurate diagnosis to specific treatment(2020) CORREIA, Filipe A. Saliba C.; MARCHINI, Giovanni S.; TORRICELLI, Fabio C.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoSarcoidosis is a multisystem granulomatous disease characterized by epithelioid non-caseating granulomas associated with clinical and radiologic findings. The cause of this disease is still uncertain. Sarcoidosis affects mostly lungs and lymph nodes and is not usually considered a urological disease, therefore, this etiology may be overlooked in several urological disorders, such as hypercalcemia, hypercalciuria and nephrolithiasis. It affects all races and genders. This review aims to describe the urological manifestations of sarcoidosis and to elucidate how the disease may affect the management of numerous urological conditions.
conferenceObject ANALYS MICRORNAS EXPRESSION IN CYSTINURIA PATIENTS(2020) AYRES, Daniel; SANTOS, Gabriel; PIMENTA, Ruan; VIANA, Nayara; GUIMARAES, Vanessa; SILVA, Iran; MARCHINI, Giovanni; BATAGELLO, Carlos; TORRICELLI, Fabio; VICENTINI, Fabio; DANILOVIC, Alexandre; LEITE, Katia; REIS, Sabrina; NAHAS, William; SROUGI, Miguel; MAZZUCCHI, Eduardo