CARLOS ALFREDO BATAGELLO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
44 resultados
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- Percutaneous nephrolithotomy in patients with spinal cord injury: should all these patients be automatically assigned a Guy's stone score of 4?(2021) TORRICELLI, Fabio C. M.; VICENTINI, Fabio C.; ZANETTI, Lucas; PERRELLA, Rodrigo; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; BATAGELLO, Carlos A.; MURTA, Claudio B.; CLARO, Joaquim F. A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoPurpose To assess the complication and stone-free rates of PCNL in patients with spinal cord injury (SCI) and to evaluate whether this population should be assigned a Guy's stone score (GSS) of 4. Methods A case-control study was conducted, and electronic charts were reviewed to search for patients with SCI, bladder dysfunction, and kidney stones who had undergone PCNL. Control cases were randomly selected from among patients with complete staghorn calculus (GSS = 4). Results One hundred and seventeen patients were included. Patients with SCI had a significant shorter operative time (119 vs. 141 min;p = 0.018). There were no significant differences between the groups in terms of the patients' position, number of renal tracts, bleeding or transfusion rate; however, there was a significantly higher complication rate (23.1% vs. 7.8%;p = 0.009) and a longer hospital stay (5.8 vs. 3.1 days;p = 0.002) among patients with SCI. With regards to the stone-free rate in patients with different grades of GSS patients with SCI who had a GSS of 1 had a stone-free rate of 85.7%, while those with a GSS of 2, 3, or 4 had 50%, 50%, and 31.5%, respectively (p = 0.024). Only patients with a GSS of 4 in the SCI group had outcomes that were similar to those of control patients (31.5% vs. 31.6%). Conclusion Patients with SCI should not be automatically assigned GSS 4. Stone-free rate is related to stone burden in these patients, although they do show a higher complication rate and a longer hospital stay than non-neurological patients.
- 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.
bookPart Sondagem vesical(2017) BATAGELLO, Carlos Alfredo; IUAMOTO, Leandro Ryuchi; KAGUEIAMA, Thiago Issaho; CURY, José; SROUGI, MiguelconferenceObject Obesity: A Major Risk Factor for Wound and Parietal Complications in Renal Transplantation.(2014) ANDRADE, H.; PALUELLO, D.; BATAGELLO, C.; BULL, A.; EBAID, G.; KANASHIRO, H.; FALCI, R.; ANTONOPOULOS, I.; NAHAS, W.; PIOVESAN, A.conferenceObject Obesity: A Major Risk Factor for Wound and Parietal Complications in Renal Transplantation.(2014) ANDRADE, H.; PALUELLO, D.; BATAGELLO, C.; BULL, A.; EBAID, G.; KANASHIRO, H.; FALCI, R.; ANTONOPOULOS, I.; NAHAS, W.; PIOVESAN, A.- One week pre-operative oral antibiotics for percutaneous nephrolithotomy reduce risk of infection: a systematic review and meta-analysis(2023) DANILOVIC, Alexandre; TALIZIN, Thalita Bento; TORRICELLI, Fabio Cesar Miranda; MARCHINI, Giovanni S.; BATAGELLO, Carlos; VICENTINI, Fabio C.; NAHAS, Willaim C.; MAZZUCCHI, EduardoPurpose: The aim of this meta-analysis is to assess the efficacy of extended dose of preoperative antibiotics to reduce infectious risk in patients undergoing percutaneous nephrolithotomy (PCNL).Materials and Methods: A literature search for prospective case-control studies or randomized controlled trials was done. PICO framework was used.Population: adult patients that underwent to PCNL; Intervention: extended dose preoperative antibiotic prophylaxis before PCNL; Control: short dose preoperative antibiotic prophylaxis befo-re PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fe-ver after PCNL and positive intraoperative urine and stone culture. This meta-analysis was registered in PROSPERO database under the number: CRD42022359589.Results: Three RCT and two prospective studies (475 patients) were included. SIRS/ sepsis outcome was retrieved from all studies included. Seven days preoperative oral antibiotics for PCNL was a protective factor for developing SIRS/sepsis (OR 0.366, 95% CI 0.234 -0.527, p < 0.001). There was no statistical association between seven-day use of antibiotics and fever (OR 0.592, 95% CI 0.147 - 2.388, p = 0.462). Patients who received seven days preoperative antibiotics had lower positive intraoperative urine culture (OR 0.284, 95% CI 0.120 - 0.674, p = 0.004) and stone culture (OR 0.351, 95% CI 0.185 - 0.663, p = 0.001) than the control group.Conclusion: one week of prophylactic oral antibiotics based on local bacterial sensi-tivity pattern plus a dose of intravenous antibiotics at the time of surgery in patients undergoing PCNL reduces the risk of infection.
- 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.
- Understanding urologic scientific publication patterns and general public interests on stone disease: lessons learned from big data platforms(2021) MARCHINI, Giovanni S.; FARIA, Kauy V. M.; NETO, Felippe L.; TORRICELLI, Fabio Cesar Miranda; DANILOVIC, Alexandre; VICENTINI, Fabio Carvalho; BATAGELLO, Carlos A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoPurpose To analyse patterns of stone disease online information-seeking behaviours in the United States and to correlate with urological literature publication aspects. Methods To compare Relative Search Volume (RSV) among different twelve preselected urologic keywords we chose ""United States"" as country and ""01/01/2009-31/12/2018"" as time range on Google Trends (GT). We defined ""ureteroscopy"" as a reference and compared RSV against it for each term. RSV was adjusted and normalized in a scale 0-100. Trend presence was evaluated by Mann-Kendall Test and magnitude by Sen's Slope Estimator (SS). Weather influence on RSV was also investigated by comparison of the ten hottest versus ten coldest states. Pearson correlation analysis was performed between number of Pubmed publications and RSV for each term over time. Results We found an upward tendency (p 0.01) for most terms. Higher temporal trends were seen for ""kidney stone"" (SS = 0.36), ""kidney pain"" (SS = 0.39) and ""tamsulosin"" (SS = 0.21). Technical treatment terms had little search volumes and no increasing trend. States with hotter weather showed higher mean RSV for ""kidney stone"" than colder ones. There was little correlation between GT and Pubmed for most terms, with the exception of ""kidney stone"" (R = 0.89; p 0.01), ""URS"" (R = 0.81; p 0.01), and ""laser lithotripsy"" (R = 0.74; p = 0.01). Conclusion There was a significant increase in online search for medical information related to stone disease. Citizens tend to look for generic terms related to symptoms or the disease itself. States with hotter weather show higher RSV than colder states. There is a discrepancy between public and medical community medical terms.
- Single-use flexible ureteroscopes: update and perspective in developing countries. A narrative review(2022) MAZZUCCHI, Eduardo; MARCHINI, Giovanni Scala; BERTO, Fernanda Christina Gabrigna; DENSTEDT, John; DANILOVIC, Alexandre; VICENTINI, Fabio Carvalho; TORRICELLI, Fabio Cesar Miranda; BATTAGELLO, Carlos Alfredo; SROUGI, Miguel; NAHAS, William CarlosFlexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital flexible ureteroscopes a great evolution has occurred. The first single-use flexible ureteroscope was launched in 2011 and new models are coming to the market. The aim of this article is to review the characteristics of these devices, compare their results with the reusable devices and evaluate the cost-benefits of adopting single-use flexible ureteroscopes in developing countries. Materials and Methods: an extensive review of articles listed at PubMed and published between 2000 and 2021 was performed. Results: Single-use flexible ureteroscopes have a shaft with 65 to 68cm length and weight between 119 and 277g. Their deflection goes up to 300 degrees. Their stone-free rates vary between 60 and 95% which is comparable to reusable scopes and operative times ranges from 54 to 86 minutes which are lower when compared to reusable flexible scopes. Their costs vary between 800 and 3180 US dollars. Conclusion: single-use flexible ureteroscopes are lighter and have superior quality of image when compared to fiberoptic ones. There are no definite data showing a higher stone-free rate or less complications with the use of single-use flexible ureteroscopes. Each institution must perform a cost-benefit analysis before making the decision of adopting or not such devices depending on the local circumstances.
conferenceObject IN VITRO EVALUATION OF SINGLE-USE DIGITAL FLEXIBLE URETEROSCOPES: A PRACTICAL COMPARISON FOR A PATIENT-CENTERED APPROACH(2018) MARCHINI, Giovanni; BATAGELLO, Carlos; MONGA, Manoj; TORRICELLI, Fabio; VICENTINI, Fabio; DANILOVIC, Alexandre; SROUGI, Miguel; NAHAS, William; MAZZUCCHI, Eduardo