EDUARDO MAZZUCCHI
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 - Líder
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
14 resultados
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- 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, ManojOBJECTIVE 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.
- Low Dose Fluoroscopy During Ureteroscopy Does Not Compromise Surgical Outcomes(2019) DANILOVIC, Alexandre; NUNES, Eduardo; LIPKIN, Michael E.; FERREIRA, Thiago; TORRICELLI, Fabio C. M.; MARCHINI, Giovanni S.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoObjective: To evaluate whether reducing the dose of fluoroscopy to 1/4 of standard dose during unilateral ureteroscopy for ureteral stone treatment would impact in a reduction of total radiation emitted and whether this strategy would impact operation time, stone-free rate, and complication rate. Methods: From August 2016 to August 2017, patients over 18 years submitted to ureteroscopy for ureteral stone between 5 and 20 mm were prospectively randomized for 1/4 dose reduction or standard dose fluoroscopy. Patients with abnormal urinary anatomy such as horseshoe kidney, pelvic kidney, or duplex system were excluded from the study. Results: Ninety-four patients were enrolled. The fluoroscopic dose reduction strategy to 1/4 of the standard dose was able to significantly reduce the cumulative radiation emitted by C-arm fluoroscopy and the dose area product (3.6 +/- 4.5 mGy vs 16.2 +/- 19.3 mGy, p = 0.0001 and 0.23 +/- 0.52 mcGycm(2) vs 1.15 +/- 2.74 mcGycm(2), p = 0.02, respectively). Fluoroscopy time was similar between groups (74.5 +/- 84.8 seconds vs 88.3 +/- 90 seconds, p = 0.44). There was no need to increase the fluoroscopy dose during any of the procedures. Surgical outcomes were not affected by fluoroscopic dose reduction strategy. Conclusion: Low dose fluoroscopy reduces the emitted radiation during ureteroscopy without compromising surgical outcomes.
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, ManojIntroduction: 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.- A comprehensive literature-based equation to compare cost-effectiveness of a flexible ureteroscopy program with single-use versus reusable devices(2019) MARCHINI, Giovanni S.; TORRICELLI, Fabio C.; BATAGELLO, Carlos A.; MONGA, Manoj; VICENTINI, Fabio C.; DANILOVIC, Alexandre; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoPurpose: to critically review all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes. Materials and Methods: A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. All factors potentially affecting surgical costs or clinical outcomes were considered. Prospective assessments, case control and case series studies were included. Results: 741 studies were found. Of those, 18 were duplicated and 77 were not related to urology procedures. Of the remaining 646 studies, 59 were considered of relevance and selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. Operative time was in average 20% shorter with digital scopes, single-use or not. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Longer scope longevity is achieved with Cidex and if a dedicated nurse takes care of the sterilization process. The main surgical factors that negatively impact device longevity are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. We have built a comprehensive financial cost-effective decision model to flexible ureteroscope acquisition. Conclusions: The cost-effectiveness of a flexible ureteroscopy program is dependent of several aspects. We have developed a equation to allow a literature-based and adaptable decision model to every interested stakeholder. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls.
- 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, EduardoObjective: 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.
- Complete supine percutaneous nephrolithotomy with GoPro (R). Ten steps for success(2018) VICENTINI, Fabio Carvalho; SANTOS, Hugo Daniel Barone dos; BATAGELLO, Carlos Alfredo; AMUNDSON, Julia Rothe; OLIVEIRA NETO, Evaristo Peixoto; MARCHINI, Giovanni Scala; SROUGI, Miguel; NAHAS, Willian Carlos; MAZZUCCHI, EduardoObjective: To show a video of a complete supine Percutaneous Nephrolithotomy (csPCNL) performed for the treatment of a staghorn calculus, from the surgeon's point of view. The procedure was recorded with a GoPro (R) camera, demonstrating the ten essential steps for a successful procedure. Materials and methods: The patient was a 38 years-old woman with 2.4cm of left kidney lower pole stone burden who presented with 3 months of lumbar pain and recurrent urinary tract infections. She had a previous diagnosis of polycystic kidney disease and chronic renal failure stage 2. CT scan showed two 1.2cm stones in the lower pole (Guy's Stone Score 2). She had a previous ipsilateral double J insertion due to an obstructive pyelonephritis. The csPCNL was uneventful with a single access in the lower pole. The surgeon had a Full HD GoPro Hero 4 Session (R) camera mounted on his head, controlled by the surgical team with a remote control. All of the mains steps were recorded. Informed consent was obtained prior to the procedure. Results: The surgical time was 90 minutes. Hemoglobin drop was 0.5g/dL. A post-operative CT scan was stone-free. The patient was discharged 36 hours after surgery. The camera worked properly and didn't cause pain or muscle discomfort to the surgeon. The quality of the recorded movie was excellent. Conclusion: GoPro (R) camera proved to be a very interesting tool to document surgeries without interfering with the procedure and with great educational potential. More studies should be conducted to evaluate the role of this equipment.
- Percutaneous Nephrolithotomy in Horseshoe Kidneys: Results of a Multicentric Study(2021) VICENTINI, Fabio Carvalho; MAZZUCCHI, Eduardo; GOKCE, Mehmet Ilker; SOFER, Mario; TANIDIR, Yiloren; SENER, Tarik Emre; MELO, Petronio Augusto de Souza; EISNER, Brian; BATTER, Timothy Hunt; CHI, Thomas; ARMAS-PHAN, Manuel; SCOFFONE, Cesare Marco; CRACCO, Cecilia Maria; PEREZ, Braulio Omar Manzo; ANGERRI, Oriol; EMILIANI, Esteban; MAUGERI, Orazio; STERN, Karen; BATAGELLO, Carlos Alfredo; MONGA, ManojObjective:To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during operation. Methods:We carried out a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK. Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of >4-mm fragments. Values ofp < 0.05 were considered significant. Results:We analyzed 106 procedures. The transfusion, complication, and immediate success rates (ISRs) were 3.8%, 17.5%, and 54.7%, respectively. The final success rate (FSR) increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments >= 4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine position. The prone group had a significantly higher BMI than the supine group (30.1vs27.7,p = 0.024). The transfusion, complication, and ISRs between the prone and supine groups were 4.5%vs2.6% (p = 0.99), 16.9%vs18.4% (p = 0.99), and 52.5%vs69.2% (p = 0.151), respectively. Surgical time was significantly longer in the prone group (126.5vs100 minutes,p = 0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group (p < 0.001). The prone group had significantly more Clavien 2 complications than the supine (p = 0.013). The FSR in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred. Conclusion:PCNL in patients with HSK is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.
- 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, EduardoIntroduction: 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.
- Tranexamic acid in patients with complex stones undergoing percutaneous nephrolithotomy: a randomised, double-blinded, placebo-controlled trial(2022) BATAGELLO, Carlos A.; VICENTINI, Fabio C.; MONGA, Manoj; MILLER, Aaron W.; MARCHINI, Giovanni S.; TORRICELLI, Fabio C. M.; DANILOVIC, Alexandre; COELHO, Rafael F.; SROUGI, Miguel; NAHAS, Willian C.; MAZZUCCHI, EduardoObjectives To assess the efficacy and safety of single-dose tranexamic acid on the blood transfusion rate and outcomes of patients with complex kidney stones undergoing percutaneous nephrolithotomy (PCNL). Patients and Methods In a randomised, double-blinded, placebo-controlled trial, 192 patients with complex kidney stone (Guy's Stone Scores III-IV) were prospectively enrolled and randomised (1:1 ratio) to receive either one dose of tranexamic acid (1 g) or a placebo at the time of anaesthetic induction for PCNL. The primary outcome measure was the occurrence rate of perioperative blood transfusion. The secondary outcome measures included blood loss, operative time, stone-free rate (SFR), and complications. ClinicalTrials.gov identifier: NCT02966236. Results The overall risk of receiving a blood transfusion was reduced in the tranexamic acid group (2.2% vs 10.4%; relative risk, 0.21, 95% confidence interval [CI] 0.03-0.76, P = 0.033; number-needed-to-treat: 12). Patients randomised to the tranexamic acid group had a higher immediate and 3-month SFR compared with those in the placebo group (29% vs 14.7%, odds ratio [OR] 2.37, 95% CI 1.15-4.87, P = 0.019, and 46.2% vs 28.1%, OR 2.20, 95% CI 1.20-4.02, P = 0.011, respectively). Faster haemoglobin recovery occurred in patients in the tranexamic acid group (mean, 21.3 days; P = 0.001). No statistical differences were found in operative time and complications between groups. Conclusions Tranexamic acid administration is safe and reduces the need for blood transfusion by five-times in patients with complex kidney stones undergoing PCNL. Moreover, tranexamic acid may contribute to better stone clearance rate and faster haemoglobin recovery without increasing complications. A single dose of tranexamic acid at the time of anaesthetic induction could be considered standard clinical practice for patients with complex kidney stones undergoing PCNL.
- Nomogram to predict uric acid kidney stones based on patient's age, BMI and 24-hour urine profiles: A multicentre validation(2015) TORRICELLI, Fabio Cesar Miranda; BROWN, Robert; BERTO, Fernanda C. G.; TARPLIN, Sarah; SROUGI, Miguel; MAZZUCCHI, Eduardo; MONGA, ManojIntroduction: We performed a multicentre validation of a nomogram to predict uric acid kidney stones in two populations. Methods: We reviewed the kidney stone database of two institutions, searching for patients with kidney stones who had stone composition analysis and 24-hour urine collection from January 2010 to December 2013. A nomogram to predict uric acid kidneys stones based on patient age, body mass index (BMI), and 24-hour urine collection was tested. Receiver-operating curves (ROC) were performed. Results: We identified 445 patients, 355 from Cleveland, United States, and 90 from Sao Paulo, Brazil. Uric acid stone formers were 7.9% and 8.9%, respectively. Uric acid patients had a significantly higher age and BMI, as well as significant lower urinary calcium than calcium stone formers in both populations. Uric acid had significantly higher total points when scored according to the nomogram. ROC curves showed an area under the curve of 0.8 for Cleveland and 0.92 for Sao Paulo. The cutoff value that provided the highest sensitivity and specificity was 179 points and 192 for Cleveland and Sao Paulo, respectively. Using 180 points as a cutoff provided a sensitivity and specificity of 87.5% and 68% for Cleveland, and 100% and 42% for Sao Paulo. Higher cutoffs were associated with higher specificity. The main limitation of this study is that only patients from high volume hospitals with uric acid or calcium stones were included. Conclusion: Predicting uric acid kidneys stone based on a nomogram, which includes only demographic data and 24-hour urine parameters, is feasible with a high degree of accuracy.