MARCELO HISANO
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
5 resultados
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- Cranberries and lower urinary tract infection prevention(2012) HISANO, Marcelo; BRUSCHINI, Homero; NICODEMO, Antonio Carlos; SROUGI, MiguelLower urinary tract infections are very common diseases. Recurrent urinary tract infections remain challenging to treat because the main treatment option is long-term antibiotic prophylaxis; however, this poses a risk for the emergence of bacterial resistance. Some options to avoid this risk are available, including the use of cranberry products. This article reviews the key methods in using cranberries as a preventive measure for lower urinary tract infections, including in vitro studies and clinical trials.
conferenceObject THE GUY'S STONE SCORE: A VERY PRACTICAL AND USEFUL TOOL TO PREDICT THE OUTCOMES OF PERCUTANEOUS NEPHROLITHOTOMY (PCNL)(2012) VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scala; MAZZUCCHI, Eduardo; CHEDID NETO, Elias Assad; BRITO, Arthur Henrique; DANILOVIC, Alexandre; HISANO, Marcelo; CLARO, Joaquim Almeida; SROUGI, MiguelOBJECTIVE: To evaluate the applicability of the Guy’s stone score for complete supine PCNL. METHODS: 117 patients that underwent to complete supine PCNL were classified according the Guy’s stone score. The data were prospectively collected but the classification according to the score was done by review of the pre-operative CT scans. All patients were operated by the same surgeon and had a pre and post operative CT scan and at the final followup. The outcomes and complications were compared among the 4 groups. RESULTS: The table 1 shows the demographic and outcomes. The groups were similar except for the median stone diameter. The differences among groups were statistically different after stratification according to the Guy’s stone score in relation to operative time, hemoglobin drop, transfusions, complications, tubeless rate, immediate success, auxiliary procedures, PCNL revisions and final success rate. CONCLUSIONS: The Guy’s stone score showed to be a very practical and useful tool to predict the outcomes of PCNL.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.- Retroperitoneoscopic adrenalectomy in pheochromocytoma(2012) HISANO, Marcelo; VICENTINI, Fabio Carvalho; SROUGI, MiguelSince the first laparoscopic adrenalectomy, the technique has evolved and it has become the standard of care for many adrenal diseases, including pheochromocytoma. Two laparoscopic accesses to the adrenal have been developed: transperitoneal and retroperitoneal. Retroperitoneoscopic adrenalectomy may be recommended for the treatment of pheochromocytoma with the same peri-operative outcomes of the transperitoneal approach because it allows direct access to the adrenal glands without increasing the operative risks. Although technically more demanding than the transperitoneal approach, retroperitoneoscopy can shorten the mean operative time, which is critical for cases with pheochromocytoma where minimizing the potential for intra-operative hemodynamic changes is essential. Blood loss and the convalescence time can be also shortened by this approach. There is no absolute indication for either the transperitoneal or retroperitoneal approach; however, the latter procedure may be the best option for patients who have undergone previous abdominal surgery and obese patients. Also, retroperitoneoscopic adrenalectomy is a good alternative for treating cases with inherited pheochromocytomas, such as multiple endocrine neoplasia type 2A, in which the pheochromocytoma is highly prevalent and frequently occurs bilaterally.
- Laparoscopic ureteropyeloanastomosis in the treatment of duplex system(2012) HISANO, Marcelo; DENES, Francisco T.; BRITO, Artur H.; LUCON, Marcos; MACHADO, Marcos G.; BRUSCHINI, Homero; SROUGI, MiguelPurpose: Duplex system is one of the most common anomalies of upper urinary tract. Anatomical and clinical presentation determine its treatment. Usually, the upper moiety has a poor function and requires resection, but when it is not significantly impaired, preservation is recommended. Laparoscopic reconstruction with upper pole preservation is presented as an alternative treatment. Materials and Methods: Four female patients with duplex system, one presenting with recurrent urinary tract infection and the others with urinary incontinence associated to infrasphincteric ectopic ureter, were treated. Surgical procedure envolved a laparoscopic ureteropyeloanastomosis of the upper pole ureter to the pelvis of the lower moiety, with prior insertion of a double J stent. Results: Surgical time varied from 120 to 150 minutes, with minimal blood loss in all cases. Follow-up varied from 15 to 30 months, with resolution of the clinical symptoms and preservation of the upper moiety function. Conclusion: Laparoscopic ureteropyeloanatomosis is a feasible and safe minimally invasive option in the treatment of duplex system.