FABIO CARVALHO VICENTINI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
10 resultados
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- Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones(2015) TORRICELLI, Fabio Cesar Miranda; DANILOVIC, Alexandre; VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scala; SROUGI, Miguel; MAZZUCCHI, EduardoThe use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed (R) database between January 1984 and October 2013 using ""shock wave lithotripsy"" and ""stone"" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.
- 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.
- International Alliance of Urolithiasis guideline on retrograde intrarenal surgery(2023) ZENG, Guohua; TRAXER, Olivier; ZHONG, Wen; OSTHER, Palle; PEARLE, Margaret S.; PREMINGER, Glenn M.; MAZZON, Giorgio; SEITZ, Christian; GEAVLETE, Petrisor; FIORI, Cristian; GHANI, Khurshid R.; CHEW, Ben H.; GIT, Kah Ann; VICENTINI, Fabio Carvalho; PAPATSORIS, Athanasios; BREHMER, Marianne; MARTINEZ, Juan Lopez; CHENG, Jiwen; CHENG, Fan; GAO, Xiaofeng; GADZHIEV, Nariman; PIETROPAOLO, Amelia; PROIETTI, Silvia; YE, Zhangqun; SARICA, KemalObjectives To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. Materials and Methods After a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. Results A total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. Conclusion The series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.
- 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.
- Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10-20 mm lower pole renal stones: a systematic review and meta-analysis(2020) CABRERA, Jose D.; MANZO, Braulio O.; TORRES, Jose E.; VICENTINI, Fabio C.; SANCHEZ, Hector M.; ROJAS, Ernesto A.; LOZADA, EdgardPurpose To compare the efficacy and safety of mini-percutaneous nephrolithotomy (mini-PCNL) versus retrograde intrarenal surgery (RIRS) for treatment of 10-20 mm lower pole renal stones. Methods A comprehensive literature search of PubMed, Scopus, the Cochrane Library, and Web of Science was conducted to identify all studies comparing mini-PCNL and RIRS for 10-20 mm lower pole renal stones before March 2019. Article selection proceeded according to the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The meta-analysis was performed with the R program version 3.5.1. Results A total of five studies were included (two randomized controlled trials and three case-controlled trials) with a total of 587 patients included. The success rate was significantly higher in the mini-PCNL group (OR 1.67; 95% CIp = 0.05). Operative and fluoroscopy times were similar for both groups (MD 2.45; 95% CIp = 0.87 and MD 2.11; 95% CIp = 0.09, respectively). Concerning the hospital stay and overall complication rates, there were no differences between the two procedures (MD 41.94; 95% CIp = 0.18 and OR 1.76; 95% CIp = 0.11). Conclusion Our analysis showed that both procedures are safe for treatment of 10-20 mm lower pole renal stones with similar complication rates, operative times, fluoroscopy times and length of hospital stay, but mini-PCNL was significantly superior in effectiveness with a higher success rate. Based on these results, mini-PCNL may be included in the guidelines as a safe and effective alternative treatment for 10-20 mm lower pole stones.
- The impact of COVID-19 in medical practice. A review focused on Urology(2021) MAZZUCCHI, Eduardo; TORRICELLI, Fabio C. M.; VICENTINI, Fabio C.; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; BATAGELLO, Carlos A.; SROUGI, Miguel; NAHAS, William C.COVID-19 pandemic is a rapidly spreading virus that is changing the World and the way doctors are practicing medicine. The huge number of patients searching for medical care and needing intensive care beds led the health care system to a burnout status especially in places where the care system was already overloaded. In this setting, and also clue to the absence of a specific treatment for the disease, health authorities had to opt for recommending or imposing social distancing to relieve the health system and reduce deaths. All other medical specialties non directly related to the treatment of COVID-19 had to interrupt or strongly reduce their activities in order to give room to seriously ill patients, since no one knows so far the real extent of the virus damage on human body and the consequences of doing non deferrable procedures in this pandemic era. Despite not been a urological disease, the urologist needs to be updated on how to deal with these patients and how to take care of himself and of the medical team he works with. The aim of this article is to review briefly some practical aspects of COVID-19 and its implications in the urological practice in our country.
- 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.
article 5 Citação(ões) na Scopus Supracostal punctures in supine percutaneous nephrolithotomy are safe(2017) WOOD, Guilherme J. A.; TORRICELLI, Fabio C. M.; VICENTINI, Fabio C.; SROUGI, Miguel; MAZZUCCHI, EduardoIntroduction: The feasibility and safety of supracostal punctures in supine percutaneous nephrolithotomy (PCNL) are still controversial. In this study we aim to compare success and complication rates from prone and supine PCNL with at least one supracostal puncture. Material and methods: We reviewed our electronic database for all supracostal PCNLs performed in our institution from February 2008 to September 2013. Patients were enrolled in the study if at least one supracostal puncture was required during surgery. Patients' demographics data, stone characteristics, intra and postoperative data, and success on first postoperative day CT were compared. Results: A total of 132 procedures were included in the analysis. Twenty-eight PCNLs were performed in supine position (21.2%), while 104 were done in prone position (78.8%). Patient's demographics and distribution of stones based on Guy's Score were similar between groups. Mean operative time and blood transfusion rate were not statistically different. There was no significant difference in the success rate (63.5% prone versus 71.4% supine, p = 0.507). Major complication rate (Clavien >= 3) was 16.3% in the prone group versus 3.6% in the supine group (p = 0.119). Conclusions: Supracostal punctures are safe and feasible in supine PCNL. It does not add additional risks and might provide equivalent success rates when compared to prone PCNLs.- 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.
- 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.