FABIO CARVALHO VICENTINI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
Resultados de Busca
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- Irreversible Renal Function Impairment Due to Silent Ureteral Stones(2016) MARCHINI, Giovanni S.; VICENTINI, Fabio Carvalho; MONGA, Manoj; TORRICELLI, Fabio Cesar; DANILOVIC, Alexandre; BRITO, Artur Henrique; CAMARA, Cesar; SROUGI, Miguel; MAZZUCCHI, EduardoOBJECTIVE To evaluate if renal function loss and hydronephrosis due to a silent ureteral stone might be reversed. MATERIALS AND METHODS We prospectively selected patients with silent ureteral stones between January 2006 and January 2014. A silent case was considered if there were no specific or subjective symptoms related to the ureteral stone. Patient, stone, and kidney characteristics were evaluated preoperatively, 3 and 12 months postoperatively. Renal function was accessed in the same intervals with serum creatinine (SCr), glomerular filtration rate (GFR), and Tc-99m-dimercaptosuccinic acid. Patients without complete pre-and postoperative evaluation were excluded. Primary end point was midterm progress of global and ipsilateral renal function. Secondary end points included the evaluation of renal and collecting system anatomy from diagnosis to 12 months after treatment. Analysis of variance with repeated measures and marginal homogeneity test were used to evaluate renal function and hydronephrosis progression. RESULTS Twenty-six patients met our inclusion criteria. Mean preoperative SCr and GFR were 1.24 mg/dL and 72.5 mL/min, respectively. At initial scintigraphy, mean renal function was 33.4%. Laser ureterolithotripsy was performed in 84.6% of cases and all patients were rendered stone free. Two patients (8%) developed ureteral stenosis. There was no difference regarding SCr (P =.89), GFR (P =.48), and renal function at scintigraphy (P =.19) during follow-up. Hydronephrosis significantly improved from preoperatively to 3 months postoperatively (P < .0001), but not from 3 to 12 months (P =.065). CONCLUSION Patients with silent ureteral stones present with significant impairment of ipsilateral renal function and hydronephrosis at diagnosis. On midterm follow-up evaluation, renal function of the affected unit remains stable whereas hydronephrosis improves after treatment. (C) 2016 Elsevier Inc.
- Marchini et al.: Silent Ureteral Stones: Effect on Kidney Function-Can Treatment of Silent Ureteral Stones Preserve Kidney Function? (Urology 2012; 79: 304-308) Reply(2012) MARCHINI, Giovanni S.; VICENTINI, Fabio C.; MAZZUCCHI, Eduardo; BRITO, Arthur; EBAID, Gustavo; SROUGI, Miguel
- 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.
- Utility of the Guy's Stone Score Based on Computed Tomographic Scan Findings for Predicting Percutaneous Nephrolithotomy Outcomes(2014) VICENTINI, Fabio C.; MARCHINI, Giovanni Scala; MAZZUCCHI, Eduardo; CLARO, Joaquim F. A.; SROUGI, MiguelOBJECTIVE To evaluate the ability of the Guy's stone score (GS) to predict the success rates and complications on the basis of the computed tomographic (CT) scan findings for renal stones treated with percutaneous nephrolithotomy (PCNL). METHODS From 2008 to 2012, a total of 147 consecutive patients (155 renal units) who underwent PCNL in a completely supine position were prospectively evaluated. All patients underwent a CT scan preoperatively, and the stones were classified according to the GS. All PCNLs were analyzed to determine the association between the GS and treatment outcomes on the basis of CT findings and complications, according to the Clavien criteria. RESULTS Of the 155 PCNLs, 27% were classified as GS1, 28.4% as GS2, 27% as GS3, and 17.6% as GS4. Only the largest diameter of the stones differed among the groups (GS1= 21.4, GS2= 26.5, GS3= 31.4, and GS4= 50.5 mm; P <. 001). After stratification according to the GS, the groups differed significantly regarding their operative times (GS1= 63 +/- 28.5, GS2= 101.4 +/- 40.8, GS3= 127.6 +/- 47.6, and GS4= 153.3 +/- 56 minutes; P <. 001), tubeless rates (GS1= 54.8%, GS2= 45.4%, GS3= 28.6%, and GS4= 7.4%; P <. 001), blood transfusion rates (GS1= 0%, GS2= 2.3%, GS3= 4.8%, and GS4= 22.2%; P=.01), complications (GS1= 4.8%, GS2= 9.1%, GS3= 26.2%, and GS4= 44.4%; P <. 001), immediate success rates (GS1= 95.2%, GS2= 79.5%, GS3= 59.5%, and GS4= 40.7%; P <. 001), and number of auxiliary procedures (GS1= 0.05 +/- 0.32, GS2= 0.28 +/- 0.6, GS3= 0.35 +/- 0.66, and GS4= 0.43 +/- 0.59; P=.031). The final success rates after the auxiliary procedures were similar among the groups (GS1= 97.6%, GS2= 86.4%, GS3= 90.5%, and GS4= 74.5%; P=.19). CONCLUSION The GS based on CT findings accurately predicted success rates and complications after PCNL for renal stones. (C) 2014 Elsevier Inc.
- Secondary Hypertension Caused by Massive Renal Lymphangiomatosis(2013) BALBO, Bruno E. P.; VICENTINI, Fabio C.; WATANABE, Elieser H.; HISANO, Marcelo; SROUGI, Miguel; ONUCHIC, Luiz F.
- Silent Ureteral Stones: Impact on Kidney Function-Can Treatment of Silent Ureteral Stones Preserve Kidney Function?(2012) MARCHINI, Giovanni S.; VICENTINI, Fabio C.; MAZZUCCHI, Eduardo; BRITO, Arthur; EBAID, Gustavo; SROUGI, MiguelOBJECTIVE To report our experience with silent ureteral stones and expose their true influence on renal function. METHODS We analyzed 506 patients who had undergone ureterolithotripsy from January 2005 to May 2010. Silent ureteral stones were calculi found in the absence of any specific or subjective ureteral stone-related symptoms. Of the 506 patients, 27 (5.3%) met these criteria (global cohort). All patients were assessed postoperatively with dimercaptosuccinic acid scintigraphy (DMSA). A difference in relative kidney function of >10% was considered abnormal. Pre- and postoperative comparative DMSA analyses were electively obtained for 9 patients (kidney function cohort). A t test was used to assess the numeric variables, and the chi-square test or Fisher's exact test was used for categorical variables. Two-tailed P < .05 was considered statistically significant. RESULTS Stones were diagnosed by radiologic abdominal evaluation for nonurologic diseases in 40% and after previous nephrolithiasis treatment in 33%. The primary therapy was ureterolithotripsy in 88%. The mean follow-up time was 23 months. The overall ureteral stone-free rate after 1 and 2 procedures was 96% and 100%, respectively. In the global cohort, the mean pre- and postoperative serum creatinine levels were similar (P = .39), and the mean postoperative function on DMSA was 31%. In the kidney function cohort, no difference was found between the pre-and postoperative DMSA findings (22% +/- 12.1% vs 20% +/- 11.8%; P = .83) and serum creatinine (0.8 +/- 0.13 mg/dL vs 1.0 +/- 0.21 mg/dL; P = .45). CONCLUSION Silent ureteral stones are associated with decreased kidney function present at the diagnosis. Hydronephrosis tends to diminish after stone removal, and kidney function remains unaltered. UROLOGY 79: 304-309, 2012. (C) 2012 Elsevier Inc.
- Adjuvant Tamsulosin or Nifedipine After Extracorporeal Shock Wave Lithotripsy for Renal Stones: a Double Blind, Randomized, Placebo-controlled Trial(2011) VICENTINI, Fabio C.; MAZZUCCHI, Eduardo; BRITO, Artur H.; CHEDID NETO, Elias A.; DANILOVIC, Alexandre; SROUGI, MiguelOBJECTIVE To evaluate the effects of the adjuvant use of tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for nonlower pole kidney stones 5-20 mm in size. METHODS We conducted a randomized double-blind trial involving 136 patients with radiopaque kidney stones. The patients received daily treatment with 0.4 mg tamsulosin, 20 mg nifedipine retard, or placebo for <= 30 days after 1 session of extracorporeal shock wave lithotripsy. Success was defined as plain film radiography showing the patient was completely stone free or with asymptomatic stone fragments <= 4 mm in size at any time during the weekly follow-up. RESULTS The success rate was 60.5% (23 of 38) in the tamsulosin group, 48.6% (17 of 35) in the nifedipine group, and 36.8% (14 of 38) in the placebo group (P = .118). In the subgroup analysis, stones 10-20 mm had significantly greater success rates in the tamsulosin (13 of 21, 61.9%) and nifedipine (15 of 25, 60%) groups compared with the placebo group (6 of 23, 26.1%; P = .024), but not for stones 5-9 mm (P = .128). The number needed to treat was 2.9 for tamsulosin and 3 for nifedipine. Adverse events were more frequent in the nifedipine than in the placebo group (28.5% vs 2.6%, respectively, P = .009), but without a significant difference between the nifedipine and tamsulosin (28.5% vs 15.8%, P = .15) or the tamsulosin and placebo (P = .54) groups. No difference was found among the groups with regard to pain intensity, interval to clearance, or steinstrasse. CONCLUSION The stone-free rates after extracorporeal shock wave lithotripsy with adjuvant tamsulosin or nifedipine were significantly increased only for nonlower pole renal stones 10-20 mm in size compared with placebo. Nifedipine was associated with more adverse effects than placebo. UROLOGY 78: 1016-1022, 2011. (C) 2011 Elsevier Inc.