GIOVANNI SCALA MARCHINI
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
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conferenceObject FACTORS ASSOCIATED WITH SEVERE SEPTIC EVENTS AFTER SURGICAL DECOMPRESSION OF OBSTRUCTING URETERAL STONES: A PROSPECTIVE ANALYSIS(2016) MARCHINI, Giovanni; MOSCARDI, Paulo; SROUGI, Victor; VICENTINI, Fabio; TORRICELLI, Fabio; BRITO, Artur; CAMARA, Cesar; SROUGI, Miguel; MAZZUCCHI, EduardoconferenceObject 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.- 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
conferenceObject PROSPECTIVE MID-TERM EVALUATION OF THE IMPACT OF SILENT URETERAL STONE TREATMENT ON RENAL FUNCTION USING 99MTC-DMSA(2016) MARCHINI, Giovanni; VICENTINI, Fablo; TORRICELLI, Fabio; DANILOVIC, Alexandre; BRITO, Artur; CAMARA, Cesar; MAZZUCCHI, Eduardo; SROUGI, Miguel- 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.
conferenceObject SUPINE PERCUTANEOUS NEPHROLITOTRIPSY IN SEPTUAGENARIAN AND OCTOGENARIAN PATIENTS: OUTCOMES OF A CASE-CONTROL STUDY(2018) TORRICELLI, Fabio; OGAWA, Guilherme; VICENTINI, Fabio; MARCHINI, Giovanni; DANILOVIC, Alexandre; BRITO, Artur; SROUGI, Miguel; NAHAS, William; MAZZUCCHI, EduardoconferenceObject PERCUTANEOUS NEPHROLITHOTOMY IN OBESE PATIENTS: COMPARISON BETWEEN THE PRONE AND TOTAL SUPINE POSITION(2012) MAZZUCCHI, Eduardo; VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scalla; DANILOVIC, Alexandre; BRITO, Artur Henrique; SROUGI, MiguelOBJECTIVE: We compared the outcomes of obese patients(BMI > 30) submitted to Percutaneous Nephrolithotomy (PCNL) in the prone or in the complete supine position. METHODS: Patients were randomly divided and all had a non-contrast computed tomography (CT) before and after the procedure. Stones were graded according to the Guy’s score and complications according to the Clavien grading. The stone-free rates, operative time, hospital stay and surgical complications were evaluated. RESULTS: 56 PCNL were performed (24 in the prone and 32 in the supine position). Mean stone area was 11.28 cm2 and 10.2 cm2 for patients in the prone and supine position (p=0.43). Overall stone-free rate after one procedure and the final result were 54.2% and 83.3% in the prone and 68.8% and 78.1% in the supine position, respectively (p=0.28 and 0.64). Stone-free rate was 100 and 88.9% for Guy’s I (p=0.84), 62.5 and 62.5% for Guy’s II (p=1.0), 75 and 54.5% for Guy’s III (p=0.6) and 20 and 75% for Guy’s IV (p=0.09) in the prone and supine positions, respectively. Mean operative time was 164.6 and 120.3 minutes in the prone and supine position (p=0.0017) and hospital stay 4.38 and 2.68 days, respectively (p=0.01). The transfusion rate was 20.8% in the prone group and zero in the supine group (p=0.01). Surgical complications rates were 33.3% and 31.3 % in the prone and supine positions, respectively (p=0.77). CONCLUSIONS: PCNL in the complete supine position in obese patients achieved similar results but complete supine position requires less transfusion, shorter operative time and hospital stay.- Percutaneous Nephrolithotomy in Obese Patients: Comparison Between the Prone and Total Supine Position(2012) MAZZUCCHI, Eduardo; VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scala; DANILOVIC, Alexandre; BRITO, Artur Henrique; SROUGI, MiguelBackground: Percutaneous nephrolithotomy (PCNL) can be performed in the prone or in the supine position. Comparisons between the two techniques in obese patients are rare in the current literature. Methods: The records of obese patients (body mass index >30) who underwent PCNL in the prone or complete supine positions were reviewed. All patients had a noncontrast CT before and after the procedure. Stones were graded according to the Guy stone score and complications according to the Clavien grading. The stone-free rates, operative time, surgical complications, and hospital stay were analyzed. Results: A total of 56 PCNL were performed in 42 patients. Twenty-four PCNL were performed in the prone and 32 in the total supine position. Stone-free rate on the first postoperative day was 50% in the prone and 46.9% in the supine position (P = 1.0). Final stone-free rates were 83.3% and 78.1%, respectively (P = 0.74). Mean operative time was 164.6 minutes in the prone and 120.3 minutes in the supine position (P = 0.0017), and hospital stay was 4.38 and 2.68 days (P = 0.014), respectively. The transfusion rate was 20.8% in the prone and zero in the supine position patients (P = 0.01). Excluding Guy IV stones, transfusion rate was 8.3% in the prone position (P = 0.1). Significant surgical complications rate was 12.5% in the prone and 3.1% in the supine position (P = 0.302). Conclusion: PCNL performed in the prone or in the complete supine position in obese patients presents similar outcomes. The supine decubitus position has the advantages of a significantly shorter operative time and hospital stay.
conferenceObject IMPACT OF INTRAOPERATIVE USE OF TRANEXAMIC ACID IN PATIENTS WITH COMPLEX KIDNEY STONES UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY: PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED TRIAL(2020) CARLOS, Carlos Alfredo; VICENTINI, Fabio Carvalho; MONGA, Manoj; MARCHINI, Giovanni Scala; TORRICELLI, Fabio Cesar Miranda; DANILOVIC, Alexandre; BRITO, Artur; SROUGI, Miguel; NAHAS, Willian Carlos; MAZZUCCHI, Eduardo