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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- Percutaneous nephrolithotomy in patients with spinal cord injury: should all these patients be automatically assigned a Guy's stone score of 4?(2021) TORRICELLI, Fabio C. M.; VICENTINI, Fabio C.; ZANETTI, Lucas; PERRELLA, Rodrigo; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; BATAGELLO, Carlos A.; MURTA, Claudio B.; CLARO, Joaquim F. A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoPurpose To assess the complication and stone-free rates of PCNL in patients with spinal cord injury (SCI) and to evaluate whether this population should be assigned a Guy's stone score (GSS) of 4. Methods A case-control study was conducted, and electronic charts were reviewed to search for patients with SCI, bladder dysfunction, and kidney stones who had undergone PCNL. Control cases were randomly selected from among patients with complete staghorn calculus (GSS = 4). Results One hundred and seventeen patients were included. Patients with SCI had a significant shorter operative time (119 vs. 141 min;p = 0.018). There were no significant differences between the groups in terms of the patients' position, number of renal tracts, bleeding or transfusion rate; however, there was a significantly higher complication rate (23.1% vs. 7.8%;p = 0.009) and a longer hospital stay (5.8 vs. 3.1 days;p = 0.002) among patients with SCI. With regards to the stone-free rate in patients with different grades of GSS patients with SCI who had a GSS of 1 had a stone-free rate of 85.7%, while those with a GSS of 2, 3, or 4 had 50%, 50%, and 31.5%, respectively (p = 0.024). Only patients with a GSS of 4 in the SCI group had outcomes that were similar to those of control patients (31.5% vs. 31.6%). Conclusion Patients with SCI should not be automatically assigned GSS 4. Stone-free rate is related to stone burden in these patients, although they do show a higher complication rate and a longer hospital stay than non-neurological patients.
- Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function(2020) TORRICELLI, Fabio C. M.; CARVALHO, Regina S.; MARCHINI, Giovanni S.; DANILOVIC, Alexandre; VICENTINI, Fabio C.; BATAGELLO, Carlos A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoINTRODUCTION: Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. METHODS: Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. RESULTS: Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien <= 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). CONCLUSION: sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stonefree rate.
- 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.
- 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.
- Understanding urologic scientific publication patterns and general public interests on stone disease: lessons learned from big data platforms(2021) MARCHINI, Giovanni S.; FARIA, Kauy V. M.; NETO, Felippe L.; TORRICELLI, Fabio Cesar Miranda; DANILOVIC, Alexandre; VICENTINI, Fabio Carvalho; BATAGELLO, Carlos A.; SROUGI, Miguel; NAHAS, William C.; MAZZUCCHI, EduardoPurpose To analyse patterns of stone disease online information-seeking behaviours in the United States and to correlate with urological literature publication aspects. Methods To compare Relative Search Volume (RSV) among different twelve preselected urologic keywords we chose ""United States"" as country and ""01/01/2009-31/12/2018"" as time range on Google Trends (GT). We defined ""ureteroscopy"" as a reference and compared RSV against it for each term. RSV was adjusted and normalized in a scale 0-100. Trend presence was evaluated by Mann-Kendall Test and magnitude by Sen's Slope Estimator (SS). Weather influence on RSV was also investigated by comparison of the ten hottest versus ten coldest states. Pearson correlation analysis was performed between number of Pubmed publications and RSV for each term over time. Results We found an upward tendency (p 0.01) for most terms. Higher temporal trends were seen for ""kidney stone"" (SS = 0.36), ""kidney pain"" (SS = 0.39) and ""tamsulosin"" (SS = 0.21). Technical treatment terms had little search volumes and no increasing trend. States with hotter weather showed higher mean RSV for ""kidney stone"" than colder ones. There was little correlation between GT and Pubmed for most terms, with the exception of ""kidney stone"" (R = 0.89; p 0.01), ""URS"" (R = 0.81; p 0.01), and ""laser lithotripsy"" (R = 0.74; p = 0.01). Conclusion There was a significant increase in online search for medical information related to stone disease. Citizens tend to look for generic terms related to symptoms or the disease itself. States with hotter weather show higher RSV than colder states. There is a discrepancy between public and medical community medical terms.
- Current trends of percutaneous nephrolithotomy in a developing country(2018) BATAGELLO, Carlos A.; VICENTINI, Fabio Carvalho; MARCHINI, Giovanni Scala; TORRICELLI, Fabio Cesar Miranda; SROUGI, Miguel; NAHAS, Willian Carlos; MAZZUCCHI, EduardoIntroduction: To present the current practice patterns on percutaneous nephrolithotomy (PCNL) in a developing country. Materials and Methods: A survey was offered to Brazilian urologists during the II International Endourology Symposium held in Sao Paulo, in 2015. The first seven questions were related to demographic data while the 20 remaining were directed to urologists who performed PCNL. Results: From 250 participants, 100 replied to the survey, 81% performed PCNL and 60.4% of performers had been in practice for less than 15 years. Eighty-one percent were trained in the prone position and 64% in supine. PCNL was learned during the residency in 66.7% and 2.5% had fellowship training. Prone position was the preferred decubitus for simple or complex calculi, though for obese patients there was no difference. Younger surgeons prefer supine while older surgeons prefer prone. The access was obtained by the surgeon in all cases, 96.3% use fluoroscopy and 3.7% prefer ultrasonography. Forty-seven percent use ultrasonic lithotripters and 4.1% laser. For kidney drainage, 71.6% place a nephrostomy tube. Double J stent is left in 77%. The postoperative image method was CT for 50%. Colonic injury was reported by 25%, predominantly in the senior group without statistically difference between positions. Conclusions: From a selected group of urologists, we observe that Brazilian urologists usually gain their own access for PCNL guided by fluoroscopy. They predominantly prefer the prone position, use fascial dilators, ultrasonic lithotripters and place a nephrostomy tube when exiting the kidney. Fellowship programs, ultrasonography, flexible nephoscopy and tubeless procedures could be encouraged.
- A large 15-year database analysis on the influence of age, gender, race, obesity and income on hospitalization rates due to stone disease(2016) MELLO, Marcos F.; MARCHINI, Giovanni Scala; CAMARA, Cesar; DANILOVIC, Alexandre; LEVY, Renata; ELUF-NETO, Jose; SROUGI, Miguel; MAZZUCCHI, EduardoPurpose: To assess the public hospitalization rate due to stone disease in a large developing nation for a 15-year period and its association with socio-demographic data. Materials and Methods: A retrospective database analysis of hospitalization rates in the Brazilian public health system was performed, searching for records with a diagnosis code of renal/ureteral calculi at admission between 1998-2012. Patients managed in an outpatient basis or private care were excluded. Socio-demographic data was attained and a temporal trend analysis was performed. Results: The number of stone-related hospitalizations increased from 15.7%, although the population-adjusted hospitalization rate remained constant in 0.04%. Male: female proportion among hospitalized patients was stable (49.3%: 50.7% in 1998; 49.2%: 50.8% in 2012), though there was a significant reduction in the prevalence of male hospitalizations (-3.8%; p=0.041). In 2012, 38% of hospitalized patients due to stone disease had 40-59 years-old. The >= 80 years-old strata showed the most significant decrease (-43.44%; p=0.022), followed by the 20-39 (-23.17%; p<0.001) and 0-19 years-old cohorts (-16.73%; p=0.012). Overall, the lowest relative hospitalization rates were found for yellow and indigenous individuals. The number of overweight/obese individuals increased significantly (+20.6%), accompanied by a +43.6% augment in the per capita income. A significant correlation was found only between income and obesity (R=0.64; p=0.017). Conclusions: The prevalence of stone disease requiring hospitalization in Brazil remains stable, with a balanced proportion between males and females. There is trend for decreased hospitalization rates of male, <40 and >= 80 years-old individuals. Obesity and income have a more pronounced correlation with each other than with stone disease.
- Comparing public interest on stone disease between developed and underdeveloped nations: are search patterns on google trends similar?(2021) MARCHINI, Giovanni S.; FARIA, Kauy V. M.; NETO, Felippe L.; TORRICELLI, Fabio Cesar Miranda; DANILOVIC, Alexandre; VICENTINI, Fabio Carvalho; BATAGELLO, Carlos A.; SROUGI, Miguel; NAHAS, Willaim C.; MAZZUCCHI, EduardoObjective: The big data provided by Google Trends may reveal patterns in health information-seeking behavior on population from Brazil and United States (US). Our objective was to explore and compare patterns of stone disease online information-seeking behaviors in both nations. Materials and Methods: To compare Relative Search Volume (RSV) among different urologic key words we chose ""US"" and ""Brazil"" as country and ""01/01/2009 - 31/12/2018"" as time-range. The final selection included 12 key words in each language. We defined ""ureteroscopy"" as a reference and compared RSV against it for each term. RSV was adjusted by the reference and normalized in a scale from 0-100. Trend presence was evaluated by Mann Kendall Test and magnitude by Sen's Slope (SS) Estimator. Results: We found an upward trend (p < 0.01) in most of the researched terms in both countries. Higher temporal trends were seen for ""Kidney Stone"" (SS=0.36), ""Kidney Pain"" (SS=0.39) and ""Tamsulosin"" (SS=0.21) in the US. Technical treatment terms had little search volumes and no increasing trend. ""Kidney Stent"" and ""Double J"" had a significant increase in search trend over time and had a relevant search volume overall in 2018. In Brazil, ""Calculo Renal"", ""Colica Renal"", ""Dor no Rim"" and ""Pedra no Rim"" had a significant increase in RSV (p < 0.001). More common and popular terms as ""Kidney Stent"" and ""Tamsulosin"" were highly correlated with ""Kidney Pain"" and ""Kidney Stone"" in both countries. Conclusions: In the last decade, there was a significant increase in online search for medical information related to stone-disease. Population from both countries tend to look more for generic terms related to symptoms, the disease, medical management and kidney stent, than for technical treatment vocabulary.
- Assessment of Residual Stone Fragments After Retrograde Intrarenal Surgery(2018) DANILOVIC, Alexandre; CAVALANTI, Andrea; ROCHA, Bruno Aragao; TRAXER, Olivier; TORRICELLI, Fabio Cesar Miranda; MARCHINI, Giovanni Scala; MAZZUCCHI, Eduardo; SROUGI, MiguelObjectives: To define the most suitable approach to assess residual stone fragments after retrograde intrarenal surgery (RIRS). Methods: Ninety-two patients (115 renal units) submitted to RIRS for symptomatic kidney stones >5mm and <20mm or <15mm in the lower Calyx diagnosed by noncontrast CT (NCCT) were prospectively studied. Residual fragments were assessed by endoscopic evaluation (END) at the end of the procedure and by NCCT, ultrasonography (US), and kidney, ureter, and bladder radiograph (KUB) on the 90th postoperative day (POD). NCCT was considered the gold standard for the evaluation of residual fragments after RIRS. Results: The 90th POD NCCT resulted in stone-free status in 74.8% (86/115), 0-2mm in 8.7% (10/115), and >2mm residual fragments in 16.5% (19/115) renal units. Stone-free status by END at the end of RIRS was coincident with NCCT in 93.0% of the cases (40/43). There were no cases of residual fragments >2mm on NCCT if END resulted in stone-free status. In all cases where END resulted in residual fragments >2mm, US proved to be correct according to NCCT. Neither US nor KUB was able to identify residual fragments between 0 and 2mm. KUB had only 31.6% (6/19) sensitivity to detect residual fragments >2mm and did not add sensitivity or specificity to US. Conclusions: In the follow-up imaging after RIRS, we suggest that if END resulted in residual fragments <2mm, a 90th POD NCCT should be performed. US may be used if END showed fragments >2mm.
- Treatment of renal lower pole stones: an update(2022) MAZZUCCHI, Eduardo; BERTO, Fernanda C. G.; DENSTEDT, John; DANILOVIC, Alexandre; BATAGELLO, Carlos Alfredo; TORRICELLI, Fabio C. M.; VICENTINI, Fabio C.; MARCHINI, Giovanni S.; SROUGI, Miguel