BRUNO ARAGAO ROCHA
Projetos de Pesquisa
Unidades Organizacionais
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina
2 resultados
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- 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.
- 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.