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Kwok JL, Panthier F, De Coninck V, Ventimiglia E, Barghouthy Y, Danilovic A, Smyth N, Brachlow J, Schmid FA, Poyet C, Eberli D, Traxer O, Keller EX. Illumination matters Part II: advanced comparative analysis of flexible ureteroscopes in a kidney model by PEARLS. World J Urol 2024; 42:298. [PMID: 38709327 DOI: 10.1007/s00345-024-04987-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/07/2024] [Indexed: 05/07/2024] Open
Abstract
PURPOSE The aim of the study was to evaluate illumination properties in an in-vitro kidney calyx model in saline. DESIGN AND METHODS We evaluated a series of contemporary flexible ureteroscopes including the Storz Flex-Xc and Flex-X2s, Olympus V3 and P7, Pusen 7.5F and 9.2F, as well as OTU WiScope using a 3D-printed closed pink kidney calyx model, submerged in saline. A spectrometer was used for illuminance and color temperature measurements at different openings located at center (direct light), 45° (direct and indirect light) and 90°(indirect light) to the axis of the scope. RESULTS Maximum illuminance was at the center opening for all scopes (range: 284 to 12,058 lx at 50% brightness and 454 to 11,871 lx at 100% brightness settings). The scope with the highest center illuminance (Flex-Xc) was 26 times superior to the scope with the lowest illuminance (Pusen 7.5Fr) at 100% brightness setting. For each scope, there was a peripheral illuminance drop ranging from - 43 to - 92% at 50% brightness and - 43% to - 88% at 100% brightness settings, respectively (all p < 0.01). Highest drop was for the P7 and the Pusen 9.2F. All scopes had illuminance skew, except the V3. All scopes had a warm color temperature. CONCLUSION Illumination properties vary between ureteroscopes in an enclosed cavity in saline, and differs at center vs 45° and 90° positions within scopes. Peripheral illuminance drop can be as high as - 92%, which is undesirable. This may affect the choice of ureteroscope and light brightness settings used in surgery by urologists.
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Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology & Urolithiasis Working Group, Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology & Urolithiasis Working Group, Arnhem, The Netherlands
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Yazeed Barghouthy
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Alexandre Danilovic
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Universidade de São Paulo Hospital das Clínicas-HCUSP, São Paulo, Brazil
- Department of Urology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Niamh Smyth
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- University Hospital Monklands, Monkscourt Avenue, Airdrie, ML60JS, UK
| | - Jan Brachlow
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Zentrum Für Urologie Winterthur, Winterthur, Switzerland
| | - Florian Alexander Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Young Academic Urologists (YAU), Endourology & Urolithiasis Working Group, Arnhem, The Netherlands.
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Lepine HL, Vicentini FC, Mazzucchi E, Molina WR, Marchini GS, Torricelli FC, Batagello CA, Danilovic A, Nahas WC. Intraoperative computed tomography for detection of residual stones in endourology procedures: systematic review and meta-analysis. Int Braz J Urol 2024; 50:250-260. [PMID: 38598828 DOI: 10.1590/s1677-5538.ibju.2024.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures. METHODS This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-effects model was selected for pooling of data. RESULTS A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant differences. Radiation exposure was also significantly reduced in two of the included studies. CONCLUSION This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies.
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Affiliation(s)
- Henrique L Lepine
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio C Vicentini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Wilson R Molina
- Department of Urology, Endourology Section, University of Kansas, Kansas City, KS, USA
| | - Giovanni S Marchini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio C Torricelli
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carlos A Batagello
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William C Nahas
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Santa Cruz JAC, Danilovic A, Vicentini FC, Brito AH, Batagello CA, Marchini GS, Torricelli FCM, Nahas WC, Mazzucchi E. Ureteral access sheath. Does it improve the results of flexible ureteroscopy? A narrative review. Int Braz J Urol 2024; 50:346-658. [PMID: 38498688 DOI: 10.1590/s1677-5538.ibju.2024.9907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
- José Agustin Cabrera Santa Cruz
- Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Artur Henrique Brito
- Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Carlos Alfredo Batagello
- Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Giovanni Scalla Marchini
- Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Fabio César Miranda Torricelli
- Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - William Carlos Nahas
- Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
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Danilovic A, Suartz CV, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Nahas WC, Mazzucchi E. Play it safe: renal function after bilateral flexible ureteroscopy for kidney stones. World J Urol 2024; 42:226. [PMID: 38594574 DOI: 10.1007/s00345-024-04924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE We searched for perioperative renal function deterioration risk factors in patients that underwent bilateral flexible ureteroscopy (fURS) for kidney stones. METHODS From August 2016 to February 2020, symptomatic patients > 18 years old with bilateral kidney stones up to 20 mm in each side were prospectively studied. Serum creatinine samples were collected on admission to surgery, immediate postoperative (IPO), on POD 3, 10, and 30. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) without a race coefficient. RESULTS Thirty patients underwent bilateral fURS. Comparing to preoperative eGFR, median IPO and POD3 eGFR (p < 0.001) were significantly lower, and POD10 (p = 0.092) and POD30 (p = 0.648) were similar to preoperative eGFR. During follow-up, 22/30 (73.3%), 14/30 (46.7%), and 7/30 (23.3%) of the patients presented a decrease > 10% eGFR, > 20% eGFR, and > 30% eGFR, respectively. Multivariate analysis demonstrated that lower preoperative eGFR is a risk factor for eGFR < 60 mL/min/1.73 m2, p = 0.019 [1.021-1.263; 1.136]; ASA > 1 is a risk factor for decrease of eGFR > 10%, p = 0.028 [1.25-51.13; 8.00]; longer operative time is a risk factor for decrease of eGFR > 20%, p = 0.042 [1.00-1.05; 1.028]; and operative time ≥ 120 min is a risk factor for decrease of eGFR > 30%, p = 0.026 [0.016-0.773; 0.113]. CONCLUSIONS Renal function suffers a reversible decrease after bilateral fURS. Our study suggests that adequate selection of patients and maintaining operative time < 120 min are relevant factors in preventing acute renal function deterioration following bilateral fURS.
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Affiliation(s)
- Alexandre Danilovic
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil.
| | - Caio Vinicius Suartz
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Fabio Cesar Miranda Torricelli
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Giovanni Scala Marchini
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Carlos Batagello
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Fabio Carvalho Vicentini
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - William C Nahas
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Eduardo Mazzucchi
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
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Talizin TB, Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Nahas WC, Mazzucchi E. Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis. Int Braz J Urol 2024; 50:152-163. [PMID: 38386786 PMCID: PMC10953597 DOI: 10.1590/s1677-5538.ibju.2023.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The aim of this study is to perform a high-quality meta-analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population-adult patients who underwent PCNL; Intervention-postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control-single dose of antibiotic during the induction of anesthesia; and Outcome-systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random-effects model was employed, and the alpha risk was defined as < 0.05. RESULTS Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 - 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 - 5.316, p=0.140). CONCLUSION Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL.
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Affiliation(s)
- Thalita Bento Talizin
- Universidade de São PauloHospital das ClínicasSão PauloSPBrasilHospital das Clínicas, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - Alexandre Danilovic
- Universidade de São PauloHospital das ClínicasSão PauloSPBrasilHospital das Clínicas, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilHospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil;
| | - Fabio Cesar Miranda Torricelli
- Universidade de São PaulFaculdade de MedicinaDisciplina de UrologiaSão PauloSPBrasilDisciplina de Urologia, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - Giovanni S. Marchini
- Universidade de São PaulFaculdade de MedicinaDisciplina de UrologiaSão PauloSPBrasilDisciplina de Urologia, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - Carlos Batagello
- Universidade de São PauloHospital das ClínicasSão PauloSPBrasilHospital das Clínicas, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - Fabio C. Vicentini
- Universidade de São PaulFaculdade de MedicinaDisciplina de UrologiaSão PauloSPBrasilDisciplina de Urologia, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
| | - William Carlos Nahas
- Instituto do Câncer do Estado de São PauloDivisão de UrologiaSão PauloSPBrasilDivisão de Urologia, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Universidade de São PaulFaculdade de MedicinaDisciplina de UrologiaSão PauloSPBrasilDisciplina de Urologia, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brasil;
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Kwok JL, Ventimiglia E, De Coninck V, Panthier F, Barghouthy Y, Danilovic A, Shrestha A, Smyth N, Schmid FA, Hunziker M, Poyet C, Daudon M, Traxer O, Eberli D, Keller EX. Pulsed Thulium:YAG laser - What is the lithotripsy ablation efficiency for stone dust from human urinary stones? Results from an in vitro PEARLS study. World J Urol 2023; 41:3723-3730. [PMID: 37831156 PMCID: PMC10693514 DOI: 10.1007/s00345-023-04640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The novel pulsed thulium:yttrium-aluminum-garnet (p-Tm:YAG) laser was recently introduced. Current studies present promising p-Tm:YAG ablation efficiency, although all are based on non-human stone models or with unknown stone composition. The present study aimed to evaluate p-Tm:YAG ablation efficiency for stone dust from human urinary stones of known compositions. METHODS Calcium oxalate monohydrate (COM) and uric acid (UA) stones were subjected to lithotripsy in vitro using a p-Tm:YAG laser generator (Thulio®, Dornier MedTech GmbH, Germany). 200 J was applied at 0.1 J × 100 Hz, 0.4 J × 25 Hz or 2.0 J × 5 Hz (average 10W). Ablated stone dust mass was calculated from weight difference between pre-lithotripsy stone and post-lithotripsy fragments > 250 µm. Estimated ablated volume was calculated using prior known stone densities (COM: 2.04 mg/mm3, UA: 1.55 mg/mm3). RESULTS Mean ablation mass efficiency was 0.04, 0.06, 0.07 mg/J (COM) and 0.04, 0.05, 0.06 mg/J (UA) for each laser setting, respectively. This translated to 0.021, 0.029, 0.034 mm3/J (COM) and 0.026, 0.030, 0.039 mm3/J (UA). Mean energy consumption was 26, 18, 17 J/mg (COM) and 32, 23, 17 J/mg (UA). This translated to 53, 37, 34 J/mm3 (COM) and 50, 36, 26 J/mm3 (UA). There were no statistically significant differences for laser settings or stone types (all p > 0.05). CONCLUSION To our knowledge, this is the first study showing ablation efficiency of the p-Tm:YAG laser for stone dust from human urinary stones of known compositions. The p-Tm:YAG seems to ablate COM and UA equally well, with no statistically significant differences between differing laser settings.
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Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique Sur La Lithiase UrinaireHôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Yazeed Barghouthy
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Alexandre Danilovic
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Universidade de São Paulo Hospital das Clínicas-HCUSP, São Paulo, Brazil
- Department of Urology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Anil Shrestha
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, National Academy of Medical Sciences, Bir Hospital and B&B Hospital, Gwarko Lalitpur, Nepal
| | - Niamh Smyth
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- University Hospital Monklands, Monkscourt Avenue, Airdrie, ML60JS, UK
| | - Florian Alexander Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Manuela Hunziker
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Michel Daudon
- Hôpital Tenon, CRISTAL Laboratory, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique Sur La Lithiase UrinaireHôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands.
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Danilovic A. Editorial Comment: Thulium fibre laser versus Holmium:YAG for ureteroscopic lithotripsy: outcomes from a prospective randomised clinical trial. Int Braz J Urol 2023; 49:267-268. [PMID: 36825958 PMCID: PMC10247238 DOI: 10.1590/s1677-5538.ibju.2023.02.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
- Serviço de Urologia, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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Danilovic A, Talizin TB, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Nahas WC, Mazzucchi E. One week pre-operative oral antibiotics for percutaneous nephrolithotomy reduce risk of infection: a systematic review and meta-analysis. Int Braz J Urol 2023; 49:184-193. [PMID: 36515617 DOI: 10.1590/s1677-5538.ibju.2022.0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE 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 before PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fever 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 sensitivity pattern plus a dose of intravenous antibiotics at the time of surgery in patients undergoing PCNL reduces the risk of infection.
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Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Universidade de São Paulo Hospital das Clínicas - HCUSP, São Paulo, SP, Brasil.,Departamento de Urologia, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Thalita Bento Talizin
- Departamento de Urologia, Universidade de São Paulo Hospital das Clínicas - HCUSP, São Paulo, SP, Brasil
| | | | - Giovanni S Marchini
- Departamento de Urologia, Universidade de São Paulo Hospital das Clínicas - HCUSP, São Paulo, SP, Brasil
| | - Carlos Batagello
- Departamento de Urologia Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fabio C Vicentini
- Departamento de Urologia, Universidade de São Paulo Hospital das Clínicas - HCUSP, São Paulo, SP, Brasil
| | - Willaim C Nahas
- Departamento de Urologia Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia, Universidade de São Paulo Hospital das Clínicas - HCUSP, São Paulo, SP, Brasil
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9
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Danilovic A. Editorial Comment: Flexible Ureterorenoscopy Versus Shockwave Lithotripsy for Kidney Stones ≤ 2 cm: A Randomized Controlled Trial. Int Braz J Urol 2022; 48:992-993. [PMID: 36173412 PMCID: PMC9747024 DOI: 10.1590/s1677-5538.ibju.2022.06.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Universidade de São PauloHospital das Clinicas Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo – FMUSP, São Paulo, SP, Brasil
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilServiço de Urologia, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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Danilovic A. Deep learning is a promising technology and seems to be the future of the CT stone evaluation. Int Braz J Urol 2022; 48:840-841. [PMID: 35838510 PMCID: PMC9388183 DOI: 10.1590/s1677-5538.ibju.2022.0132.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil.,Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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Danilovic A. Editorial Comment: Comparison of mini percutaneous nephroli-thotomy and standard percutaneous nephrolithotomy for renal stones >2cm: a systematic review and meta-analysis. Int Braz J Urol 2022; 48:591-593. [PMID: 35373951 PMCID: PMC9060169 DOI: 10.1590/s1677-5538.ibju.2022.03.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Danilovic A. Editorial Comment: The effects of pregaba-lin, solifenacin and their combination the-rapy on ureteral double-J stentrelated symp-toms: A randomized controlled clinical trial. Int Braz J Urol 2022; 48:358-360. [PMID: 35170901 PMCID: PMC8932024 DOI: 10.1590/s1677-5538.ibju.2022.02.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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13
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Danilovic A. Editorial Comment: Classification of the renal papil-lary abnormalities by flexible ureteroscopy: evalua-tion of the 2016 version and update. Int Braz J Urol 2022; 48:361-362. [PMID: 35170902 PMCID: PMC8932033 DOI: 10.1590/s1677-5538.ibju.2022.02.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Mazzucchi E, Berto FC, Denstedt J, Danilovic A, Batagello CA, Torricelli FC, Vicentini FC, Marchini GS, Srougi M, Nahas WC. Treatment of renal lower pole stones: an update. Int Braz J Urol 2022; 48:165-174. [PMID: 33861537 PMCID: PMC8691227 DOI: 10.1590/s1677-5538.ibju.2020.1023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/19/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Eduardo Mazzucchi
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Fernanda C.G. Berto
- Western University OntarioDivision of UrologyCanadaDivision of Urology, Western University Ontario, Canada
| | - John Denstedt
- Western University OntarioDivision of UrologyCanadaDivision of Urology, Western University Ontario, Canada
| | - Alexandre Danilovic
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Carlos Alfredo Batagello
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Fabio C.M. Torricelli
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Fabio C. Vicentini
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Giovanni S. Marchini
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Miguel Srougi
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - William C. Nahas
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
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Rodrigues JECM, Vicentini FC, Danilovic A, Marchini GS, Torricelli FCM, Batagello CA, Mazzucchi E, Nahas WC. Comparison of the outcomes of flexible ureteroscopy and mini-percutaneous nephrolithotomy for the treatment of kidney stones: a matched-pair analysis. Rev Assoc Med Bras (1992) 2022; 68:1481-1485. [PMID: 36417657 PMCID: PMC9683915 DOI: 10.1590/1806-9282.20221177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mini-percutaneous nephrolithotomy is a recent advancement in the field of kidney stone treatment; however, its role has not been completely established. We aimed to compare the outcomes of initial Mini-percutaneous nephrolithotomy and flexible ureteroscopy. METHODS A retrospective review of consecutive mini-percutaneous procedures was performed. Inclusion criteria were as follows: all percutaneous nephrolithotomy procedures performed with an access sheath up to 24Fr, kidney stone burdens up to 1550 mm3; and the presence of postoperative computed tomography (for control). The data collected for Mini-percutaneous nephrolithotomy procedures were paired 1:2 with patients treated with flexible ureteroscopy for stones between 100 and 1550 mm3, and with postoperative computed tomography for control. A 14Fr Mini-percutaneous nephrolithotomy set was used. The stone-free rate was defined as the absence of fragments on the control computed tomography, whereas success was limited to 2-mm residual fragments. Statistical analysis was performed using SPSS version 19. RESULTS A total of 63 patients met the inclusion criteria (42 with flexible ureteroscopy and 21 with mini-percutaneous nephrolithotomy). Demographic data were comparable. The stone-free rate and success were similar between the groups (76.2 vs. 66.7%, p=0.42 and 90.5 vs. 85.7%, p=0.57). The complication rate was also similar (26.1 vs. 9.6%, p=0.188), but Mini-percutaneous nephrolithotomy had longer hospitalization and fluoroscopy time (p=0.001 in both). CONCLUSIONS Our initial study of Mini-percutaneous nephrolithotomy showed that it is a promising procedure, with outcomes similar to flexible ureteroscopy, but with higher inpatient numbers and fluoroscopy times. A larger study population size and better equipment may improve the outcomes of mini-percutaneous nephrolithotomy.
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Affiliation(s)
| | | | | | | | | | | | - Eduardo Mazzucchi
- Universidade de São Paulo, Hospital of Clinics – São Paulo (SP), Brazil
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Danilovic A. Editorial Comment: The effect of shock wave lithotripsy and retrograde intrarenal surgery on health-related quality of life in 10-20 mm renal stones: a prospective randomized pilot study. Int Braz J Urol 2021; 48:186-187. [PMID: 34735091 PMCID: PMC8691243 DOI: 10.1590/s1677-5538.ibju.2022.01.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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17
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Mazzucchi E, Marchini GS, Berto FCG, Denstedt J, Danilovic A, Vicentini FC, Torricelli FCM, Battagello CA, Srougi M, Nahas WC. Single-use flexible ureteroscopes: update and perspective in developing countries. A narrative review. Int Braz J Urol 2021; 48:456-467. [PMID: 34786927 PMCID: PMC9060176 DOI: 10.1590/s1677-5538.ibju.2021.0475] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/31/2021] [Indexed: 11/22/2022] Open
Abstract
Flexible 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.
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Affiliation(s)
- Eduardo Mazzucchi
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | | | - John Denstedt
- Division of Urology, Western University, London, Ontario, Canada
| | - Alexandre Danilovic
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fabio Cesar Miranda Torricelli
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Carlos Alfredo Battagello
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Miguel Srougi
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - William Carlos Nahas
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
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Danilovic A, Marchini GS, Pucci ND, Coimbra B, Torricelli FCM, Batagello C, Vicentini FC, Srougi M, Nahas WC, Mazzucchi E. Effect of a low-calorie diet on 24-hour urinary parameters of obese adults with idiopathic calcium oxalate kidney stones. Int Braz J Urol 2021; 47:1136-1147. [PMID: 34469666 PMCID: PMC8486438 DOI: 10.1590/s1677-5538.ibju.2021.0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/15/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose: to evaluate the effect of low-calorie diet on 24-hour urinary metabolic parameters of obese adults with idiopathic calcium oxalate kidney stones. Materials and Methods: Adult idiopathic calcium oxalate stone formers, with body mass index (BMI) ≥30kg/m2 and a known lithogenic metabolic abnormality, were submitted to low-calorie diet for twelve weeks. After enrolment, anthropometric measures, serum exams, 24-hour urinary metabolic parameters and body impedance were collected one month prior to dietary intervention and at the end of twelve weeks. Correlations between weight loss, waist circumference loss, fat loss and variation in 24-hour urinary lithogenic parameters and calcium oxalate urinary supersaturation (CaOx SS) as per Tiselius equation were analysed. Results: From January 2017 to January 2018, 39 patients were enrolled to participate in this study. Median (range) prescribed diet was 1300 (1100-2100) Kcal/day. Mean age was 51.7±11.0 (29-68) years old and 69.2% were female. 30.8% of the participants shifted from obesity to BMI <30kg/m2 and none to BMI <25kg/m2. A significant correlation was found between baseline 24-hour urinary oxalate and weight (p=0.018) and BMI (p=0.026). No correlation was found between variation of weight, waist circumference, fat mass and 24-h urinary stone risk factors or CaOx SS. Conclusions: Short-term modest weight loss induced by twelve weeks of low-calorie diet is not associated with a decrease of 24-hour urinary lithogenic parameters in idiopathic calcium oxalate stone formers. Calcium oxalate urinary stone formation is probably multifactorial and driven by other factors than weight.
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Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- Departamento de Nutrição, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Nidia Denise Pucci
- Departamento de Nutrição, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Brian Coimbra
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fabio Cesar Miranda Torricelli
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Carlos Batagello
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Miguel Srougi
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - William C Nahas
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
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Danilovic A. Editorial Comment: Classification of the renal papil-lary abnormalities by flexible ureteroscopy: evalua-tion of the 2016 version and update. Int Braz J Urol 2021; 47:1268-1269. [PMID: 34469678 PMCID: PMC8486451 DOI: 10.1590/s1677-5538.ibju.2021.06.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Srougi M, Nahas WC, Mazzucchi E. Does previous standard percutaneous nephrolithotomy impair retrograde intrarenal surgery outcomes? Int Braz J Urol 2021; 47:1198-1206. [PMID: 34469672 PMCID: PMC8486447 DOI: 10.1590/s1677-5538.ibju.2021.0253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/01/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose: The objective of this study is to evaluate the impact of a previous standard percutaneous nephrolithotomy (PCNL) on the outcomes of retrograde intrarenal surgery (RIRS). Materials and Methods: Outcomes of RIRS performed from January 2017 to January 2020 in adult patients with residual stone fragments ≤20mm after a standard PCNL (Post-PCNL) and symptomatic adult patients with kidney stones ≤20mm (Control) were prospectively studied. Stone-free rate (SFR) was evaluated on a postoperative day 90 non-contrast computed tomography. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. Results: Outcomes of 55 patients and 57 renal units of the post-PCNL group were compared to 92 patients and 115 renal units of the control group. SFR was lower in post-PCNL group than in control (28/57, 49.1% vs. 86/115, 74.8%, p <0.001). Overall complications were more frequent in post-PCNL group (p=0.004). Infundibula strictures were identified and incised with laser in 15/57 (26.3%) renal units of the post-PCNL group. Thirteen renal units had infundibulum stricture at the site of previous percutaneous tract (13/15; 86.7%, p=0.004) and one renal unit had three infundibula strictures. Postoperative complications were not affected by the treatment of infundibula strictures (p=0.198). Conclusions: Previous standard PCNL significantly impairs the outcomes of RIRS. Infundibula strictures can be found in 26.3% of the patients with residual stone fragments after standard PCNL for large burden kidney stones. The main site of infundibulum stricture after standard PCNL is the infundibulum of the entry calyx.
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Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fábio César Miranda Torricelli
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Carlos Batagello
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Olivier Traxer
- Sorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, F-75020 Paris, France, University, Paris, France
| | - Miguel Srougi
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William C Nahas
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
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Marchini GS, Faria KVM, L F, Torricelli FCM, Danilovic A, Vicentini FC, Batagello CA, Srougi M, Nahas WC, Mazzucchi E. Comparing public interest on stone disease between developed and underdeveloped nations: are search patterns on google trends similar? Int Braz J Urol 2021; 47:989-996. [PMID: 34260176 PMCID: PMC8321444 DOI: 10.1590/s1677-5538.ibju.2020.1076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/04/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE 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.
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Affiliation(s)
- Giovanni S Marchini
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kauy V M Faria
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Felippe L
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Fábio César Miranda Torricelli
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alexandre Danilovic
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Fábio Carvalho Vicentini
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Carlos A Batagello
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Miguel Srougi
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Willaim C Nahas
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Srougi M, Nahas WC, Mazzucchi E. Response to Giusti et al. re "Prospective Evaluation of Bilateral Retrograde Intrarenal Surgery: Is It Really Safe?". J Endourol 2021; 35:561-562. [PMID: 33852345 DOI: 10.1089/end.2021.29108.ada] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Giovanni Scala Marchini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos Batagello
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Carvalho Vicentini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Olivier Traxer
- Sorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Miguel Srougi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Danilovic A. Editorial Comment: Objective Assessment and Standard Setting for Basic Flexible Ureterorenoscopy Skills Among Urology Trainees Using Simulation-Based Methods. Int Braz J Urol 2021; 47:462-463. [PMID: 33284554 PMCID: PMC7857756 DOI: 10.1590/s1677-5538.ibju.2021.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil
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Lopes RI, Perrella R, Watanabe CH, Beltrame F, Danilovic A, Murta CB, Claro JFDA, Vicentini FC. Patients with encrusted ureteral stents can be treated by a single session combined endourological approach. Int Braz J Urol 2021; 47:574-583. [PMID: 33621006 PMCID: PMC7993973 DOI: 10.1590/s1677-5538.ibju.2020.0511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/22/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To describe our experience in the management of retained encrusted ureteral stents using a single session combined endourological approach. MATERIALS AND METHODS Patients with retained encrusted ureteral stents who had been submitted to a single session combined endourological approach from June 2010 to June 2018 were prospectively evaluated. Patients were divided according to the Forgotten-Encrusted-Calcified (FECal) classification. The stone burden, surgical intervention, number of interventions until stone free status, operation time, hospital stay, complications, stone analysis, and stone-free rate were compared between groups. ANOVA was used to compare numerical variables, and the Mann-Whitney or Chi-square test to compare categorical variables between groups. RESULTS We evaluated 50 patients with a mean follow-up of 2.9±1.4 years (mean±SD). The groups were comparable in terms of age, sex, laterality, BMI, comorbidities, ASA, reason for stent passage, and indwelling time. The stone burden was higher for grades IV and V (p=0.027). Percutaneous nephrolithotomy was the most common procedure (p=0.004) for grades IV and V. The number of procedures until the patients were stone-free was 1.92±1.40, and the hospital stay (4.2±2.5 days), complications (22%), and stone analysis (66% calcium oxalate) were similar between groups. The stone-free rate was lower in grades III to V (60%, 54.5%, and 50%). CONCLUSIONS The endoscopic combined approach in the supine position is a safe and feasible technique that allows removal of retained and encrusted stents in a single procedure. The FECal classification seems to be useful for surgical planning.
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Affiliation(s)
- Roberto Iglesias Lopes
- Divisão de Urologia, Hospital Brigadeiro, São Paulo, SP, Brasil.,Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | | | | | - Alexandre Danilovic
- Divisão de Urologia, Hospital Brigadeiro, São Paulo, SP, Brasil.,Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | | | - Fabio Carvalho Vicentini
- Divisão de Urologia, Hospital Brigadeiro, São Paulo, SP, Brasil.,Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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25
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Danilovic A. Editorial Comment: The Impact of Ureteral Access Sheath Use on the Development of Abnormal Postoperative Upper Tract Imaging after Ureteroscopy. Int Braz J Urol 2021; 47:460-461. [PMID: 33284553 PMCID: PMC7857740 DOI: 10.1590/s1677-5538.ibju.2021.02.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil
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Danilovic A, Torricelli FCM, Dos Anjos G, Cordeiro MD, Machado MG, Srougi M, Nahas WC. REPLY BY THE AUTHORS: RE: Impact of COVID-19 on a urology residency program. Int Braz J Urol 2021; 47:911-912. [PMID: 33848091 PMCID: PMC8321490 DOI: 10.1590/s1677-5538.ibju.2021.0060.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio Cesar Miranda Torricelli
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Gabriel Dos Anjos
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Mauricio Dener Cordeiro
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcos Giannetti Machado
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William C Nahas
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Mazzucchi E, Torricelli FCM, Vicentini FC, Marchini GS, Danilovic A, Batagello CA, Srougi M, Nahas WC. The impact of COVID-19 in medical practice. A review focused on Urology. Int Braz J Urol 2021; 47:251-262. [PMID: 32840335 PMCID: PMC7857770 DOI: 10.1590/s1677-5538.ibju.2020.99.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/22/2022] Open
Abstract
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 due 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.
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Affiliation(s)
- Eduardo Mazzucchi
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.,Correspondence address: Eduardo Mazzucchi, MD, Setor de Endourologia, Divisão de Urologia, Faculdade de Medicina de São Paulo da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 / 7 andar, sala 710 F, São Paulo, SP, 05403-000, Brasil. E-mail:
| | - Fabio C. M. Torricelli
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - Fabio C. Vicentini
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - Giovanni S. Marchini
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - Alexandre Danilovic
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - Carlos A. Batagello
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - Miguel Srougi
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - William C. Nahas
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
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Batagello CA, Vicentini FC, Monga M, Miller AW, Marchini GS, Torricelli FCM, Danilovic A, Coelho RF, Srougi M, Nahas WC, Mazzucchi E. Tranexamic acid in patients with complex stones undergoing percutaneous nephrolithotomy: a randomised, double-blinded, placebo-controlled trial. BJU Int 2021; 129:35-47. [PMID: 33630393 DOI: 10.1111/bju.15378] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of single-dose tranexamic acid on the blood transfusion rate and outcomes of patients with complex kidney stones undergoing percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS In a randomised, double-blinded, placebo-controlled trial, 192 patients with complex kidney stone (Guy's Stone Scores III-IV) were prospectively enrolled and randomised (1:1 ratio) to receive either one dose of tranexamic acid (1 g) or a placebo at the time of anaesthetic induction for PCNL. The primary outcome measure was the occurrence rate of perioperative blood transfusion. The secondary outcome measures included blood loss, operative time, stone-free rate (SFR), and complications. ClinicalTrials.gov identifier: NCT02966236. RESULTS The overall risk of receiving a blood transfusion was reduced in the tranexamic acid group (2.2% vs 10.4%; relative risk, 0.21, 95% confidence interval [CI] 0.03-0.76, P = 0.033; number-needed-to-treat: 12). Patients randomised to the tranexamic acid group had a higher immediate and 3-month SFR compared with those in the placebo group (29% vs 14.7%, odds ratio [OR] 2.37, 95% CI 1.15-4.87, P = 0.019, and 46.2% vs 28.1%, OR 2.20, 95% CI 1.20-4.02, P = 0.011, respectively). Faster haemoglobin recovery occurred in patients in the tranexamic acid group (mean, 21.3 days; P = 0.001). No statistical differences were found in operative time and complications between groups. CONCLUSIONS Tranexamic acid administration is safe and reduces the need for blood transfusion by five-times in patients with complex kidney stones undergoing PCNL. Moreover, tranexamic acid may contribute to better stone clearance rate and faster haemoglobin recovery without increasing complications. A single dose of tranexamic acid at the time of anaesthetic induction could be considered standard clinical practice for patients with complex kidney stones undergoing PCNL.
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Affiliation(s)
- Carlos A Batagello
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fabio C Vicentini
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Endourology, Hospital Brigadeiro, Sao Paulo, Brazil
| | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Stevan B. Streem Center for Endourology and Stone Disease, Cleveland Clinic, Cleveland, OH, USA.,Urology Division, University of California San Diego, San Francisco, CA, USA
| | - Aaron W Miller
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Stone Translational Research Laboratory, Cleveland Clinic, Cleveland, OH, USA.,Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Giovanni S Marchini
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fabio C M Torricelli
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alexandre Danilovic
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rafael F Coelho
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Willian C Nahas
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Botelho Y, Marchini GS, Monga M, Torricelli FC, Danilovic A, Vicentini FC, Batagello CA, Srougi M, Nahas WC, Mazzucchi E. Prone split-leg endoscopic-guided percutaneous nephrolithotomy: the surgeons perspective with A Gopro® view. Int Braz J Urol 2021; 47:680-681. [PMID: 33621024 PMCID: PMC7993946 DOI: 10.1590/s1677-5538.ibju.2020.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/26/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: To demonstrate the entire surgeon's point of view of a prone split-leg (PSL) endoscopic guided percutaneous nephrolithotomy (ePCNL) recorded with a GoPro® camera for standardization of the essential technical steps towards a successful procedure (1). Materials and methods: A 40y.o female patient presented with right flank pain for three years. She had previously been submitted to shock wave lithotripsy without success. Non-contrast computed tomography (NCCT) revealed a 2cm stone in the renal pelvis with 1400HU and stone-to-skin distance of 11cm (Guy's Stone Score 1). PCNL approach was chosen for providing higher chances of stone-free after a single procedure. Informed consent was obtained. The PSL ePCNL was uneventful with a single access in a mid-pole. The surgeon had a Full HD GoPro Hero 4® camera mounted on his head, controlled by the surgical staff with a remote control. All essential surgical steps were recorded. Results: Operative time was 90 minutes. Hemoglobin drop was 0.7g/dL. The post-operative NCCT scan was stone-free. The patient was discharged 24h after surgery. Kidney stent was left with a string and removed after 5days. The camera worked properly and didn't cause any kind of discomfort to the surgeon. The quality of the recorded movie was excellent. Conclusion: By recording the surgeon's perspective of an endoscopic urological procedure, we were able to provide a comprehensive understanding of the surgical technique by assembling the endoscopic, fluoroscopic, and operative field views. The GoPro® camera proved to be an interesting tool to document surgical procedures without compromising outcomes and has great potential for educational purposes.
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Affiliation(s)
- Yuri Botelho
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Manoj Monga
- University of California, San Diego, California, USA
| | - Fabio C Torricelli
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Fabio C Vicentini
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Carlos A Batagello
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Miguel Srougi
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - William C Nahas
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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Danilovic A, Ferreira TAC, Gomes SA, Wei IA, Vicentini FC, Torricelli FCM, Marchini GS, Mazzucchi E, Srougi M, Nahas WC. Metabolic assessment in pure struvite stones formers: is it necessary? J Bras Nefrol 2021; 43:200-206. [PMID: 33577639 PMCID: PMC8257276 DOI: 10.1590/2175-8239-jbn-2020-0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/02/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Magnesium ammonium phosphate stones (MAP), also known as struvite stones, are associated with urinary infection and impairment of renal unit. The aim of this study is to evaluate the urinary metabolic risk factors for recurrence of renal calculi in patients submitted to nephrectomy due to MAP stones. METHODS We retrospectively reviewed the charts of patients > 18 years old submitted to total nephrectomy due to pure MAP stones and pure calcium oxalate (CaOx) stones from July 2006 to July 2016. Urinary metabolic parameters were assessed through 24-hour urine exams ≥ 3 months after nephrectomy. Urinary metabolic parameters and new event related to lithiasis were compared. RESULTS Twenty-eight and 39 patients were included in MAP and CaOx group, respectively. Abnormalities in 24-hour urine samples were similar between groups. Hypercalciuria occurred in 7.1 and 10.3% of patients in MAP and CaOx group, respectively (p = 0.66), whereas hypocitraturia was present in 65.2 and 59.0% of patients with MAP and CaOx group, respectively (p = 0.41). No significant difference in new events was found between MAP and CaOx groups (17.9 vs. 23.1%, respectively; p = 0.60). CONCLUSION A 24-hour urine evaluation should be offered to patients submitted to nephrectomy due to pure MAP stones in order to detect metabolic risk, improve treatment, and prevent stone recurrence.
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Affiliation(s)
- Alexandre Danilovic
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Urologia, São Paulo, SP, Brasil
| | | | - Samirah Abreu Gomes
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Clínica Médica, Laboratório de Nefrologia Celular, Genética e Molecular, São Paulo, SP, Brasil
| | - Isabela Akemi Wei
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Urologia, São Paulo, SP, Brasil
| | | | | | - Giovanni Scala Marchini
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Urologia, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Urologia, São Paulo, SP, Brasil
| | - Miguel Srougi
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Urologia, São Paulo, SP, Brasil
| | - William Carlos Nahas
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Urologia, São Paulo, SP, Brasil
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Reggio E, Danilovic A, Silvinato A, Bernardo WM. Urinary lithiasis - conventional open surgery. ACTA ACUST UNITED AC 2021; 66:1615-1619. [PMID: 33331564 DOI: 10.1590/1806-9282.66.12.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 11/22/2022]
Abstract
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Torricelli FCM, Carvalho RS, Marchini GS, Danilovic A, Vicentini FC, Batagello CA, Srougi M, Nahas WC, Mazzucchi E. Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function. ACTA ACUST UNITED AC 2021; 66:1696-1701. [PMID: 33331579 DOI: 10.1590/1806-9282.66.12.1696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/17/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION 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 stone-free rate.
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Affiliation(s)
- Fabio C M Torricelli
- Divisão de Urologia, Departamento de Cirurgia, Faculdade Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Giovanni S Marchini
- Divisão de Urologia, Departamento de Cirurgia, Faculdade Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Divisão de Urologia, Departamento de Cirurgia, Faculdade Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio C Vicentini
- Divisão de Urologia, Departamento de Cirurgia, Faculdade Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carlos A Batagello
- Divisão de Urologia, Departamento de Cirurgia, Faculdade Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Departamento de Cirurgia, Faculdade Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William C Nahas
- Divisão de Urologia, Departamento de Cirurgia, Faculdade Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Divisão de Urologia, Departamento de Cirurgia, Faculdade Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Srougi M, Nahas WC, Mazzucchi E. Residual Stone Fragments After Percutaneous Nephrolithotomy: Shockwave Lithotripsy vs Retrograde Intrarenal Surgery. J Endourol 2021; 35:609-614. [PMID: 33096975 DOI: 10.1089/end.2020.0868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Despite technology incorporation to percutaneous nephrolithotomy (PCNL), residual stone fragments (RSFs) may still persist after PCNL and need to be addressed to avoid regrowth or ureteral obstruction. The objective of this study was to compare the outcomes of retrograde intrarenal surgery (RIRS) to extracorporeal shockwave lithotripsy (SWL) for treating patients with RSFs after a previous standard PCNL. Materials and Methods: Adult patients with RSF after a standard PCNL submitted to RIRS or SWL in our Institution from January 2017 to January 2020 were retrospectively studied. Stone-free rate (SFR) was evaluated on postoperative day (POD) 90 by noncontrast CT (NCCT) or ultrasound and kidney, ureter, and bladder radiograph (KUB) for each renal unit. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. Sample size was calculated for a power of 80% and a significance level of 0.05, assuming SFR of 20% for SWL and 50% for RIRS. Results: Thirty-three patients treated by SWL were compared with 36 patients treated by RIRS. Hospitalization time was longer in the RIRS group (4.18 vs 12.33 hours, p = 0.001). SFR and success rate were lower in SWL than RIRS group (24.2% vs 58.3%, p = 0.007 and 30.3% vs 72.2%, p = 0.004, respectively), using POD 90 NCCT in 81.8% and ultrasound and KUB in 18.2% of the SWL group and using POD 90 NCCT in 100% of the RIRS group. Minor complications (Clavien-Dindo < III) occurred in 11 of 36 (30.6%) patients submitted to RIRS and in 2 of 33 (6.1%) patients submitted to SWL group (p = 0.025). Two patients (6.1%) of the SWL group had Clavien-Dindo IIIb complication owing to Steinstrasse and were submitted to ureteroscopy. Emergency room visits were similar between groups (6.1% vs 8.3%, p = 1.0). Conclusions: RIRS has better SFR, higher minor complications, and lower major complications than SWL for the treatment of RSFs after standard PCNL.
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Affiliation(s)
- Alexandre Danilovic
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Giovanni Scala Marchini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos Batagello
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Carvalho Vicentini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Olivier Traxer
- Sorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Miguel Srougi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Danilovic A, Torricelli FCM, Dos Anjos G, Cordeiro MD, Machado MG, Srougi M, Nahas WC. Impact of COVID-19 on a urology residency program. Int Braz J Urol 2020; 47:448-453. [PMID: 33284549 PMCID: PMC7857747 DOI: 10.1590/s1677-5538.ibju.2020.0707] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/26/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio Cesar Miranda Torricelli
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Gabriel Dos Anjos
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Mauricio Dener Cordeiro
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcos Giannetti Machado
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William C Nahas
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Danilovic A. Editorial Comment: Continuous monitoring of intrapelvic pressure during flexible ureteroscopy using a sensor wire: a pilot study. Int Braz J Urol 2020; 47:196-197. [PMID: 33047927 PMCID: PMC7712716 DOI: 10.1590/s1677-5538.ibju.2021.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil
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Danilovic A. Editorial Comment: Safety of a Novel Thu-lium Fiber Laser for Lithotripsy: An In Vitro Study on the Thermal Effect and Its Impact Factor. Int Braz J Urol 2020; 46:849-850. [PMID: 32648427 PMCID: PMC7822380 DOI: 10.1590/s1677-5538.ibju.2020.05.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil
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Danilovic A. Editorial Comment: Techniques - Ultrasound-guided percutaneous nephrolithotomy: How we do it. Int Braz J Urol 2020; 46:845-846. [PMID: 32648425 PMCID: PMC7822381 DOI: 10.1590/s1677-5538.ibju.2020.05.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Torricelli FCM, Vicentini FC, Zanetti L, Perrella R, Marchini GS, Danilovic A, Batagello CA, Murta CB, Claro JFA, Srougi M, Nahas WC, Mazzucchi E. Percutaneous nephrolithotomy in patients with spinal cord injury: should all these patients be automatically assigned a Guy's stone score of 4? World J Urol 2020; 39:2129-2134. [PMID: 32930845 DOI: 10.1007/s00345-020-03443-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/05/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE 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.
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Affiliation(s)
- Fabio C M Torricelli
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil.
| | - Fabio C Vicentini
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil.,Division of Urology, Hospital Brigadeiro, Sao Paulo, SP, Brazil
| | - Lucas Zanetti
- Faculdade das Américas School of Medicine, Sao Paulo, SP, Brazil
| | | | - Giovanni S Marchini
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
| | - Alexandre Danilovic
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
| | - Carlos A Batagello
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
| | - Claudio B Murta
- Division of Urology, Hospital Brigadeiro, Sao Paulo, SP, Brazil
| | | | - Miguel Srougi
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
| | - William C Nahas
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
| | - Eduardo Mazzucchi
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
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Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Srougi M, Nahas WC, Mazzucchi E. Prospective Evaluation of Bilateral Retrograde Intrarenal Surgery: Is It Really Safe? J Endourol 2020; 35:14-20. [PMID: 32689826 DOI: 10.1089/end.2020.0611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The aim of this study was to prospectively compare the outcomes of bilateral same-session retrograde intrarenal surgery (BSS RIRS) with unilateral RIRS and to compare the outcomes of first with second operated kidneys in BSS RIRS. Subjects and Methods: Consecutive symptomatic adult patients with kidney stones up to 20 mm who accepted to be treated by RIRS were prospectively studied. Stone-free rate (SFR) was evaluated by non-contrast CT for each renal unit, and surgical complications were evaluated based on Clavien-Dindo classification. Results: SFR (73.9% vs 76.1%, p = 0.830) and hospitalization time (14.43 ± 18.81 hours vs 13.00 ± 4.89 hours, p = 0.564) were similar between unilateral and BSS RIRS groups, with less consumption of disposable devices in BSS RIRS (p = 0.017). Operative time was longer in BSS RIRS (61.24 ± 26.62 minutes vs 88.65 ± 33.19 minutes, p < 0.001). Bilateral group had significant more overall complications by Clavien-Dindo classification than unilateral (15.9% vs 39.9%, p = 0.030) and more emergency room (ER) visits (11.6% vs 34.8%, p = 0.026). Moreover, although both groups temporarily increased creatinine levels, it was significantly higher in bilateral RIRS (p = 0.019). First operated kidney outcomes were similar to second operated kidney outcomes of BSS RIRS. Conclusion: Although BSS RIRS had similar SFR and consumed less disposable devices, it had a higher overall complication rate, a higher frequency of ER visits, and higher creatinine levels during follow-up than unilateral RIRS. There is no significant outcome difference between first and second operated kidneys in BSS RIRS.
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Affiliation(s)
- Alexandre Danilovic
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Giovanni Scala Marchini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos Batagello
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Carvalho Vicentini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Olivier Traxer
- Department of Urology, Sorbonne Université, GRC n20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Miguel Srougi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Danilovic A, Nunes E, Lipkin ME, Ferreira T, Torricelli FCM, Marchini GS, Srougi M, Nahas WC, Mazzucchi E. Low Dose Fluoroscopy During Ureteroscopy Does Not Compromise Surgical Outcomes. J Endourol 2020; 33:527-532. [PMID: 30793920 DOI: 10.1089/end.2018.0722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate whether reducing the dose of fluoroscopy to ¼ of standard dose during unilateral ureteroscopy for ureteral stone treatment would impact in a reduction of total radiation emitted and whether this strategy would impact operation time, stone-free rate, and complication rate. Methods: From August 2016 to August 2017, patients over 18 years submitted to ureteroscopy for ureteral stone between 5 and 20 mm were prospectively randomized for ¼ dose reduction or standard dose fluoroscopy. Patients with abnormal urinary anatomy such as horseshoe kidney, pelvic kidney, or duplex system were excluded from the study. Results: Ninety-four patients were enrolled. The fluoroscopic dose reduction strategy to ¼ of the standard dose was able to significantly reduce the cumulative radiation emitted by C-arm fluoroscopy and the dose area product (3.6 ± 4.5 mGy vs 16.2 ± 19.3 mGy, p = 0.0001 and 0.23 ± 0.52 mcGycm2 vs 1.15 ± 2.74 mcGycm2, p = 0.02, respectively). Fluoroscopy time was similar between groups (74.5 ± 84.8 seconds vs 88.3 ± 90 seconds, p = 0.44). There was no need to increase the fluoroscopy dose during any of the procedures. Surgical outcomes were not affected by fluoroscopic dose reduction strategy. Conclusion: Low dose fluoroscopy reduces the emitted radiation during ureteroscopy without compromising surgical outcomes.
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Affiliation(s)
- Alexandre Danilovic
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Nunes
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Michael E Lipkin
- 2 Division of Urologic Surgery, Surgery Department, Duke University Medical Center, Durham, North Carolina
| | - Thiago Ferreira
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio C M Torricelli
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Giovanni S Marchini
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miguel Srougi
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Iscaife A, Marchini GS, Srougi V, Torricelli FCM, Danilovic A, Vicentini FC, Machado M, Hisano M, Tiseo BC, Bissoli JC, Cocuzza M, Hallak J, Srougi M, Nahas WC. The urologist's role in the fight of COVID-19 pandemic: mandatory mindset shift on the frontline. Int Braz J Urol 2020; 46:879-882. [PMID: 32459458 PMCID: PMC7822373 DOI: 10.1590/s1677-5538.ibju.2020.0316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alexandre Iscaife
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Giovanni S Marchini
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Victor Srougi
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Fabio C M Torricelli
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Fabio C Vicentini
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Marcos Machado
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Marcelo Hisano
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Bruno C Tiseo
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Júlio C Bissoli
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Marcello Cocuzza
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Jorge Hallak
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - William C Nahas
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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Danilovic A. Editorial Comment: The significance of in-traoperative renal pelvic urine and stone cul-tures for patients at a high risk of post-ureteroscopy systemic inflammatory res-ponse syndrome. Int Braz J Urol 2020; 46:847-848. [PMID: 32648426 PMCID: PMC7822375 DOI: 10.1590/s1677-5538.ibju.2020.05.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil
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Reggio E, Danilovic A, Rubira C, Silvinato A, Bernardo WM. Urinary lithiasis: evaluation of the use of laser vs. Pneumatic ureteral lithotripsy. Rev Assoc Med Bras (1992) 2020; 66:108. [PMID: 32428141 DOI: 10.1590/1806-9282.66.2.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ernesto Reggio
- . Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil
| | | | - Claudio Rubira
- . Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil
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Danilovic A. Editorial Comment: Efficacy and Safety of Complete Intraureteral Stent Placement versus Conventional Stent Placement in Relieving Ureteral Stent Related Symptoms: A Randomized, Prospective, Single Blind, Multicenter Clinical Trial. Int Braz J Urol 2020; 46:269-270. [PMID: 32022518 PMCID: PMC7025831 DOI: 10.1590/s1677-5538.ibju.2020.02.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Correia FASC, Marchini GS, Torricelli FC, Danilovic A, Vicentini FC, Srougi M, Nahas WC, Mazzucchi E. Renal manifestations of sarcoidosis: from accurate diagnosis to specific treatment. Int Braz J Urol 2020; 46:15-25. [PMID: 31851454 PMCID: PMC6968907 DOI: 10.1590/s1677-5538.ibju.2019.0042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/09/2019] [Indexed: 03/04/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease characterized by epithelioid noncaseating 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.
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Affiliation(s)
- Filipe A Saliba C Correia
- Seção de Endourologia, Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Giovanni S Marchini
- Seção de Endourologia, Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Fábio C Torricelli
- Seção de Endourologia, Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Seção de Endourologia, Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Fábio C Vicentini
- Seção de Endourologia, Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Miguel Srougi
- Seção de Endourologia, Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - William C Nahas
- Seção de Endourologia, Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Seção de Endourologia, Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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46
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Danilovic A. Editorial Comment: Renal Stone Features Are More Important Than Renal Anatomy to Predict Shock Wave Lithotripsy Outcomes: Results from a Prospective Study with CT Follow-Up. Int Braz J Urol 2020; 46:271-272. [PMID: 32022519 PMCID: PMC7025838 DOI: 10.1590/s1677-5538.ibju.2020.02.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil
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47
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Danilovic A. Editorial Comment: Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery (RIRS) for lower pole stones: outcomes with a systematic review of literature. Int Braz J Urol 2020; 46:273-274. [PMID: 32022520 PMCID: PMC7025846 DOI: 10.1590/s1677-5538.ibju.2020.02.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Alexandre Danilovic
- Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil
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48
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Torricelli FCM, Monga M, Yamauchi FI, Marchini GS, Danilovic A, Vicentini FC, Batagello CA, Srougi M, Nahas WC, Mazzucchi E. Renal Stone Features Are More Important Than Renal Anatomy to Predict Shock Wave Lithotripsy Outcomes: Results from a Prospective Study with CT Follow-Up. J Endourol 2020; 34:63-67. [DOI: 10.1089/end.2019.0545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Fabio C. M. Torricelli
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Manoj Monga
- Stevan B. Streem Center for Endourology & Stone Disease, Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Fernando I. Yamauchi
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Giovanni S. Marchini
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Alexandre Danilovic
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio C. Vicentini
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos A. Batagello
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C. Nahas
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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49
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Reggio E, Danilovic A, Rubira C, Silvinato A, Bernardo WM. Urinary lithiasis: evaluation of the use of laser vs. Pneumatic ureteral lithotripsy. Rev Assoc Med Bras (1992) 2019; 65:1329-1335. [PMID: 31800891 DOI: 10.1590/1806-9282.65.11.1329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Affiliation(s)
- Ernesto Reggio
- Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil
| | | | - Claudio Rubira
- Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil
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50
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Reggio E, Danilovic A, Tustumi F, Bernardo WM. Urinary lithiasis: diagnostic investigation. Rev Assoc Med Bras (1992) 2019; 65:1336. [PMID: 31800892 DOI: 10.1590/1806-9282.65.11.1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ernesto Reggio
- Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil
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