Publications by authors named "Alexandre Danilovic"

68 Publications

REPLY BY THE AUTHORS: RE: Impact of COVID-19 on a urology residency program.

Int Braz J Urol 2021 Jul-Aug;47(4):911-912

Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2021.0060.1DOI Listing
February 2021

Tranexamic acid in patients with complex stones undergoing percutaneous nephrolithotomy: a randomized, double-blinded, placebo-controlled trial.

BJU Int 2021 Feb 25. Epub 2021 Feb 25.

Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.

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 who have undergone percutaneous nephrolithotomy (PCNL).

Material And Methods: In a randomized, double-blinded, placebo-controlled trial, 192 patients with complex kidney stone (Guy's Stone Scores III-IV) were prospectively enrolled and randomized (1:1 ratio) to receive either one dose of tranexamic acid (1 g) or a placebo at the time of anesthetic 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 randomized to the tranexamic acid group showed higher immediate and three-month SFR compared with those in the placebo group (29% vs 14.7%, odds ratio [95% CI]: 2.37 [1.15-4.87], P = 0.019, and 46.2% vs 28.1%, odds ratio [95% CI]: 2.20 [1.20-4.02], P = 0.011, respectively). Faster hemoglobin recovery was demonstrated by patients in the tranexamic 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 contributes to better stone clearance rate and faster hemoglobin recovery without increasing complications. A single dose of tranexamic acid at the time of anesthetic induction could be considered standard clinical practice for patients with complex kidney stones undergoing PCNL.
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http://dx.doi.org/10.1111/bju.15378DOI Listing
February 2021

Patients with encrusted ureteral stents can be treated by a single session combined endourological approach.

Int Braz J Urol 2021 May-Jun;47(3):574-583

Divisão de Urologia, Hospital Brigadeiro, São Paulo, SP, Brasil.

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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http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.0511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993973PMC
June 2020

Metabolic assessment in pure struvite stones formers: is it necessary?

J Bras Nefrol 2021 Feb 8. Epub 2021 Feb 8.

Universidade de São Paulo, Faculdade de Medicina, Divisão de Urologia, São Paulo, SP, Brasil.

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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http://dx.doi.org/10.1590/2175-8239-JBN-2020-0106DOI Listing
February 2021

Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function.

Rev Assoc Med Bras (1992) 2020 Dec;66(12):1696-1701

Divisão de Urologia, Departamento de Cirurgia, Faculdade Medicina da Universidade de São Paulo, São Paulo, SP, Brasil.

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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http://dx.doi.org/10.1590/1806-9282.66.12.1696DOI Listing
December 2020

Urinary lithiasis - conventional open surgery.

Rev Assoc Med Bras (1992) 2020 Dec;66(12):1615-1619

Coordenador do Programa Diretrizes da Associação Medica Brasileira, São Paulo, SP, Brasil.

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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http://dx.doi.org/10.1590/1806-9282.66.12.1615DOI Listing
December 2020

Editorial Comment: Objective Assessment and Standard Setting for Basic Flexible Ureterorenoscopy Skills Among Urology Trainees Using Simulation-Based Methods.

Int Braz J Urol 2021 Mar-Apr;47(2):462-463

Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2021.02.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857756PMC
December 2020

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 Mar-Apr;47(2):460-461

Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2021.02.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857740PMC
December 2020

Impact of COVID-19 on a urology residency program.

Int Braz J Urol 2021 Mar-Apr;47(2):448-453

Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.0707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857747PMC
December 2020

Understanding urologic scientific publication patterns and general public interests on stone disease: lessons learned from big data platforms.

World J Urol 2020 Oct 27. Epub 2020 Oct 27.

Section of Endourology, Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar 255, Cerqueira César, 05403-900, Sao Paulo, Brazil.

Purpose: To analyse patterns of stone disease online information-seeking behaviours in the United States and to correlate with urological literature publication aspects.

Methods: To compare Relative Search Volume (RSV) among different twelve preselected urologic keywords we chose "United States" as country and "01/01/2009-31/12/2018" as time range on Google Trends (GT). We defined "ureteroscopy" as a reference and compared RSV against it for each term. RSV was adjusted and normalized in a scale 0-100. Trend presence was evaluated by Mann-Kendall Test and magnitude by Sen's Slope Estimator (SS). Weather influence on RSV was also investigated by comparison of the ten hottest versus ten coldest states. Pearson correlation analysis was performed between number of Pubmed publications and RSV for each term over time.

Results: We found an upward tendency (p < 0.01) for most terms. Higher temporal trends were seen for "kidney stone" (SS = 0.36), "kidney pain" (SS = 0.39) and "tamsulosin" (SS = 0.21). Technical treatment terms had little search volumes and no increasing trend. States with hotter weather showed higher mean RSV for "kidney stone" than colder ones. There was little correlation between GT and Pubmed for most terms, with the exception of "kidney stone" (R = 0.89; p < 0.01), "URS" (R = 0.81; p < 0.01), and "laser lithotripsy" (R = 0.74; p = 0.01).

Conclusion: There was a significant increase in online search for medical information related to stone disease. Citizens tend to look for generic terms related to symptoms or the disease itself. States with hotter weather show higher RSV than colder states. There is a discrepancy between public and medical community medical terms.
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http://dx.doi.org/10.1007/s00345-020-03477-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590553PMC
October 2020

Residual Stone Fragments After Percutaneous Nephrolithotomy: Shockwave Lithotripsy Retrograde Intrarenal Surgery.

J Endourol 2021 Jan 13. Epub 2021 Jan 13.

Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.

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. 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. Thirty-three patients treated by SWL were compared with 36 patients treated by RIRS. Hospitalization time was longer in the RIRS group (4.18 12.33 hours,  = 0.001). SFR and success rate were lower in SWL than RIRS group (24.2% 58.3%,  = 0.007 and 30.3% 72.2%,  = 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 ( = 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% 8.3%,  = 1.0). 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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http://dx.doi.org/10.1089/end.2020.0868DOI Listing
January 2021

Editorial Comment: Continuous monitoring of intrapelvic pressure during flexible ureteroscopy using a sensor wire: a pilot study.

Int Braz J Urol 2021 Jan-Feb;47(1):196-197

Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2021.01.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712716PMC
October 2020

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 Sep 15. Epub 2020 Sep 15.

Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil.

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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http://dx.doi.org/10.1007/s00345-020-03443-1DOI Listing
September 2020

The impact of COVID-19 in medical practice. A review focused on Urology.

Int Braz J Urol 2021 Mar-Apr;47(2):251-262

Setor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.

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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http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.99.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857770PMC
December 2020

Prospective Evaluation of Bilateral Retrograde Intrarenal Surgery: Is It Really Safe?

J Endourol 2021 Jan 9;35(1):14-20. Epub 2020 Sep 9.

Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.

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. 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. SFR (73.9% 76.1%,  = 0.830) and hospitalization time (14.43 ± 18.81 hours 13.00 ± 4.89 hours,  = 0.564) were similar between unilateral and BSS RIRS groups, with less consumption of disposable devices in BSS RIRS ( = 0.017). Operative time was longer in BSS RIRS (61.24 ± 26.62 minutes 88.65 ± 33.19 minutes,  < 0.001). Bilateral group had significant more overall complications by Clavien-Dindo classification than unilateral (15.9% 39.9%,  = 0.030) and more emergency room (ER) visits (11.6% 34.8%,  = 0.026). Moreover, although both groups temporarily increased creatinine levels, it was significantly higher in bilateral RIRS ( = 0.019). First operated kidney outcomes were similar to second operated kidney outcomes of BSS RIRS. 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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http://dx.doi.org/10.1089/end.2020.0611DOI Listing
January 2021

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 Sep-Oct;46(5):849-850

Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.05.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822380PMC
October 2020

Editorial Comment: Techniques - Ultrasound-guided percutaneous nephrolithotomy: How we do it.

Int Braz J Urol 2020 Sep-Oct;46(5):845-846

Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.05.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822381PMC
October 2020

Urinary lithiasis: evaluation of the use of laser vs. Pneumatic ureteral lithotripsy.

Rev Assoc Med Bras (1992) 2020 May;66(2):108

. Coordenador do Programa Diretrizes da Associação Médica Brasileira, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/1806-9282.66.2.108DOI Listing
May 2020

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 Mar-Apr;46(2):273-274

Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.02.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025846PMC
April 2020

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 Mar-Apr;46(2):271-272

Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.02.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025838PMC
April 2020

Renal manifestations of sarcoidosis: from accurate diagnosis to specific treatment.

Int Braz J Urol 2020 Jan-Feb;46(1):15-25

Seção de Endourologia, Divisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.

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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http://dx.doi.org/10.1590/S1677-5538.IBJU.2019.0042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968907PMC
February 2020

Urinary lithiasis: diagnostic investigation.

Rev Assoc Med Bras (1992) 2019 Nov;65(11):1336

Coordenador do Programa Diretrizes da Associação Médica Brasileira, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/1806-9282.65.11.1336DOI Listing
November 2019

Urinary lithiasis: evaluation of the use of laser vs. Pneumatic ureteral lithotripsy.

Rev Assoc Med Bras (1992) 2019 Nov;65(11):1329-1335

Coordenador do Programa Diretrizes da Associação Médica Brasileira, São Paulo, SP, Brasil.

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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http://dx.doi.org/10.1590/1806-9282.65.11.1329DOI Listing
November 2019

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 01 21;34(1):63-67. Epub 2019 Nov 21.

Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Lower pole kidney stones have been associated with poor shock wave lithotripsy (SWL) outcomes because of its location. However, the real impact of collecting system anatomy on stone clearance after SWL is uncertain. There is a lack of prospective well-controlled studies to determine whether lower pole kidney stones have inferior outcomes than nonlower pole kidney stones when treated with SWL. We prospectively evaluated patients with a single kidney stone of 5-15 mm undergoing SWL from June 12 through January 19. All patients were subjected to computed tomography before and 3 months after the procedure. Demographic data (age, gender, and body mass index), stone features (stone size, stone area, stone density, and stone-skin distance-SSD), and collecting system anatomy (infundibular length and width, and infundibulopelvic angle) were recorded. Outcomes (fragmentation and stone clearance rates) were compared between lower pole and nonlower pole cases. Then, a multivariate analysis including all variables was performed to determinate which parameters significantly impact on SWL outcomes. One hundred and twenty patients were included in the study. Mean stone size was 8.3 mm and mean stone density was 805 Hounsfield units. Overall stone fragmentation, success, and stone-free rates were 84.1%, 64.1%, and 34.1%, respectively. There were no significant differences in stone fragmentation (76.0% 71.4%;  = 0.624), success rate (57.6% 53.3%;  = 0.435), and stone-free rate (40.2% 35.7%;  = 0.422) in the lower nonlower pole groups, respectively. On multivariate analysis, only stone density ( < 0.001) and SSD ( = 0.006) significantly influenced fragmentation. Stone size ( = 0.029), stone density ( = 0.002), and SSD ( = 0.049) significantly influenced kidney stone clearance. Stone size, stone density, and SSD impact on SWL outcomes. Lower pole kidney stones have similar fragmentation and stone clearance compared with nonlower pole kidney stones.
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http://dx.doi.org/10.1089/end.2019.0545DOI Listing
January 2020

Urinary lithiasis: diagnostic investigation.

Rev Assoc Med Bras (1992) 2019 09 12;65(8):1037-1041. Epub 2019 Sep 12.

. Coordenador do Programa Diretrizes da Associação Médica Brasileira, São Paulo, SP, Brasil.

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http://dx.doi.org/10.1590/1806-9282.65.8.1037DOI Listing
September 2019