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Qin F, Sun YF, Wang XN, Li B, Zhang ZL, Zhang MX, Xie F, Liu SH, Wang ZJ, Cao YC, Jiao W. Application of a novel computer-assisted surgery system in percutaneous nephrolithotomy: A controlled study. World J Clin Cases 2022; 10:6039-6049. [PMID: 35949849 PMCID: PMC9254189 DOI: 10.12998/wjcc.v10.i18.6039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most complex renal stones are managed primarily with percutaneous nephrolithotomy (PCNL). However, PCNL is still a great challenge for surgeons because of poor comprehension on complex adjacent structures. Novel techniques are required to assist in planning and navigation.
AIM To apply and evaluate the Hisense computer-assisted surgery (CAS) system in PCNL.
METHODS A total of 60 patients with complex renal stones were included. Thirty patients in the CAS group had three-dimensional (3D) virtual models constructed with the CAS system. The model assisted in planning and navigating in the CAS system. Thirty patients in the control group planned and navigated as standard PCNL, without the application of the CAS system. Success rate of one attempt, operation time, initial stone-free rate, decrease in hemoglobin, and complications were collected and analyzed.
RESULTS There were no statistically significant differences in the baseline characteristics or planning characteristics. The success rate of one puncturing attempt (90% vs 67%, P = 0.028) and the initial stone-free rate (87% vs 63%, P = 0.037) were significantly higher in the CAS group. However, there were no statistically significant differences in the operation time (89.20 ± 29.60 min vs 92.33 ± 33.08 min, P = 0.859) or in the decrease in hemoglobin (11.07 ± 8.32 g/L vs 9.03 ± 11.72 g/L, P = 0.300) between the CAS group and the control group. No statistically significant differences in the incidence of complications (Clavien-Dindo grade ≥ 2) were found.
CONCLUSION Compared with standard PCNL, CAS-assisted PCNL had advantages in terms of the puncturing success rate and stone-free rate. The Hisense CAS System was recommended to assist in preoperative planning and intraoperative navigation for an intuitive, precise and convenient PCNL.
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Affiliation(s)
- Fei Qin
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Ye-Feng Sun
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xin-Ning Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Bin Li
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Zhi-Lei Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Ming-Xin Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Fei Xie
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Shuai-Hong Liu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Zi-Jie Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Yuan-Chao Cao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Wei Jiao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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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] [Abstract] [Key Words] [MESH Headings] [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
- 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 - FMUSP, São Paulo, SP, Brasil
| | - Fábio César Miranda Torricelli
- 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 - FMUSP, São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- 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 - FMUSP, São Paulo, SP, Brasil
| | - Carlos Batagello
- 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 - FMUSP, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- 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 - FMUSP, São Paulo, SP, Brasil
| | - Olivier Traxer
- Sorbonne UniversitéHôpital TenonParisFranceSorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, F-75020 Paris, France, University, Paris, France
| | - Miguel Srougi
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSão PauloSPFranceDivisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William C. Nahas
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSão PauloSPFranceDivisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSão PauloSPFranceDivisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Karani R, Arada RB, Okhunov Z, Tapiero S, Landman J, Clayman RV. Endoscopic Guided Percutaneous Nephrolithotomy. J Endourol 2021; 35:S62-S67. [PMID: 34499544 DOI: 10.1089/end.2020.0556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is the treatment of choice for kidney stones >2 cm in size. Obtaining a nephrostomy tract to access the kidney is a key step in this procedure that ultimately determines the patient's outcome. We describe each step of the endoscopic guided approach to PCNL as performed at the University of California, Irvine. Each step of the endoscopic guided PCNL is described and depicted in the video. Surgical steps depicted in the video are from various recorded PCNL procedures from our institution. This guide outlines the indications, preoperative preparation, patient positioning, surgical steps, and postoperative care for patients undergoing PCNL using the endoscopic guided approach. Direct observation of nephrostomy puncture, tract dilation using the balloon, and passing of the Amplatz sheath allow for proper access to the kidney and lower risk of injury. By following this systematic module of endoscopic guided PCNL, a nephrostomy tract can be created and accessed under direct observation, facilitating the routine steps of PCNL.
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Affiliation(s)
- Rajiv Karani
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Raphael B Arada
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Shlomi Tapiero
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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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] [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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Soliman T, Khalil M, Omar R, Mohey A, Ahmed S, Sherif H, Abdelazim M. Management of upper calyceal stone by percutaneous nephrolithotomy through lower calyx access: prone versus supine position. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00025-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The best way in the management of calyceal stone by percutaneous nephrolithotomy (PCNL) is to go directly into the desired calyx. However, in upper calyx, this direct entry may be associated with undesired complications, and through lower calyx is limited in prone PCNL. Recently, there is another option about reaching it through the lower calyx in supine position with more accessibility and better manipulation. This study aimed to evaluate the management of the upper calyceal stone by PCNL through lower calyx access in prone versus supine position.
Methods
A total of 38 patients with upper calyceal stone (≥ 2 cm) were randomly divided into two groups; the first group included 18 patients managed by PCNL in the prone position, and the second group included 20 patients managed in supine position. All data of both procedures were collected and statistically analyzed to compare between both groups.
Results
There is no statistically significant difference between groups as regards demographic and stone characters. The angle between the access to the lower calyx and access of the upper calyx was significantly wider in the supine group versus prone group (130.2° ± 23.46° vs. 89.67° ± 14.56°, respectively). The mean operative and fluoroscopy time was significantly longer in the prone group. There is no significant difference in intraoperative or postoperative morbidity. The stone-free rate was significantly higher in the supine group than the prone group (85% vs 38.9%, respectively). Also stone approachability was higher in the supine group than prone group (95% vs. 66.7%, respectively).
Conclusion
Management of upper calyceal stone by PCNL through the lower calyx is safe, but it is more effective in the supine position than in prone position.
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Gadzhiev N, Malkhasyan V, Akopyan G, Petrov S, Jefferson F, Okhunov Z. Percutaneous nephrolithotomy for staghorn calculi: Troubleshooting and managing complications. Asian J Urol 2020; 7:139-148. [PMID: 32257807 PMCID: PMC7096695 DOI: 10.1016/j.ajur.2019.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/06/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
Staghorn calculi comprise a unique subset of complex kidney stone disease. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn stones. Despite continuous refinements to the technique and instrumentation of PCNL, these stones remain a troublesome challenge for endourologists and are associated with a higher rate of perioperative complications than that for non-staghorn stones. Common and notable intraoperative complications include bleeding, renal collecting system injury, injury of visceral organs, pulmonary complications, thromboembolic complications, extrarenal stone migration, and misplacement of the nephrostomy tube. Postoperative complications include infection and urosepsis, bleeding, persistent nephrocutaneous urine leakage, infundibular stenosis, and death. In this review, we report recommendations regarding troubleshooting measures that can be used to identify and characterize these complications. Additionally, we include information regarding management strategies for complications associated with PCNL for staghorn calculi.
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Affiliation(s)
- Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Russia
- Corresponding author.
| | - Vigen Malkhasyan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Gagik Akopyan
- Department of Urology, Sechenov First Moscow State Medical University, Russia
| | - Sergei Petrov
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Russia
| | | | - Zhamshid Okhunov
- Department of Urology, University of California, Oakland, CA, USA
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Winoker JS, Chandhoke RA, Atallah W, Gupta M. Morphometry scores: Clinical implications in the management of staghorn calculi. Asian J Urol 2020; 7:78-86. [PMID: 32257799 PMCID: PMC7096674 DOI: 10.1016/j.ajur.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/09/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022] Open
Abstract
Due to their large size, rapid growth, and attendant morbidity, staghorn calculi are complex clinical entities that impose significant treatment-related challenges. Moreover, their relative heterogeneity-in terms of both total stone burden and anatomic distribution-limits the ability to standardize their characterization and the reporting of surgical outcomes. Several morphometry systems currently exist to define the volumetric distribution of renal stones, in general, and to predict the outcomes of percutaneous nephrolithotomy; however, they fall short in their applicability to staghorn stones. In this review, we aim to discuss the clinical utility of morphometry systems and the influence of pelvicalyceal anatomy on the management of these complex calculi.
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Affiliation(s)
- Jared S Winoker
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan A Chandhoke
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Danilovic A, Rocha BA, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Viana PCC, Srougi M, Nahas WC, Mazzucchi E. Size is Not Everything That Matters: Preoperative CT Predictors of Stone Free After RIRS. Urology 2019; 132:63-68. [PMID: 31310774 DOI: 10.1016/j.urology.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To define computed tomography (CT) predictors of residual fragments after retrograde intrarenal surgery (RIRS) for kidney stones up to 20 mm in patients never submitted to surgical procedures for stone removal. METHODS From August 2016 to August 2017, symptomatic adult patients with kidney stones less than 20 mm treated by RIRS had their pre- and postoperative CT prospectively evaluated in search for predictors of residual stone fragments. Stone size, stone volume, number of stones, stone density, and location were evaluated in preoperative CT and analyzed as predictors for residual stone fragments on 90 POD CT. Stone location was represented by the infundibulopelvic angle (IPA) measured for each stone on preoperative noncontrast CT using multiplanar reconstruction. RESULTS Ninety-two patients were successfully submitted to RIRS. Bilateral procedures were performed in 23 patients (25%) resulting in 115 renal units operated. Operative time was 54.5 ± 26.7 minutes (mean ± SD) and 96.7% (89/92) of the patients were discharged up to 12 hours after the procedure. Postoperative CT demonstrated stone-free in 86 of 115 (74.8%), 0-2 mm in 10 of 115 (8.7%), and > 2 mm residual fragments in 19 of 115 (16.5%) procedures. Logistic regression analysis revealed steep IPA was a predictor for any residual stone fragment after RIRS for kidney stones < 20 mm (P= .012). ROC curve showed that IPA < 41° was associated with a higher chance of residual fragments after RIRS. CONCLUSION IPA < 41° is associated with a higher chance of residual fragments after RIRS for kidney stones up to 20 mm.
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Affiliation(s)
- Alexandre Danilovic
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Bruno Aragão Rocha
- Department of Radiology, 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
- 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
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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