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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
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Contemporary cystectomy and urinary diversion.

Stephan Madersbacher1, Urs E Studer

  • 1Department of Urology, University of Berne, Anna-Seiler Haus, 3010 Berne, Switzerland. stephan.madersbacher@insel.ch

World Journal of Urology
|August 28, 2002
PubMed
Summary

Radical cystectomy is standard for invasive bladder cancer. Nerve-sparing techniques and pelvic lymphadenectomy improve outcomes, while orthotopic bladder substitution offers favorable long-term voiding function.

Area of Science:

  • Urology
  • Surgical Oncology

Background:

  • Radical cystectomy is the standard treatment for invasive bladder cancer.
  • Controversy exists regarding the optimal threshold for its indication.
  • Pelvic lymphadenectomy plays a crucial role in managing lymph node metastases.

Purpose of the Study:

  • To review the current indications and outcomes of radical cystectomy for invasive bladder cancer.
  • To discuss the role of lymphadenectomy and nerve-sparing surgical techniques.
  • To evaluate the long-term results of orthotopic bladder substitution.

Main Methods:

  • Review of existing literature on radical cystectomy, lymphadenectomy, and bladder reconstruction.
  • Analysis of oncological outcomes, functional results (erectile function, continence), and voiding outcomes.

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  • Long-term follow-up data analysis exceeding 10 years.
  • Main Results:

    • Meticulous pelvic lymphadenectomy can cure 20-30% of patients with lymph node metastases.
    • Unilateral nerve-sparing surgery is feasible and does not compromise oncological outcomes.
    • Orthotopic bladder substitution demonstrates sustained favorable voiding outcomes with age-related incontinence increase.

    Conclusions:

    • Radical cystectomy remains a cornerstone for invasive bladder cancer, with ongoing refinement in surgical techniques.
    • Nerve-sparing approaches and thorough lymphadenectomy are vital for optimizing patient function and survival.
    • Orthotopic bladder substitution provides durable lower urinary tract reconstruction with acceptable long-term functional results.