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Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations

Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...

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Culture of Bladder Cancer Organoids as Precision Medicine Tools
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[Clinical-pathology relationship in bladder cancer].

P Navarro Medina1, A Blanco Diez, J L Artiles Hernández

  • 1Servicio de Urología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria. patricionm@terra.es

Actas Urologicas Espanolas
|July 9, 2008
PubMed
Summary
This summary is machine-generated.

Computerized Axial Tomography (TAC) has a limited role in staging muscle-invasive bladder cancer before radical cystectomy. Its accuracy is low, especially for advanced disease, suggesting restricted use could reduce costs without compromising surgical decisions.

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Area of Science:

  • Urology
  • Oncology
  • Radiology

Background:

  • Muscle-invasive bladder cancer requires accurate staging for treatment planning.
  • Radical cystectomy is a primary treatment option for this condition.
  • Pre-operative imaging plays a crucial role in determining the extent of disease.

Purpose of the Study:

  • To evaluate the effectiveness of Computerized Axial Tomography (TAC) in the pre-operative staging of muscle-invasive bladder cancer.
  • To assess the accuracy of TAC in determining bladder (pT) and lymph node (pN) involvement.
  • To analyze the impact of TAC findings on surgical management decisions.

Main Methods:

  • Retrospective cohort study of 63 patients undergoing radical cystectomy for bladder cancer.
  • Comparison of TAC staging with pathological anatomy results (TNM classification).
  • Evaluation of TAC's impact on surgical approach.

Main Results:

  • TAC correctly staged the bladder in only 28.6% of cases, with understaging in 50.8% and overstaging in 20.6%.
  • TAC sensitivity for bladder cancer decreased with more advanced stages, while specificity increased (44% for pT2 to 94% for pT4).
  • Lymph node staging by TAC was accurate in 73.5% of cases, primarily in node-negative patients, with low sensitivity (28%) and specificity (55%).

Conclusions:

  • Computerized Axial Tomography (TAC) has a limited impact on the clinical staging of muscle-invasive bladder cancer.
  • The primary benefit of TAC is in patients with suspected advanced disease.
  • Restricting TAC use to these cases could significantly reduce costs with minimal risk of inappropriate surgical management.