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In managing urinary tract infections (UTIs) in nursing, a comprehensive assessment is essential. Begin by gathering subjective data, such as the patient’s complaints of dysuria (painful urination), urinary frequency, urgency, suprapubic pain, and any lower abdominal discomfort. This information can be complemented by questions regarding previous UTIs, sexual activity, and personal hygiene practices, which can provide insight into risk factors. Objective assessment should focus on signs...
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Urinary Tract Calculi III: Medical Management01:30

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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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Urinary Bladder01:23

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The urinary bladder is a hollow, muscular sac that temporarily stores urine before it is expelled from the body. It can hold approximately 600 mL of urine prior to micturition. The bladder is retroperitoneal and located behind the pubic symphysis in the pelvic floor.
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Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care01:30

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A healthcare provider can diagnose a urinary tract infection (UTI) through several methods:Medical History and Symptoms: The provider will take a detailed medical history and ask about symptoms such as frequent urination, burning sensation during urination, and lower abdominal pain.Urinalysis: A clean-catch urine sample is collected in a sterile container and tested for the presence of bacteria, white blood cells (leukocytes), nitrites, blood, and protein. The presence of leukocytes and...
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Urinary Tract Calculi VI: Surgical Management01:25

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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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Urinary Tract Calculi IV: Nutrition Therapy and Prevention01:27

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Management of renal calculi focuses on effective strategies like tailored nutrition and hydration therapy. Adjusting diet and fluid intake reduces stone formation and recurrence, making these interventions simple yet powerful in kidney stone prevention and management.Understanding Kidney StonesKidney stones form when calcium, oxalate, uric acid, and cystine concentrate and crystallize in urine. Factors contributing to their formation include genetic predisposition, certain medical conditions,...
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Induction of Invasive Transitional Cell Bladder Carcinoma in Immune Intact Human MUC1 Transgenic Mice: A Model for Immunotherapy Development
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Systemic therapy in bladder preservation.

Daniel M Girardi1, Pooja Ghatalia2, Parminder Singh3

  • 1Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.

Urologic Oncology
|November 23, 2020
PubMed
Summary

Neoadjuvant chemotherapy (NAC) shows promise for muscle-invasive bladder cancer, especially in bladder preservation strategies. Biomarker-driven approaches may personalize treatment and improve outcomes.

Keywords:
BiomarkerBladder sparingImmunotherapyNeoadjuvant chemotherapyUrothelial carcinoma

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Area of Science:

  • Oncology
  • Urology

Background:

  • Bladder cancer, particularly muscle-invasive types, has high mortality and recurrence rates post-surgery.
  • Neoadjuvant chemotherapy (NAC) can improve survival by reducing tumor stage and treating micrometastases before radical cystectomy.

Purpose of the Study:

  • To review neoadjuvant chemotherapy (NAC) in bladder preservation for muscle-invasive bladder cancer.
  • To highlight NAC studies in patients ineligible for cisplatin-based regimens.
  • To discuss novel bladder-sparing strategies and biomarker-driven treatments.

Main Methods:

  • Literature review of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer.
  • Analysis of studies focusing on bladder preservation and cisplatin-ineligible patients.
  • Examination of multimodality treatments and biomarker research.

Main Results:

  • Neoadjuvant chemotherapy (NAC) is evidence-based for radical cystectomy but controversial for bladder preservation.
  • Patient response to NAC is a significant prognostic factor for survival.
  • Biomarker strategies may guide treatment de-intensification for complete responders.

Conclusions:

  • NAC holds potential for bladder preservation in muscle-invasive bladder cancer.
  • Further research is needed for robust NAC protocols in bladder-sparing settings.
  • Biomarker-guided therapy can personalize treatment and improve outcomes.