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Voiding Cystourethrography (VCUG) and Cystography are specialized radiographic procedures used to examine the structure and function of the bladder and urethra.Voiding Cystourethrography (VCUG)A Voiding Cystourethrogram (VCUG) is a diagnostic imaging procedure that assesses the anatomy and function of the lower urinary tract. It focuses on the bladder, bladder neck, and urethra, helping detect abnormalities such as vesicoureteral reflux (VUR)—the backward or reverse flow of urine into the...
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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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Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...
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The lower urinary system consists of the urinary bladder and urethra, which are essential in storing and expelling urine from the body. Together with the internal and external sphincters, these structures work together to regulate urination effectively.Anatomy of the BladderThe urinary bladder is a muscular, stretchable organ behind the pubic bone and in front of the rectum. In females, the bladder is positioned anterior to the vagina and inferior to the uterus, while in males, it is located...
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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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Overcoming the Chasm Between Evidence and Routine Practice for Bladder Cancer; Just a Quixotic Notion?

M Varughese1

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|April 12, 2021
PubMed
Summary

Outcomes for bladder cancer remain poor despite evidence supporting treatments like neoadjuvant chemotherapy. Most patients with muscle-invasive bladder cancer do not receive curative care, highlighting a gap between research and practice.

Keywords:
Bladder cancerconcurrent radiosensitisationnon-metastatic muscle-invasive bladder canceroncogeriatricsquality performance indicatorsradiotherapy consensus statements

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Area of Science:

  • Oncology
  • Urology

Background:

  • Bladder cancer outcomes have stagnated for 30 years.
  • Evidence supports neoadjuvant chemotherapy and radiosensitization for muscle-invasive bladder cancer, yet most patients do not receive these treatments.
  • The elderly population with bladder cancer often has comorbidities, complicating treatment decisions.

Purpose of the Study:

  • To examine patient-centered, evidence-based care for bladder cancer.
  • To investigate the reasons for the discrepancy between clinical trial evidence and routine practice in bladder cancer treatment.
  • To propose strategies to improve the uptake of curative-intent therapies for bladder cancer.

Main Methods:

  • Review of clinical trial evidence for bladder cancer interventions.
  • Analysis of population-based data on bladder cancer treatment patterns.
  • Examination of patient-centered care principles in the context of bladder cancer therapy.

Main Results:

  • Despite evidence, most patients with non-metastatic muscle-invasive bladder cancer do not receive curative-intent treatments.
  • Radical cystectomy is often the default treatment, with limited comparative data against other modalities like radiotherapy.
  • A significant gap persists between evidence-based recommendations and actual clinical practice for bladder cancer.

Conclusions:

  • There is a critical need to address the disparity in bladder cancer treatment.
  • Patient-centered evidence-based care, including bladder conservation therapy, must be prioritized.
  • Proposals are needed to reverse the trend of suboptimal treatment in bladder cancer patients.