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The diagnosis and staging of UTUC is best virtual sex with computed tomography urography and URS. Selective urinary cytology has high sensitivity in high-grade tumours, including carcinoma in situ. Perform a computed tomography (CT) urography for virtual sex and staging. Upper urinary tract UCs that invade the muscle wall usually have virtual sex very poor prognosis.

Many virtual sex factors have been identifed and can be used to risk-stratify patients in order to decide on the most appropriate local treatment (radical vs. Factors can virtual sex divided into patient-related factors and tumour-related factors. A delay between diagnosis of an invasive tumour and its removal may increase the risk of disease progression. Positive soft co drug merck surgical margin is associated with a higher disease recurrence after RNU.

Because of the rarity of UTUC, the main limitations of molecular studies virtual sex their retrospective design and, for most studies, small sample size. The factors to consider for risk stratification are presented in Figure 6. The main factors included in these models, which may be used when counselling patients regarding follow-up and administration of peri-operative chemotherapy, are detailed in Figure 6.

Patient-specific factors such as male gender, previous bladder cancer, smoking and pre-operative chronic kidney disease. Virtual sex prognostic factors for risk stratification include tumour multifocality, size, stage, grade, hydronephrosis and variant histology.

Currently, no prognostic biomarkers are validated for clinical use. Use prognostic factors to risk-stratify patients for therapeutic guidance. Kidney-sparing surgery for low-risk UTUC reduces the morbidity associated with radical surgery (e. This option should therefore be discussed in all low-risk cases, irrespective of the status virtual sex the contralateral kidney.

In addition, it can also be considered in select patients with a serious renal insufficiency or having a solitary kidney (LE: 3). Recommendations for kidney-sparing management of UTUC are listed in Section 7.

This may also be offered for low-risk tumours in the lower caliceal system that are inaccessible or difficult to manage by flexible URS. Segmental ureteral resection with wide margins provides adequate pathological specimens for staging and grading while preserving the ipsilateral kidney.

Retrograde instillation through a single J virtual sex ureteric stent is also used. A systematic review and meta-analysis virtual sex the oncologic outcomes of patients with papillary UTUC or CIS of the upper tract treated with kidney-sparing surgery and adjuvant endocavitary treatment analysed the effect of adjuvant therapies (i.

The analyses were based virtual sex retrospective small studies suffering from publication and reporting bias. The median follow-up of patients with a complete response was 11 months. Offer kidney-sparing management as primary treatment option to patients with low-risk tumours. Offer kidney-sparing management visual ureterectomy) to patients with high-risk tumours limited to the distal ureter.

This decision will have to be made on a case-by-case basis in consultation with the patient. Several precautions may lower the risk of tumour spillage:1. One prospective randomised study has shown that laparoscopic RNU is inferior to open RNU for non-organ confined UTUC. Several techniques have been considered to street cocaine names distal ureter resection, including the pluck technique, stripping, transurethral resection of the intramural ureter, and intussusception.

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Comments:

07.09.2019 in 17:29 Антонина:
Вы допускаете ошибку. Пишите мне в PM, пообщаемся.

08.09.2019 in 14:11 Анна:
может у кого есть сылка на хорошее качество?

09.09.2019 in 04:28 Стела:
Нифига себе сюрпризы

12.09.2019 in 08:33 sertlama:
Опять же, если рассматривать все исходя из теории ботов. то тут ведется просто очень связная беседа Админ - ау?