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OBJECTIVE: To describe the experiences of women with histories of depression who used a responsive infant bassinet during the first 6 months after birth during the COVID-19 pandemic. DESIGN: Secondary qualitative descriptive study with analytic expansion. SETTING: United States. PARTICIPANTS: Women (N = 139) who gave birth up to 6 months previously and had histories of depression. METHODS: We used Kyngäs's method of inductive content analysis to analyze 109 open-ended responses that were collected between August 2020 to November 2021 as part of a previously conducted longitudinal study of women who used a responsive bassinet. RESULTS: Most participants indicated that the responsive bassinet improved their infants' sleep, which, in turn, subjectively improved their sleep and mood. External stressors and challenges presented barriers to good sleep for the participants and their infants, and participants described how these challenges contributed to their symptoms related to mood. When participants reported that they used the responsive bassinet, they shared that their infants were swaddled in the supine sleep position. Participants who did not use the bassinet commonly reported unsafe sleep practices. We identified seven themes from the data: Improved Maternal Sleep Quality, Barriers to Good Maternal Sleep, Mood and Sleep Go Hand and Hand, External Stressors Impair Mood, Improved Infant Sleep Quality, Barriers to Good Infant Sleep, and Safe Sleep Positioning. CONCLUSION: These findings can be used to inform clinicians on how a responsive bassinet may offer women at high risk for postpartum depression improved sleep and instrumental support. Future researchers should use validated measures to objectively evaluate rates of postpartum depression and sleep quality in high-risk women when using a responsive bassinet.
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COVID-19 , Humanos , Feminino , COVID-19/psicologia , COVID-19/epidemiologia , Adulto , Afeto , Estados Unidos/epidemiologia , Recém-Nascido , Pesquisa Qualitativa , Lactente , Depressão/epidemiologia , Depressão/psicologia , Cuidado do Lactente/métodos , SARS-CoV-2 , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Estudos Longitudinais , Qualidade do Sono , Sono/fisiologia , Mães/psicologiaRESUMO
PURPOSE: For infants with congenital heart disease (CHD) requiring surgery, prolonged hospital stays, intermittent caregiver visitation, and constrained unit staffing ratios present barriers to adequately address post-operative stressors and associated need to retain cognitive and physiological reserves. Similar patients requiring high-engagement interventions, such as hospitalized infants with neonatal abstinence syndrome, have found success in utilizing responsive bassinets to soothe infants and save floor nurses' time. However, it remains unclear if such technology can be leveraged in the CHD population given their complex hemodynamics, feeding intolerance, and monitoring requirements. METHODS: This multidisciplinary feasibility study evaluated responsive bassinet use in a cohort of infants with CHD <6 months of age in a medical-surgical unit at a midwestern children's hospital. Specifically assessing 1) implementation requirements, challenges, and potential of utilizing the device, together with 2) ability to perform bedside monitoring (monitoring) and 3) measuring physiologic trends during use. RESULTS: Between 11/2020-1/2022, nine infants utilized a responsive bassinet over 599 h (mean 13, range 4-26 days per infant). No increase in monitoring alarms and accurate vital signs monitoring during bassinet activity were noted with appropriate physiologic responses for infants with single ventricle and biventricular surgeries. CONCLUSIONS: Feasibility of introducing new technology into care, and successful use of its functionality for soothing was found to be plausible for infants with CHD. PRACTICE IMPLICATIONS: After cardiac surgery, infants with CHD have need for interventions to reduce stress. Use of a soothing bassinet has the potential to aid in doing so without interference with monitoring requirements.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Lactente , Recém-Nascido , Criança , Humanos , Estudos de Viabilidade , Cardiopatias Congênitas/cirurgiaRESUMO
Domestic cradles are beds that are movable but non-mobile for babies up to five months of age. The "anthropo-mechanical" cradle simulates the physiological movement of the human body. The article reviews scientific literature discussing the impacts of swinging on infants, provides classifications of all currently used cradles due to how the child moves, and briefly describes modern technologies within cradle automation. This made it possible to calculate and propose safe motion parameters within mechatronic cradles. The main conclusions of the article are as follows: (1) the scientific literature reports the beneficial effects of harmonic movement on a child, (2) motion analyses substantiating the classifications of all cradles into six types (tilting, yawing, hammock, Sarong, swing, and surging cradle; the classification criterion included the nature of the cradle movement in relation to the planes and anatomical axes of the child's body), (3) modern technologies allowing for the use of movement with thoughtful parameters, thus, safer for a child, (4) movement within the parameters similar to the motion and speed passively performed by the child in the womb while a mother is walking was considered beneficial and safe, and (5) the use of advanced technology allows for the possibility to devise and create an automatic mechatronic cradle with a child-safe motion. Future innovative anthropo-mechanical cradles that follow physiological human motion parameters can be used safely, with a vertical amplitude ranging from -13 to + 15 mm and a frequency of up to 2 Hz.
Assuntos
Leitos , Movimento , Lactente , Humanos , Movimento (Física)RESUMO
INTRODUCTION: The aim was to propose an update of the French Urology Association Cancer Committee (ccAFU) Recommendations on the management of upper urinary tract urothelial carcinomas (UUT-UC). METHODS: A systematic Medline search was performed between 2020 and 2022, taking account of the diagnosis, treatment options and follow-up of UUT-UC, while evaluating the references with their levels of evidence. RESULTS: The diagnosis of this rare pathology is based on CTU acquisition during excretion and flexible ureterorenoscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment. Nevertheless conservative treatment can be discussed for low risk lesions: tumour of low-grade, with no infiltration on imaging, unifocal<2cm, eligible for full treatment therefore requiring close endoscopic surveillance by flexible ureteroscopy in compliant patients. After RNU, postoperative instillation of chemotherapy is recommended to reduce the risk of recurrence in the bladder. Adjuvant chemotherapy has shown clinical benefits compared to surveillance after RNU for tumours (pT2-T4 N0-3 M0). CONCLUSION: These updated recommendations should contribute to improving not only patients' level of care, but also the diagnosis and decision-making concerning treatment for UUT-UC.
Assuntos
Carcinoma de Células de Transição , Neoplasias Renais , Neoplasias Ureterais , Neoplasias Urológicas , Humanos , Neoplasias Ureterais/diagnóstico , Neoplasias Ureterais/terapia , Neoplasias Ureterais/patologia , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/terapia , Carcinoma de Células de Transição/patologia , Pelve Renal/patologia , Neoplasias Renais/diagnóstico , Neoplasias Renais/terapia , Neoplasias Renais/patologia , Neoplasias Urológicas/diagnóstico , Neoplasias Urológicas/terapiaRESUMO
INTRODUCTION: -The purpose was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC). METHODS: - A systematic Medline search was performed between 2018 and 2020, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence. RESULTS: - The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumor, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduce risk of bladder recurrence. A systemic chemotherapy is recommended after RNU in pT2-T4 N0-3 M0 disease. CONCLUSION: - These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC.
Assuntos
Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/terapia , Neoplasias Renais/diagnóstico , Neoplasias Renais/terapia , Neoplasias Ureterais/diagnóstico , Neoplasias Ureterais/terapia , Algoritmos , Humanos , PrognósticoRESUMO
The purpose was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC). A systematic Medline search was performed between 2018 and 2020, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence.The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumor, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduce risk of bladder recurrence. A systemic chemotherapy is recommended after RNU in pT2T4 N03 M0 disease. These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC.
L'objectif était de proposer une mise à jour des recommandations du Comité de cancérologie de l'Association française d'urologie (AFU) pour la prise en charge des tumeurs de la voie excrétrice supérieure (TVES). Une revue systématique de la littérature (Medline) a été effectuée de 2018 à 2020 sur les éléments du diagnostic, les options de traitement et la surveillance des TVES en évaluant les références avec leur niveau de preuve. Le diagnostic de cette pathologie rare repose sur l'uro-TDM avec acquisition au temps excréteur et l'urétérorénoscopie souple avec prélèvements biopsiques. Le traitement chirurgical de référence est la néphro-urétérectomie totale (NUT), mais un traitement conservateur peut être discuté pour les lésions dites « à bas risque ¼ : tumeur de bas grade, sans infiltration sur l'imagerie, unifocale < 2 cm, accessible à un traitement complet et nécessitant alors une surveillance endoscopique rapprochée par urétéroscopie souple chez un patient compliant. Une instillation postopératoire de chimiothérapie est recommandée et permet de diminuer le risque de récidive vésicale après NUT. La chimiothérapie adjuvante a démontré son bénéfice clinique comparée à la surveillance après NUT pour les tumeurs (pT2T4 N03 M0). Ces nouvelles recommandations doivent contribuer à améliorer non seulement la prise en charge des patients, mais aussi le diagnostic et la décision thérapeutique des TVES.
Assuntos
Humanos , Sistema Urinário/patologia , Neoplasias Urogenitais/prevenção & controle , Ureteroscopia/métodos , NefroureterectomiaAssuntos
Cateterismo Cardíaco , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/terapia , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/instrumentação , Feminino , Hemodinâmica , Humanos , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Recuperação de Função Fisiológica , Dispositivo para Oclusão Septal , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/fisiopatologiaRESUMO
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations. Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.005. C'est cette nouvelle version qui doit être utilisée pour citer l'article. This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published. The replacement has been published at the doi:10.1016/j.purol.2019.01.005. That newer version of the text should be used when citing the article.
Assuntos
Carcinoma de Células de Transição/terapia , Oncologia/normas , Neoplasias Urológicas/terapia , Carcinoma de Células de Transição/patologia , França , Humanos , Oncologia/organização & administração , Oncologia/tendências , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Neoplasias Urológicas/patologia , Urotélio/patologiaRESUMO
INTRODUCTION: To propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC). METHODS: A systematic Medline search was performed between 2016 and 2018, with regards to the diagnosis, the options of treatment and the follow-up of UTUC, to evaluate the different studies with levels of evidence. RESULTS: The diagnosis of this rare disease is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low-risk diseases: unifocal tumour, possible complete resection low-grade and lack of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended in order to reduce the risk of bladder recurrence. An adjuvant chemotherapy is recommended after RNU in pT2-T4 N0-3 M0 disease. CONCLUSION: These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment of UTUC.
RESUMO
INTRODUCTION: The purpose was to propose an update of the french guidelines from the national committee CCAFU on upper tract urothelial carcinomas (UTUC). METHODS: A systematic Medline search was performed between 2013 and 2016, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence. RESULTS: The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumour, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscope) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduced risk of baldder recurrence. The place of systemic therapy (adjuvant and neoadjuvant chemotherapy) remains to define. CONCLUSION: These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC. © 2016 Elsevier Masson SAS. All rights reserved.
Assuntos
Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/terapia , Neoplasias Renais/diagnóstico , Neoplasias Renais/terapia , Neoplasias Ureterais/diagnóstico , Neoplasias Ureterais/terapia , Algoritmos , HumanosRESUMO
PURPOSE: To assess techniques, indications and results of conservative surgical management in upper tract urothelial carcinomas (UTUCs). MATERIAL AND METHODS: A systematic review of the scientific literature was performed in the Medline database (PubMed) using different associations of the following key words alone or in combination: ureter; renal pelvis; urothelial carcinoma; cancer; survival; renal insufficiency; ureteroscopy; kidney; grade; stage; surveillance. RESULTS: Conservative management is indicated in imperative cases (solitary kidney) or in elective cases to preserve renal function as much as possible. When a patient has two kidneys, indications of conservative treatment are dedicated to UTUC with the following characteristics: less than 1cm, low grade, unique contingent upon the fact that the patient has understood that stringent follow-up was mandatory. Current technique of reference is flexible ureteroscopy but open segmental ureterectomy is still indicated in isolated tumor of distal ureter. Oncologic outcomes after conservative management are equivalent to those obtained after nephroureterectomy in low grade/volume UTUCs. CONCLUSION: Indications of conservative management in UTUCs have been expanded in the past years in relationship with the development of new and sophisticated endourological ureteroscopes to obtain good oncologic outcomes contingent upon a stringent follow-up and even a systematic second look procedure in certain cases.
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Carcinoma de Células de Transição/cirurgia , Neoplasias Urológicas/cirurgia , Urotélio/patologia , Carcinoma de Células de Transição/patologia , Endoscopia , Humanos , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias Urológicas/patologia , Procedimentos Cirúrgicos UrológicosRESUMO
OBJECTIVE: To propose a state of the art regarding imaging techniques for the diagnosis and work-up of upper tract urothelial carcinoma (UTUC). METHODS: A systematic review of the scientific literature was performed in the Medline database (PubMed) until 2014 using different associations of the following keywords: urothelial carcinomas; upper urinary tract; ureter; renal pelvis; CT scan; MRI; ultrasound; urography. RESULTS: Imaging has a prominent role in the diagnosis, extension and follow-up assessment of upper tract urothelial cancers (UTUC). The couple ultrasound/intravenous urography made way for the multidetector computed tomography urography (MDCTU) and for the magnetic resonance imaging urography (MRU), which can also be combined in some cases. This review of the literature presents available techniques for the exploration of the upper urinary tract, the main protocols (in particular the interest of furosemide addition), details the interpretation techniques for searching UTUC on serial imaging, as well as the main differential diagnoses, and their accuracy. Finally, the role of imaging, according to patient's context is discussed. The combination or fusion of different modalities (CT, MR ) for the same objective is highlighted and presented as the likely evolution of UTUC imaging. CONCLUSION: MDCTU is nowadays the gold standard imaging modality for the diagnosis of UTUC.
Assuntos
Carcinoma de Células de Transição/patologia , Neoplasias Urológicas/patologia , Urotélio/patologia , Diagnóstico Diferencial , Diagnóstico por Imagem , Diuréticos/administração & dosagem , Furosemida/administração & dosagem , HumanosRESUMO
INTRODUCTION: Our purpose was to provide a state-of-the-art regarding the different non-surgical treatment modalities available for urologists in the modern management of upper urinary tract carcinoma (UTUC). MATERIALS AND METHODS: A systematic review of the literature was carried out on Medline and Embase databases: urinary tract; urothelial carcinoma; ureteral cancer; renal pelvis cancer; chemotherapy; radiotherapy; instillation. RESULTS: The medical treatment of UTUC is based on the extrapolation of data coming from bladder cancer studies. It is based on instillation of topical agents in the upper tract, chemotherapy or radiotherapy. However, the fact that UTUCs are scarce and the lack of randomized prospective trials do not provide definitive conclusions on the impact of these treatments. CONCLUSION: The optimal medical management of UTUC is mostly based on expert's opinion so far in combination with the surgical treatment. The international collaborations for UTUC that have been developed in recent years should provide concrete answers in the near future.
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Carcinoma de Células de Transição/terapia , Neoplasias Urológicas/terapia , Urotélio/patologia , Administração Intravesical , Antineoplásicos/administração & dosagem , Vacina BCG/uso terapêutico , Carcinoma de Células de Transição/imunologia , Carcinoma de Células de Transição/patologia , Terapia Combinada , Humanos , Neoplasias Urológicas/imunologia , Neoplasias Urológicas/patologiaRESUMO
PURPOSE: To propose a state-of-the art of current knowledge about clinical, ureteroscopic and photodynamic for the diagnosis of the upper urinary tract cancer (UTUC). MATERIAL AND METHOD: A systematic review of the literature search was performed from the database Medline (NLM, Pubmed), focused on the following keywords: urothelial carcinomas; upper urinary tract; ureter; renal pelvis; diagnosis; fluorescence; ureteroscopy; photodynamic technique; biopsy; cytology. RESULTS: Gross hematuria and flank pain are the two main clinical symptoms revealing a UTUC in daily clinical practice. Urinary cystoscopy and cystoscopy are mandatory to rule out a concomittant synchronous bladder tumour. Flexible ureteroscopy has revolutionized the management of UTUC by allowing a full exploration of upper urinary tract, an endoscopi vizualization of the tumour and assessment of grade with biopsies. A flexible ureteroscopy is mandatory in diagnostic evaluation of UTUC as soon as a conservative management is being considered. New investigation technologies such as fluorescence, narrow band imaging and optical coherence tomography (± combined with ultra sound), are promising for a near future. CONCLUSION: It has to be understood that the diagnostic work-up of a UTUC has to be exhaustive and particularly the search of another urothelial carcinoma within the urinary tract. Flexible ureterosocopy has revolutionized the diagnosis and management of UTUC and belongs fully to its initial evaluation.
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Carcinoma de Células de Transição/diagnóstico , Neoplasias Urológicas/diagnóstico , Urotélio/patologia , Biópsia , Dor no Flanco/etiologia , Hematúria/etiologia , Humanos , Hibridização in Situ Fluorescente , Imagem de Banda Estreita , Imagem Óptica , Tomografia de Coerência Óptica , Ureteroscopia , Urina/citologia , UrografiaRESUMO
AIM: To describe the main prognostic factors with an impact on survival of patients diagnosed with upper tract urothelial carcinomas (UTUC). MATERIAL AND METHODS: A systematic review of the literature has been performed using Pubmed without timeline restriction with the following keywords (MeSH): urothelial carcinoma; ureter; renal pelvis; prognosis; recurrence; survival; predictive models; nomogram. RESULTS: The level of evidence was low (3) in every available studies. There were 4 categories of prognostic factors in UTUCs: clinical (patient and tumor characteristics); surgical; pathological and molecular. The most important pre-operative prognostic factors were: size>3cm, grade (biopsy and cytology); multifocality; important hydronephrosis; co-morbidity (ASA), ECOG status, and a surgical delay of no more than 3months. After surgery, the most important prognostic factors are: stage, grade, carcinoma in situ, lymphovascular invasion and lymph node involvement. Serum markers from inflammation (CRP) could be useful for the prediction of advanced stages. Molecular markers are still under evaluation. CONCLUSION: The identification of prognostic factors in UTUC has improved over the past years. These prognostic factors can be considered alone but also as a panel or inside predictive tools to predict accurately patient's survival.
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Carcinoma de Células de Transição/mortalidade , Neoplasias Urológicas/mortalidade , Urotélio/patologia , Biomarcadores Tumorais , Proteína C-Reativa/análise , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Humanos , Hidronefrose/complicações , Metástase Linfática , Invasividade Neoplásica , Recidiva Local de Neoplasia , Prognóstico , Tempo para o Tratamento , Neoplasias Urológicas/patologia , Neoplasias Urológicas/cirurgia , Urotélio/cirurgiaRESUMO
PURPOSE: Upper tract urothelial carcinomas (UTUC) are rare tumors. Pathologist have a crucial role in establishing the diagnosis and the evaluation of the prognosis of these tumors. MATERIAL AND METHODS: A systematic review of the scientific literature was performed in the Medline database (PubMed) using different associations of the following key words alone or concomittantly: ureter; renal pelvis; urothelial carcinoma; specimen; pathology; histology; classification; grade; stage; prognosis. A particular search was done on the characteristics of the specimen management provided by urologists to pathologists and main prognostic specificities expected in UTUCs. RESULTS: Urinary cytology and biopsies are useful to provide the grade of the tumor according to the WHO classification 2004. The urologist needs to depict the clinical context to the pathologist in order to eliminate differential diagnosis. The main prognostic informations provided by the pathologist from the specimen analysis are the following: stage (TNM 2009), grade (WHO 2004), carcinoma in situ, location within upper tract, multifocality, necrosis, tumor size, lymphovascular invasion, margins and potentially microsatellite status when a HNPCC case is suspected. CONCLUSION: The pathologic analysis of a UTUC specimen needs nowadays to fulfill standardised international criteria of quality. However, specific additional aspects reported in the literature (e.g., lymphovascular invasion) are not systematically depicted.
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Carcinoma de Células de Transição/patologia , Neoplasias Urológicas/patologia , Urotélio/patologia , Adenocarcinoma/patologia , Biópsia , Carcinoma Neuroendócrino/patologia , Carcinoma Papilar/patologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células de Transição/genética , Humanos , Imuno-Histoquímica , Metástase Linfática , Instabilidade de Microssatélites , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Neoplasias Urológicas/genéticaRESUMO
PURPOSE: To review current knowledge about techniques of radical nephroureterectomy (RNU) for the treatment of the upper urinary tract cancer (UTUC). MATERIAL AND METHOD: A systematic review of the literature search was performed from the database Medline (NLM, Pubmed), focused on the following key-words; nephroureterectomy; renal pelvis; ureter; bladder-cuff excision; urothelial carcinoma; surgery; lymph-node dissection; laparoscopy. RESULTS: The removal of a bladder-cuff during RNU is mandatory. After the surgical procedure, intravesical instillation of ametycine reduces significantly the risk of recurrence into the bladder. Ureteral stripping should not be practiced and continuity of the bladder wall must be restored to avoid compromising the post-operative instillation. Lymphadenectomy during RNU is of prognostic and therapeutic interests. However, the anatomic sites of lymphadenectomy and the number of nodes to be analyzed are not consensual. The oncological results of laparoscopic approach are similar to those of open surgery. CONCLUSION: The RNU must include a lymphadenectomy and an excision of a bladder-cuff and restore the sealing of the bladder to allow practicing of a EPOI. Laparoscopic or open surgery may be used equally, and must respect these rules to avoid compromising the oncological outcome.
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Carcinoma de Células de Transição/cirurgia , Nefrectomia , Ureter/cirurgia , Neoplasias Urológicas/cirurgia , Urotélio/patologia , Carcinoma de Células de Transição/patologia , Humanos , Laparoscopia , Excisão de Linfonodo , Ureteroscopia , Neoplasias Urológicas/patologiaRESUMO
AIM: To describe the epidemiology, the risk and genetic factors involved in carcinogenesis pathways of upper urinary tumors UTUCs. MATERIAL: A systematic review of the scientific literature was performed from the database Medline (National Library of Medicine, PubMed) and websites of the HAS and the ANSM using the following keywords: epidemiology; risk factor; tobacco; aristolochic acid; urothelial carcinoma; ureter; renal pelvis. The search was focused on the characteristics, the mode of action, the efficiency and the side effects of the various drugs concerned. RESULTS: The estimated UTUC incidence is 1.2 cases/100,000 inhabitant per year in Europe. The incidence of renal pelvis tumor has been stable for 30years, while the frequency of ureteric locations has increased over time. Locally advanced stage and high grade are more frequent at the time of diagnosis. The median age for diagnosis is 70-years-old. Male-to-female ratio is nearly 2. Main carcinogenic factors are tobacco consumption and occupational exposure. There are specific risk factors for UTUC such acid aristolochic (balkan's nephropathy and Chinese herbs nephropathy). Familial cases are distinct from sporadic cases. UTUCs belong to the HNPCC syndrome and they rank third in its tumor spectrum. CONCLUSION: UTUCs are scarce tumors with specific epidemiologic characteristics. UTUCs share common risk factors with other urothelial carcinomas such as bladder tumors but have also specific risk factors that clinicians should know.
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Carcinoma de Células de Transição/epidemiologia , Carcinoma de Células de Transição/etiologia , Neoplasias Urológicas/epidemiologia , Neoplasias Urológicas/etiologia , Urotélio/patologia , Nefropatia dos Bálcãs/complicações , Benzidinas/efeitos adversos , Predisposição Genética para Doença , Humanos , Hidrocarbonetos Clorados/efeitos adversos , Incidência , Inflamação/complicações , Exposição Ocupacional/efeitos adversos , Hidrocarbonetos Policíclicos Aromáticos/efeitos adversos , Prevalência , Fatores de Risco , Distribuição por Sexo , Fumar/efeitos adversos , Infecções Urinárias/complicaçõesRESUMO
INTRODUCTION: The objective was to update the guidelines of the French Urological Association Cancer Committee for upper tract urothelial carcinoma (UTUC). METHODS: A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence. RESULTS: The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Total nephro-urectomy remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed : unifocal tumour and diameter < 1 cm and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscope) in compliant patients is therefore necessary. CONCLUSION: These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for UTUC.