EAU Update SeriesPub Date : 2003-12-01Epub Date: 2003-11-19DOI: 10.1016/S1570-9124(03)00060-6
Peter Whelan
{"title":"The Medical Treatment of Metastatic Renal Cell Cancer","authors":"Peter Whelan","doi":"10.1016/S1570-9124(03)00060-6","DOIUrl":"10.1016/S1570-9124(03)00060-6","url":null,"abstract":"<div><p>Patients who present with or subsequently develop metastases from renal cell carcinoma still have a poor prognosis. However, in recent years the use of immunotherapy as either a single agent or in double or triple combinations has shown some welcome reproducible responses in this disease. Too much reliance, however, on phase II studies has tended to obscure the critical role of prognostic factors in the survival of patients with metastatic renal cell cancer. A critical analysis is offered with the current state of therapy and the exciting new fields of therapeutic research are discussed.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"1 4","pages":"Pages 237-246"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1570-9124(03)00060-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73980787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EAU Update SeriesPub Date : 2003-12-01Epub Date: 2003-10-21DOI: 10.1016/S1570-9124(03)00053-9
H. Van Poppel, F. Deroo, S. Joniau
{"title":"Open Surgical Treatment of Localised Renal Cell Cancer","authors":"H. Van Poppel, F. Deroo, S. Joniau","doi":"10.1016/S1570-9124(03)00053-9","DOIUrl":"10.1016/S1570-9124(03)00053-9","url":null,"abstract":"<div><p>The open surgical treatment of renal cell carcinoma has undergone critical review over the past decade. Initially treated with radical nephrectomy, renal cell carcinoma is now more often approached with nephron-sparing surgical techniques. Because of the widespread availability of non-invasive imaging tests such as renal ultrasound and CT scan, many renal cell carcinomas are now being found incidentally. With the increasing number of incidentally detected kidney tumors, a size and stage migration has occurred in renal cell carcinoma. The absolute indications for partial nephrectomy involve circumstances in which the patient is at risk for renal failure if radical nephrectomy were to be performed. Early studies showed that disease-free survival rates were similar between cancers treated with radical and partial nephrectomy. The tendency now is to offer partial nephrectomy as a surgical option to patients with renal lesions measuring 4.0<!--> <!-->cm or smaller even in the presence of a normal contralateral kidney. A follow-up at regular intervals is recommended because certain recurrences may indicate second surgery. A rise in incidence, improved diagnostic procedures and evolving therapeutic possibilities emphasise the importance of open surgical treatment of localised renal cell carcinoma.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"1 4","pages":"Pages 220-225"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1570-9124(03)00053-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82169103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EAU Update SeriesPub Date : 2003-12-01Epub Date: 2003-10-21DOI: 10.1016/S1570-9124(03)00054-0
H Lang, D Jacqmin
{"title":"Laparoscopic Surgical Treatment of Localized Renal Cell Carcinoma","authors":"H Lang, D Jacqmin","doi":"10.1016/S1570-9124(03)00054-0","DOIUrl":"10.1016/S1570-9124(03)00054-0","url":null,"abstract":"<div><p>Laparoscopic surgery has been developed in recent years in urology. Is there a place for laparoscopic surgery in the treatment of kidney cancer?</p><p><strong><em>Radical nephrectomy</em></strong> done by laparoscopy seems to be efficient and mimics the open technique. The early results are satisfactory and at least as good as the gold standard. The only unknown issues are the oncological long-term results.</p><p><strong><em>Nephron-sparing laparoscopic surgery</em></strong> is feasible as it has been proven in several publications. Nevertheless, some problems have still to be overcome. A long haemostasis and the need for a vascular clamping have to be improve and long-term oncological results are still lacking.</p><p><strong><em>Conclusion:</em></strong> Laparoscopic radical nephrectomy will probably become soon a standard. More technical progress has to be made for laparoscopic nephron-sparing surgery which is a more demanding technique before it becomes a standard.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"1 4","pages":"Pages 226-229"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1570-9124(03)00054-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83045374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EAU Update SeriesPub Date : 2003-12-01Epub Date: 2003-11-06DOI: 10.1016/S1570-9124(03)00057-6
Véronique Lindner , Hervé Lang , Didier Jacqmin
{"title":"Pathology and Genetics in Renal Cell Cancer","authors":"Véronique Lindner , Hervé Lang , Didier Jacqmin","doi":"10.1016/S1570-9124(03)00057-6","DOIUrl":"10.1016/S1570-9124(03)00057-6","url":null,"abstract":"<div><p>The adult renal tumors are represented for about 90% by renal cell carcinoma (RCC). These epithelial malignant neoplasms are subclassified in five main types: conventional or common RCC, including clear and eosinophilic cell carcinoma, chromophobe RCC, papillary (or chromophilic) RCC, collecting duct carcinoma and RCC unclassified. This classification, proposed and accepted in the Heidelberg Workshop in 1997, is based on current genetic knowledge, correlates with morphological characteristics, in line with the evolutive behaviour of these neoplasms.</p><p>The different histopathological and biomolecular prognostic factors are reviewed as the data from genetic alterations in familial and sporadic RCC.</p><p>Some other frequent tumors have to be differentiated from RCC, as oncocytomas and angiomyolipomas, because of their benign behaviour.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"1 4","pages":"Pages 197-208"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1570-9124(03)00057-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75551309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EAU Update SeriesPub Date : 2003-12-01Epub Date: 2003-10-21DOI: 10.1016/S1570-9124(03)00052-7
H Lang, D Jacqmin
{"title":"Prognostic Factors in Renal Cell Carcinoma","authors":"H Lang, D Jacqmin","doi":"10.1016/S1570-9124(03)00052-7","DOIUrl":"10.1016/S1570-9124(03)00052-7","url":null,"abstract":"<div><p>Prognostic factors in renal cell carcinoma can be related to the tumor, the patient or the treatment.</p><p><strong><em>Tumor related factors:</em></strong> The pathological stage is certainly the best prognostic factor associated with the histological type and the grade. Microvascular invasion is a possible one. Many biomolecular markers have been tested but up to now none has proved any value in everyday practice.</p><p><strong><em>Patient-related factors:</em></strong> Presentation, performance status and comorbidity are the most important clinical prognostic factors. ESR and C-reactive protein are interesting serum markers and of course genetic alterations such as those of VHL disease have a significant impact.</p><p><strong><em>Treatment-related factors:</em></strong> Surgery is the only efficient treatment if done properly. The increasing use of new modalities such as cryoablation, radiofrequency or HIFU is still under evaluation.</p><p><strong><em>Conclusion:</em></strong> Despite all the studies done to detect prognostic factors, the only significant parameters are the old ones: performance status, stage, grade and histological type.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"1 4","pages":"Pages 215-219"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1570-9124(03)00052-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82484349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EAU Update SeriesPub Date : 2003-12-01Epub Date: 2003-10-29DOI: 10.1016/S1570-9124(03)00056-4
Ziya Kirkali , Can Öbek
{"title":"Clinical Aspects of Renal Cell Carcinoma","authors":"Ziya Kirkali , Can Öbek","doi":"10.1016/S1570-9124(03)00056-4","DOIUrl":"10.1016/S1570-9124(03)00056-4","url":null,"abstract":"<div><p>Renal cell carcinoma (RCC) represents a heterogeneous group of tumors, the most common of which is clear cell adenocarcinoma. RCC accounts for 3% of adult tumors. The incidence has increased more than 30% over the past two decades. It is generally postulated that the increased incidence rates reflect earlier diagnosis at an earlier stage, largely due to more liberal use of radiological imaging techniques. However, advanced disease has also been diagnosed more frequently and the mortality rate has increased as well. Prevention of RCC should focus on smoking cessation and maintaining ideal body mass index. Familial forms of kidney cancer have been described on four distinct histological patterns: clear cell, papillary, chromophobe, and oncocytoma. Genetic forms afflict individuals at an earlier age with a multifocal and recurrent pattern; therefore, nephron-sparing procedures should be the treatment of choice for these patients. The yield of screening the general population for RCC is still relatively low and hence not cost-effective. Screening should be reserved for individuals who carry high risk for RCC. The classic triad of flank pain, macroscopic hematuria, and palpable abdominal mass is now detected in fewer than 10% of patients, and is a late sign. Today, most tumors are diagnosed incidentally. Paraneoplastic syndromes have been reported in 10–40% of patients and can be seen at any stage of disease. The indications and application of percutaneous biopsy for renal masses are limited and mainly used to make differential diagnosis with an infectious process, lymphoma and metastases to the kidney.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"1 4","pages":"Pages 189-196"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1570-9124(03)00056-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80976797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EAU Update SeriesPub Date : 2003-09-01Epub Date: 2003-08-05DOI: 10.1016/S1570-9124(03)00037-0
Kari Bø
{"title":"Is There Still a Place for Physiotherapy in the Treatment of Female Incontinence?","authors":"Kari Bø","doi":"10.1016/S1570-9124(03)00037-0","DOIUrl":"10.1016/S1570-9124(03)00037-0","url":null,"abstract":"<div><p><strong><em>Objectives:</em></strong> The aim of this article is to report evidence-based knowledge on short- and long-term effects, adverse effects, adherence, dropout and motivational problems of pelvic floor muscle (PFM) training for stress urinary incontinence (SUI).</p><p><strong><em>Methods:</em></strong> Randomised controlled trials (RCTs) retrieved from computerized search, Clinical Practice Guidelines (AHCPR, US), the Cochrane library, and International Consultation on Incontinence (ICI) consensus statements were used as sources of evidence.</p><p><strong><em>Results:</em></strong> Several RCTs have demonstrated that PFM training is more effective than no treatment for SUI. Subjective cure/improvement rates of PFM training reported in RCTs vary between 56 and 70%. Cure rates defined as <2<!--> <!-->grams of leakage on different pad tests vary between 44 and 69%. Only one study has analysed data of long-term follow-up for as long as 10 years. Successful results were maintained in two thirds of the patients originally classified as successful.</p><p><strong><em>Conclusions:</em></strong> Pelvic floor muscle training has proved to be an effective treatment for female SUI in RCTs. It has no side effects, and is cost effective compared to surgery. There is a need for more physiotherapists specializing in this area, and better collaboration between urologists and physiotherapists to organize better health services for SUI patients and for planning of future high quality clinical trials.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"1 3","pages":"Pages 145-153"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1570-9124(03)00037-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77680912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
EAU Update SeriesPub Date : 2003-09-01Epub Date: 2003-08-05DOI: 10.1016/S1570-9124(03)00035-7
Andreas Bannowsky, Klaus-Peter Juenemann
{"title":"Innervation and Function of the Female Urinary Bladder and Urethra","authors":"Andreas Bannowsky, Klaus-Peter Juenemann","doi":"10.1016/S1570-9124(03)00035-7","DOIUrl":"10.1016/S1570-9124(03)00035-7","url":null,"abstract":"<div><p>Only few, but nonetheless specific anatomical differences exist between the female and the male urinary bladder. In men, the prostate gland, as a potentially obstructive organ, and in women the pelvic floor due to possible insufficiency after childbirth or through fluctuation of estrogen, may give rise to specific problems. The detailed knowledge of the anatomical, morphological and physiological fundamentals is of essential importance for understanding the mechanisms and innervation of the female urinary bladder.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"1 3","pages":"Pages 120-127"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1570-9124(03)00035-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84089932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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