Archivos españoles de urología
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Adjuvant intravesical bacillus Calmette- Guérin (BCG) therapy is the standard conservative adjuvant treatment and the most effective regimen for patients with high-risk non-muscle-invasive bladder cancer (NMIBC). The term "BCG failure" is generally used to refer to recurrence or progression following BCG therapy, as experienced by many patients. However, the term has been defined inconsistently, and several studies have indicated that patients with a particular pattern of BCG failure have a worse prognosis. There are many different treatment options for patients who experience BCG failure. ⋯ The definition, prediction, and treatment of BCG failure remain topics of debate. Patients with BCG failure need carefully selected, individualized therapy in experienced hands. Stratification of patients with BCG failure into groups can identify those with a better or worse prognosis. RC should be the selected option if a patient experiences BCG failure, but several promising intravesical salvage options are available for those cases in which the patient is unfit for surgery or bladder preservation is preferred. Currently data are still inadequate to allow formulation of definitive recommendations, and larger and higher quality studies of salvage intravesical therapies are urgently required.
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Review Case Reports
Spontaneous retroperitoneal hemorrhage (Wünderlich syndrome): a two-case report.
To review the etiology, diagnosis and treatment of spontaneous retroperitoneal hemorrhage. ⋯ Diagnosis of acute abdomen due to retroperitoneal hemorrhage requires a combination of clinical information and imaging tests. We emphasize the role of IV contrast helical CT scan for a definitive diagnosis, which demonstrated the active bleeding point, the amount of hemorrhage, and the probable origin, and provided guide for therapeutic planning.
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Review Meta Analysis
Molecular markers for ischemia, do we have something better then creatinine and glomerular filtration rate?
Acute kidney injury (AKI) can occur spontaneously or iatrogenically, and rates of AKI continue to rise over the last two decades despite improvements in clinical care and development of preventive strategies. Serum creatinine (sCr) is the current gold standard for measuring changes in kidney function and identifying AKI. Detection of AKI by sCr, however, is delayed and small rises connote significantly increased morbidity and mortality. ⋯ A review of the current literature regarding these biomarkers reveals that they individually have unique strengths and weaknesses that can provide different types of information about patients. Currently, NGAL is the urine biomarker with the most promise as an individual marker. However, combining multiple markers to form a 'biomarker panel' along with sCr is an improvement over current clinical risk prediction models alone, and may be able to provide more individualized detail about the type and location of renal injury.
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Androgen deprivation plays a major role in the treatment of prostate cancer. Preclinical studies have shown that androgen deprivation provides both an independent cytotoxic effect and radiosensitization on prostate tumors. For men with non-metastatic prostate cancer, the addition of androgen deprivation to radiotherapy has been shown to improve survival for intermediate and high risk disease compared to radiation alone. This review discusses the clinical trial data regarding combination of androgen deprivation and radiation and provides recommendations for its use in men undergoing radiotherapy for localized prostate cancer.
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To review the literature and present a contemporary image of androgen deprivation for prostate cancer. ⋯ Reassessing the gold standard of hormonal blockade in advanced prostate cancer is mandatory.The undeniable evolution of IAD needs to be embraced by the urological community.