The Urologic clinics of North America
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Urol. Clin. North Am. · Feb 2020
ReviewIdentification of Candidates for Salvage Therapy: The Past, Present, and Future of Defining Bacillus Calmette-Guérin Failure.
Disease progression and recurrence are common among patients on Bacillus Calmette-Guérin (BCG) therapy, and options for bladder-preserving subsequent therapy remain limited. Ongoing efforts to develop better second-line bladder-sparing therapies rely on clinical trials of patients deemed to have failed management with BCG. This article describes historical definitions of BCG failure, as well as recent efforts to better delineate and refine the clinical criteria for identifying individual patients who will not benefit from further intravesical BCG therapy. It also reviews guidance from the most recent expert consensus panels and professional association guidelines regarding which patients should not receive additional BCG therapy.
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After Bacillus Calmette-Guerin (BCG) failure, there is likely a 6- to 24-month window whereby salvage intravesical therapy might allow for preservation of the bladder without disease worsening. Combination intravesical, salvage therapy for nonmuscle invasive bladder cancer represents a promising avenue for treatment in patients unfit or unwilling to undergo cystectomy. BCG with concomitant immune stimulating agents or immune checkpoint inhibitors, combination chemotherapy regimens, such as gemcitabine and docetaxol, and novel agents currently in clinical trials provide hope for a bladder-sparing alternative for patients after BCG failure.
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Urol. Clin. North Am. · Feb 2020
ReviewSalvage Therapy for Non-muscle-invasive Bladder Cancer: Novel Intravesical Agents.
Bacillus Calmette-Guerin (BCG)-refractory high-grade non-muscle-invasive bladder cancer remains a challenging problem. Radical cystectomy is standard of care, but carries significant morbidity. ⋯ These include novel combinations of existing intravesical agents, novel modes of delivery such as hyperthermia, viral mediated therapies, and immunotherapy. We review the need for novel treatment with existing agents and their long-term results, and discuss novel intravesical therapies and the data currently available on these therapies.
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Urol. Clin. North Am. · Feb 2018
ReviewPerioperative Preparation and Nutritional Considerations for Patients Undergoing Urinary Diversion.
Patients undergoing urinary diversion are at high risk for complications in the perioperative period. The exact cause of these complications remains poorly defined but is likely multifactorial. Current efforts to optimize patients in the perioperative period, including prehabilitation, smoking cessation, recognition and treatment of comorbid conditions and malnutrition, immunonutrition supplementation, carbohydrate loading, and prevention of known complications and implementation of enhanced recovery after surgery pathways, seem beneficial in helping to improve outcomes in this at-risk population. Further studies (some of which are ongoing) are necessary to help optimize these strategies and identify which modifiable factors have the greatest impact.
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Urol. Clin. North Am. · Aug 2017
ReviewSurveillance Strategies for Neurogenic Lower Urinary Tract Dysfunction.
Patients with neurogenic lower urinary tract dysfunction (NLUTD) experience significant morbidity and mortality due to urological complications including upper tract damage and bladder malignancy. This has led to increased surveillance in patients NLUTD. This article discusses the methods available for surveillance of patients with NLUTD and pulls information from the largest and most established organizations that have produced evidence-based surveillance guidelines for NLUTD. These organizations include the Paralyzed Veterans of America (PVA), US Department of Veterans Affairs, European Association of Urology (EAU), The NICE organization from the UK, and cites additional literature not been included in these documents.