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1.
Urologie ; 62(10): 1064-1069, 2023 Oct.
Article in German | MEDLINE | ID: mdl-37264284

ABSTRACT

Guidelines can only give treatment recommendations for defined patient groups if high quality and meaningful evidence is available. However, patients included in clinical trials for the treatment of metastatic and/or locally advanced bladder cancer (mUC) are generally not representative for the spectrum of patients encountered in daily clinical practice. In particular, patients with different systemic pretreatments, variable prestudy responses or variable time to tumor progression are not sufficiently considered in trials and guideline recommendations. Accordingly, recommendations for the treatment of mUC patients with previous perioperative systemic therapy are lacking. To provide some guidance for daily uro-oncological practice despite the limited evidence, we sought to develop expert opinion-based treatment recommendations. These recommendations focus on palliative first-line therapy of mUC. Both perioperative pretreatment with classical cisplatin-based systemic therapy and/or immunotherapy, as well as the time to tumor recurrence have been considered.


Subject(s)
Urinary Bladder Neoplasms , Urinary Bladder , Humans , Urinary Bladder/pathology , Neoplasm Recurrence, Local/drug therapy , Urinary Bladder Neoplasms/drug therapy , Cisplatin/therapeutic use , Immunotherapy
2.
Urologe A ; 60(11): 1416-1423, 2021 Nov.
Article in German | MEDLINE | ID: mdl-34652474

ABSTRACT

BACKGROUND: Transurethral resection of the urinary bladder (TURB) is the standard intervention in the diagnostic workup and treatment of non-muscle invasive bladder cancer. In order to minimize cancer recurrence and potential complications, continuous technical development of TURB is of high clinical interest. OBJECTIVES: Presentation of the current standards and discussion of technological changes. MATERIALS AND METHODS: Analysis of the current guideline recommendations and literature research. RESULTS: The limitations of classic monopolar TURB is supplemented by new resection methods (en bloc) and technologies (bipolar and laser resection). Along with improved visualization through partially established technologies of photodynamic and digital image enhancement, there is potential for optimization regarding the likelihood of recurrences and complications as well as the histological quality of the resected material. CONCLUSION: A positive impact on the oncological value and safety of TURB seems possible through the use of modern technologies. Further establishment up to evidence-based guideline recommendations are necessary.


Subject(s)
Urinary Bladder Neoplasms , Humans , Neoplasm Recurrence, Local , Urinary Bladder Neoplasms/surgery , Urologic Surgical Procedures
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