The widespread use of video-electroencephalogram monitoring has dramatically increased our recognition of the high prevalence and diversity of nonepileptic seizures. Nonepileptic seizures stand squarely in the interface between psychiatry and neurology, an area that has been both claimed and denied by both sides. Collaborative exploration of this border zone has provided new insights into a disorder that may be as ancient as epilepsy.
It has been hypothesized that patients with bladder cancer (BCa) might suffer from subsequent upper tract urothelial carcinoma (UTUC) if hydronephrosis is managed via US. We analyzed the impact of several factors at transurethral resection of bladder tumor (TURBT) on the occurrence of metachronous UTUC.METHODS: Retrospective analysis of 545 patients with BCa presenting with hydronephrosis and managed with US or PN. All the patients underwent TURBT and subsequent radical cystectomy between 1990 and 2019 at 23 tertiary care centers. Patients without hydronephrosis, not undergoing UUT decompression or without concomitant UTUC were excluded from the study. A 1:1 propensity score matching (PSM) estimated using logistic regression was performed using preoperative parameters such as: age, ASA score, clinical T stage, tumor multifocality, CIS at TURBT. Univariable and multivariable Cox regression analyses were used to predict the occurrence of metachronous UTUC after BCa diagnosis, adjusting for clinicopathological variables. Kaplan-Meier analyses predicted recurrence, cancer specific mortality (CSM) and overall mortality (OM) according to the drainage modality.RESULTS: After PSM we obtained 125 (50%) BCa patients managed with US and 125 (50%) with PN. Hydronephrosis was due to direct BCa obstruction in 193 (77%) cases. US and PN were maintained in situ for a mean of 130 and 71 days, respectively (p<0.001). Patients receiving PN had a higher rate of muscle invasive BCa (74 vs 36%, p<0.001) at TURBT in comparison with the US cohort. On univariable and multivariable analysis we found no statistically significant association between clinico-pathological features at TURBT and the occurrence of metachronous UTUC. Similarly, the presence of hydronephrosis due to BCa obstruction and the duration of indwelling US were not statistically associated with the development of metachronous UTUC. Lastly, the two cohorts didn't show differences in terms of CSM and OM (Log-rank 0.6 and 0.5, respectively).CONCLUSIONS: Ureteral stenting does not increase the risk of developing metachronous UTUC in patients with BCa presenting with hydronephrosis requiring UUT decompression. The choice of managing the hydronephrosis in patients with BCa should not be based on concerns of developing metachronous UTUC.
Introduction: Low grade upper tract urothelial cancer is an uncommon urothelial tumor for which treatment involves multiple ureteroscopic interventions and potentially radical nephroureterectomy. Given the burden of these procedures, there is growing interest in determining how the utilization, complications and morbidities associated with treatment contribute to the burden of care for upper tract urothelial cancer. The aim of this study was to conduct a systematic literature review to understand the economic burden of treating low grade upper tract urothelial cancer.
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