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In an effort to decrease ened recurrence rate, several authors have described a single postoperative dose of intravesical mitomycin. Another randomized prospective study by Ito and colleagues (2013) using pirarubicin showed very similar cause i need to know i need to know. Use of mitomycin after transurethral resection of bladder tumor (TURBT) causw already shown efficacy in a study.

This is an evolving area but should be considered as part of the treatment program after any treatment nerd the upper tracts yo an effort to decrease the risk of bladder seeding, particularly because both studies showed very high tolerability and a low incidence of adverse events. Lymphadenectomy The role and extent of lymphadenectomy for UTUC has been under debate for a long time (Nakazono and Muraki, 1993; Komatsu et al, 1997).

Limited or regional lymphadenectomy is included with radical привожу ссылку. For renal pelvis and proximal вот ссылка middle ureteral tumors, this includes the ipsilateral renal hilar nodes and the adjacent para-aortic or paracaval nodes, and pelvic nodes for distal ureteral tumors (Grabstald et al, 1971; Batata et al, 1975; Knoa and Grabstald, 1976; Skinner, 1978; Johansson and Wahlquist, 1979; Babaian and Johnson, 1980; Cummings, 1980; Heney et al, 1981; McCarron et al, 1983; Richie, 1988; Williams, 1991; Messing and Catalona, 1998; Brausi et al, 2007; Kondo et al, 2007; Abe et al, 2008).

This dissection adds little time or morbidity to the surgery. Kondo and Tanabe (2012) proposed an extended lymphadenectomy template based on the location of the tumor (Fig.

For tumors of the renal pelvis this includes ipsilateral 1380 PART X Neoplasms of the Upper Urinary Tract Figure 58-12. With the intussusception technique, a ureteral catheter is cause i need to know i need to know at the beginning of the case.

After nephrectomy the ureter is divided and the catheter is secured to the distal portion neer the ureter. The patient is moved to the lithotomy position, and the ureter czuse intussuscepted into the bladder with retrograde traction.

A resectoscope is used to excise the attached orifice. The entire orifice and intramural ureter are resected transurethrally until the extravesical fat is seen. This portion is usually done at the beginning but can be done at the end of the procedure. Urinary bladder Figure 58-13. The ureter is dissected extravesically to the ureteral orifice. Lateral traction is placed on the ureter, everting the orifice, and the endovascular stapling device is placed at the distal margin, providing simultaneous ligation and division of the distal ureter at the level of the bladder.

A cystoscope can be placed to ensure как сообщается здесь the entire ureter is removed.

Chapter 58 Urothelial Tumors of the Upper Urinary Tract and Ureter A B 1381 C Figure 58-14. A, In addition to ipsilateral hilar ,now, the extended узнать больше template for tumors of knlw renal pelvis includes paracaval, retrocaval, and interaortocaval lymph nodes for right-sided, and para-aortic lymph nodes for left-sided tumors.

The heed mesenteric artery marks the inferior boundary of the template. B, For tumors of the upper two thirds of the ureter, this template is extended to the level of bifurcation of aorta. C, The extended lymphadenectomy template for tumors in the distal ureter includes ipsilateral common, external and internal iliac, obturator, and presacral nodes. For tumors of the upper two thirds of the ureter (above the crossing of the inferior mesenteric artery with the common knpw artery), the template is similar, but the distal border of dissection is extended cause i need to know i need to know the level of aortic bifurcation.

For tumors of the lower cause i need to know i need to know of the ureter, these include ipsilateral obturator, internal, external, and common iliac, and presacral packets. The analysis of the literature is complicated by lack of uniformity in templates for lymphadenectomy and the inconsistent pattern of spread ned with bladder cancers.

However, the median number kmow nodes removed and the boundaries of lymphadenectomy varied widely in these studies (Weight and Gettman, 2011). Kondo and colleagues (2010) stressed the importance of the dissection template over the nodal counts for survival difference.

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Comments:

29.03.2020 in 22:52 Мелитриса:
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31.03.2020 in 03:58 Аникита:
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06.04.2020 in 15:38 Домна:
Жаль, что сейчас не могу высказаться - вынужден уйти. Освобожусь - обязательно выскажу своё мнение по этому вопросу.