The Experts below are selected from a list of 1002 Experts worldwide ranked by ideXlab platform
Marianne Brehmer - One of the best experts on this subject based on the ideXlab platform.
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Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up
World Journal of Urology, 2019Co-Authors: Mudhar Hasan, Morgan Rouprêt, Francis Keeley, Cecilia Cracco, Robert Jones, Michael Straub, Olivier Traxer, Palle Jörn Sloth Osther, Marianne BrehmerAbstract:PURPOSE : To summarize current knowledge on upper urinary tract carcinoma (UTUC) regarding risk stratification, long-term results, and follow-up. METHODS : A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC, September 2018, Stockholm. RESULTS : To optimize oncological outcome considering both cancer-specific survival (CSS) and overall survival (OS), it is essential to identify pre- and postoperative prognostic factors. In low-risk UTUC, kidney-sparing surgery (KSS) and radical nephroureterectomy (RNU) offer equivalent CSS, whereas RNU may result in poorer OS due to nephron loss. For more aggressive tumours, undergrading can lead to insufficient treatment. The strongest prognostic factors are tumour stage and grade. Determining grade is best achieved by ureterorenoscopy (URS) with focal samples, biopsy and cytology. Staging is more difficult but can be indirectly achieved by multiphase Computed Tomography Urography (CTU) or tumour grade determined by cytology and histopathology. Patients treated with KSS should be monitored closely with regular follow-ups (URS and CTU). CONCLUSION : KSS should be offered in low-risk UTUC when feasible, whereas RNU is the treatment of choice in organ-confined high-risk UTUC. Intravesical recurrence (IVR) is common after RNU, but a single postoperative dose of mitomycin instillation decreases IVR. Endourological management has high local and bladder recurrence rates; however, its effect on CSS or overall survival OS is unclear. RNU is associated with significant risk of chronic kidney disease. Careful selection of patients and risk stratification are mandatory, and patients should be followed according to strict protocols.
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diagnostic accuracy of Computed Tomography Urography and visual assessment during ureterorenoscopy in upper tract urothelial carcinoma
BJUI, 2017Co-Authors: Alexandra Grahn, Camilla Malm, Fredrik Jäderling, Eva Radecka, Mats O. Beckman, Miden Mellehannah, Marianne BrehmerAbstract:Objective To investigate diagnostic accuracy of multiphase Computed Tomography Urography (MCTU) and visual assessment at ureterorenoscopy (URS) for detection of upper tract urothelial carcinoma (UTUC). Patients and Methods Consecutive patients referred to our tertiary care centre were included in a prospective study covering the period 2005 to 2012. The patients underwent initial imaging and URS with focal samples taken. Cytopathological results served as reference standard. Results We investigated 174 renal units (RUs; renal pelvis and adjacent ureter) in 148 patients. UTUC was found in 104 RUs. MCTU had an accuracy of 0.74, sensitivity of 0.89, specificity of 0.51, positive predictive value of 0.73, and negative predictive value of 0.75; corresponding values for URS were 0.84, 0.84, 0.85, 0.89, and 0.78, respectively. MCTU had significantly higher sensitivity and accuracy compared with other imaging techniques (P<0.05). Compared with MCTU, URS had similar sensitivity but significantly greater specificity and accuracy. Conclusion Both MCTU and URS are important tools in the diagnostic evaluation of UTUC although neither of those techniques achieves 100% accuracy. MCTU should be chosen as the radiographical method if there are no contraindications and URS should always be combined with focal cytology and biopsies of suspicious lesions. To enhance diagnostic precision both MCTU and URS with focal samples should be included in the diagnostic procedure. The present results add impact to current diagnostic guidelines.
A. Mcnamara - One of the best experts on this subject based on the ideXlab platform.
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improved pelvicalyceal visualization with multidetector Computed Tomography Urography comparison with helical Computed Tomography
European Radiology, 2005Co-Authors: V. Raptopoulos, A. McnamaraAbstract:Our aim was to compare the quality of pelvicalyceal visualization on Computed Tomography (CT) Urography using a small intravenous contrast material dose, hydration, and high-resolution multidetector CT (MDCT) with that of conventional helical CT. The test (MDCT) group (49 consecutive patients, 98 kidneys) was scanned 5 min following an intravenous bolus of 30 ml of iodinated contrast material. The control (helical CT) group (50 consecutive patients, 95 kidneys) was scanned 5 min following injection of 120–150 ml of intravenous contrast material. Enhancement and quality of calyceal detail were measured using a five-scale grading system (1 for no detail, 5 for cupped calyces). Calyceal attenuation was substantial in both groups (more than 220 Hounsfield units, HU) but less in the test group compared with the control group (mean 475 and 920 HU, respectively), p<0.0001. In the test group, the calyceal attenuation was less than 500 HU in the majority of cases (65/98 kidneys), while the opposite was true for the control group, where calyceal attenuation was more than 750 HU in 50/95 kidneys (p<0.001). The quality of calyceal detail was 3.4/5 in the test group compared with 1.8/5 in the control group (p<0.0001). The combination of hydration, low-contrast dose, and the high image resolution achieved with MDCT significantly improves calyceal visualization in CT Urography.
Pilar M Laguna - One of the best experts on this subject based on the ideXlab platform.
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comparison of radiation dose from conventional and triple bolus Computed Tomography Urography protocols in the diagnosis and management of patients with renal cortical neoplasms
The Journal of Urology, 2014Co-Authors: Pilar M LagunaAbstract:Objective To retrospectively compare the radiation dose of triple-bolus Computed Tomography (TBCT) and conventional CT (CCT) Urography protocols, analyze the effects of body mass index (BMI) on radiation dose in each group, and assess image quality. Materials and Methods We retrospectively reviewed the images of patients who underwent CCT or TBCT imaging in the management of renal cortical neoplasms. We used standard volumetric CT dose index (CTDIvol) and dose length product (DLP) to estimate radiation exposure. In addition, 2 urologists rated the quality of 20 CT images from each group using a survey with a 5-point Likert scale. The survey consisted of 10 questions relating to the ability of the scan to identify relevant renal anatomy. Results The study included 120 patients. CTDIvol and DLP were 28.7% and 40.4% lower in the TBCT protocol, respectively (both P P Conclusion In patients with renal cortical neoplasms, TBCT provides comparable image quality to CCT, with lower ionizing radiation exposure without compromising image quality. Obese patients may benefit more from TBCT scans.
Mudhar Hasan - One of the best experts on this subject based on the ideXlab platform.
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Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up
World Journal of Urology, 2019Co-Authors: Mudhar Hasan, Morgan Rouprêt, Francis Keeley, Cecilia Cracco, Robert Jones, Michael Straub, Olivier Traxer, Palle Jörn Sloth Osther, Marianne BrehmerAbstract:PURPOSE : To summarize current knowledge on upper urinary tract carcinoma (UTUC) regarding risk stratification, long-term results, and follow-up. METHODS : A scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC, September 2018, Stockholm. RESULTS : To optimize oncological outcome considering both cancer-specific survival (CSS) and overall survival (OS), it is essential to identify pre- and postoperative prognostic factors. In low-risk UTUC, kidney-sparing surgery (KSS) and radical nephroureterectomy (RNU) offer equivalent CSS, whereas RNU may result in poorer OS due to nephron loss. For more aggressive tumours, undergrading can lead to insufficient treatment. The strongest prognostic factors are tumour stage and grade. Determining grade is best achieved by ureterorenoscopy (URS) with focal samples, biopsy and cytology. Staging is more difficult but can be indirectly achieved by multiphase Computed Tomography Urography (CTU) or tumour grade determined by cytology and histopathology. Patients treated with KSS should be monitored closely with regular follow-ups (URS and CTU). CONCLUSION : KSS should be offered in low-risk UTUC when feasible, whereas RNU is the treatment of choice in organ-confined high-risk UTUC. Intravesical recurrence (IVR) is common after RNU, but a single postoperative dose of mitomycin instillation decreases IVR. Endourological management has high local and bladder recurrence rates; however, its effect on CSS or overall survival OS is unclear. RNU is associated with significant risk of chronic kidney disease. Careful selection of patients and risk stratification are mandatory, and patients should be followed according to strict protocols.
V. Raptopoulos - One of the best experts on this subject based on the ideXlab platform.
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improved pelvicalyceal visualization with multidetector Computed Tomography Urography comparison with helical Computed Tomography
European Radiology, 2005Co-Authors: V. Raptopoulos, A. McnamaraAbstract:Our aim was to compare the quality of pelvicalyceal visualization on Computed Tomography (CT) Urography using a small intravenous contrast material dose, hydration, and high-resolution multidetector CT (MDCT) with that of conventional helical CT. The test (MDCT) group (49 consecutive patients, 98 kidneys) was scanned 5 min following an intravenous bolus of 30 ml of iodinated contrast material. The control (helical CT) group (50 consecutive patients, 95 kidneys) was scanned 5 min following injection of 120–150 ml of intravenous contrast material. Enhancement and quality of calyceal detail were measured using a five-scale grading system (1 for no detail, 5 for cupped calyces). Calyceal attenuation was substantial in both groups (more than 220 Hounsfield units, HU) but less in the test group compared with the control group (mean 475 and 920 HU, respectively), p<0.0001. In the test group, the calyceal attenuation was less than 500 HU in the majority of cases (65/98 kidneys), while the opposite was true for the control group, where calyceal attenuation was more than 750 HU in 50/95 kidneys (p<0.001). The quality of calyceal detail was 3.4/5 in the test group compared with 1.8/5 in the control group (p<0.0001). The combination of hydration, low-contrast dose, and the high image resolution achieved with MDCT significantly improves calyceal visualization in CT Urography.