By Chris Dawson, Hugh Whitfield
Urological difficulties surround a variety of either distressing and probably existence threatening stipulations and the variety of common perform displays is turning out to be swiftly as a result of the expanding age of the inhabitants. either trustworthy and entire, the second one variation of the ABC of Urology offers a completely up to date and revised advisor to the speciality which highlights the new advances during this region. Concentrating in particular at the therapy and prognosis of the most typical stipulations, the emphasis is on shared care, the place the talents of the first care crew are utilized in conjunction with sanatorium referral.
This concise, well-illustrated and hugely functional textual content will give you the ideal reference for normal practitioners and perform nurses, in addition to junior medical professionals dealing with health facility referrals
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Additional resources for ABC of Urology
Von Hippel-Lindau disease is an autosomal dominant disorder that occurs in one per 36 000 population. Half of such cases develop renal cell carcinoma. The gene for Von Hippel-Lindau disease is a tumour suppressor gene on chromosome 3. It contains three exons and encodes a protein of 213 amino acids. Loss of its activity favours tumour growth. Abnormalities in the gene for Von HippelLindau disease are evident in 75% of sporadic cases of renal cell carcinoma. Furthermore, mutation of p53 has been reported in 6–40% of cases of renal cell carcinoma and may correlate with tumour grade and stage.
The standard test for prostate specific antigen measures the total amount of the antigen in the bloodstream, but it exists in different states. Most prostate specific antigen in serum is bound to protein, but a proportion exists free in the bloodstream. The proportion of free prostate specific antigen reduces in patients with prostate cancer. The proportion of free prostate specific antigen can be measured, and this can be expressed as a ratio of the level of total prostate specific antigen. A free to total prostate specific antigen ratio of Ͻ 25% in men with a total level of 4–10 ng/ml has been shown to detect 95% of cancers while avoiding 20% of unnecessary biopsies.
It must be recognised that pT1 disease is already showing invasive potential and has a significant risk of progression. The overall intention of treatment is preservation of the bladder and achievement of normal life expectancy. Poorly differentiated tumours (pT1 G3) are always subject to repeat biopsy to confirm the stage. If confirmed, intravesical immunotherapy is indicated (six instillations of BCG). If muscle invasion is detected, the protocol for pT2 tumours is followed. Widespread pT1 G3 tumour associated with carcinoma in situ is a dangerous situation, and serious consideration should be given to early radical cystectomy.
ABC of Urology by Chris Dawson, Hugh Whitfield