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Follow-up of nonmuscle invasive transitional cell carcinoma of the bladder: how and how often? Curr Opin Urol 2008; 18:504-7. [PMID: 18670275 DOI: 10.1097/mou.0b013e32830b86a9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nonmuscle invasive bladder cancer represents a heterogeneous disease due to different natural history of its various appearances. The purpose of this article is to review recent literature regarding follow-up strategies. RECENT FINDINGS Management of nonmuscle invasive bladder cancer has become more complex in respect to diagnosis, treatment and follow-up. Follow-up should therefore be based on individual patient-risk assessment. In addition to improved diagnosis by fluorescence-guided cystoscopy and other new diagnostic tools like optical-coherence tomography management has concentrated on optimizing different concepts of intravesical therapy. SUMMARY The intent of nonmuscle invasive bladder cancer management is to control recurrence and progression and to identify invasive tumours at the earliest possible stage. To obtain exact staging, besides a proper transurethral resection of bladder, a restaging transurethral resection of bladder should be performed in T1 patients. Data from the literature supports the immediate postoperative intravesical instillation of different chemotherapeutic agents in low-risk patients. Multifocal papillary lesions might necessitate a more intensive adjuvant regimen, whereas intravesical immunotherapy using bacillus Calmette-Guerin is recommended in patients who are at a high-risk of progression. Early cystectomy should be considered in patients with recurrent T1 tumours or refractory carcinoma in situ to avoid unfavourable tumour progression.
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Persad R, Lamm D, Brausi M, Soloway M, Palou J, Böhle A, Colombel M, Akaza H, Buckley R, Witjes JA. Current Approaches to the Management of Non-Muscle Invasive Bladder Cancer: Comparison of Current Guidelines and Recommendations. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eursup.2008.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Routine Use of Photodynamic Diagnosis of Bladder Cancer: Practical and Economic Issues. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eursup.2008.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Jichlinski P, Lovisa B, Erling C, Aymon D, van den Berg H, Wagnieres G. [Fluorescence cystoscopy. Perspective in clinical practice and research]. Urologe A 2008; 47:975-7. [PMID: 18516580 DOI: 10.1007/s00120-008-1778-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many studies confirm the clinical interest of photodynamic diagnostics (PDD) in non-muscle invasive bladder cancer management. PDD or fluorescence cystoscopy is not only of great value in occult urothelial cancer detection, but may have a positive impact on disease-free survival and prognosis. Yet, its specificity is found to be highly variable between studies mainly in relation to different disease profiles. New imaging techniques aimed at enhancing visualization to assess the bladder wall are under development.
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Affiliation(s)
- P Jichlinski
- Universitätsklinik für Urologie, CHUV Hospital, CH-1011, Lausanne, Switzerland.
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Mitropoulos D, Adamakis I, Perimenis P. Contemporary diagnosis of bladder cancer. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2008; 2:713-720. [PMID: 23495780 DOI: 10.1517/17530059.2.6.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Early diagnosis of bladder cancer is mandatory, as a delay in treatment has been shown to affect prognosis. The current diagnostic standard of cystoscopy and cytology is costly, invasive and inconvenient, whereas advances in molecular biology have resulted in the evolvement of several markers. OBJECTIVE To review diagnostic considerations in the use of old and new technical modalities and tests for the detection of bladder cancer. METHODS A PubMed search of the literature concerning bladder cancer diagnosis was performed. Reviews are included on certain topics to avoid extensive reference to separate studies. CONCLUSION Recent technical advances have an impact on the management of patients with suspected bladder cancer. Cytology is still an important adjunct in the diagnostic work-up, whereas urine-bound tests may have a role in screening and surveillance. However, cystoscopy is the standard of care for the detection of bladder cancer. Fluorescence cystoscopy is an adjunctive tool, especially for the prompt identification of carcinoma in situ.
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Affiliation(s)
- Dionisios Mitropoulos
- Associate Professor of Urology University of Athens, Medical School, 1st Department of Urology, Mikras Asias 17, 115 27 Athens, Greece +30 210 7701141 ; +30 210 7701141 ;
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Hall MC, Chang SS, Dalbagni G, Pruthi RS, Seigne JD, Skinner EC, Wolf JS, Schellhammer PF. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol 2008; 178:2314-30. [PMID: 17993339 DOI: 10.1016/j.juro.2007.09.003] [Citation(s) in RCA: 572] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Indexed: 01/12/2023]
Affiliation(s)
- M Craig Hall
- American Urological Association Education and Research, Inc., USA.
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Kalsi J, Harland SJ, Feneley MR. Electromotive drug administration with mitomycin C for intravesical treatment of non-muscle invasive transitional cell carcinoma. Expert Opin Drug Deliv 2007; 5:137-45. [DOI: 10.1517/17425247.5.1.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Photodynamic diagnosis in urology: state-of-the-art. Eur Urol 2007; 53:1138-48. [PMID: 18096307 DOI: 10.1016/j.eururo.2007.11.048] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 11/28/2007] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To provide an overview on the methodology and clinical relevance of fluorescence diagnosis with exogenous fluorochromes or fluorochrome prodrugs in urology. METHODS The methodology is summarised on the basis of our experience and the relevant literature. Clinical results and perspectives are reported and concluded after we scanned and evaluated sources from PubMed. Search items were "aminolev*" or "hypericin" or "photodyn*" or "porphyrin" or "fluorescence" or "autofluorescence" and "bladder" or "prostate" or "kidney" or "peni*" or "condylo*". Some literature was also obtained from journals not indexed. RESULTS A large number of clinical trials have shown that photodynamic diagnosis (PDD) improves the ability to detect inconspicuous urothelial carcinoma of the bladder. Fluorescence diagnosis has recently been approved in Europe for the detection of bladder cancer after instillation of a hexaminolevulinate (Hexvix) solution. PDD is recommended by the European Association of Urology for the diagnosis of carcinoma in situ of the bladder. To date, the major weakness of PDD for the detection of bladder cancer is its relatively low specificity. Initial results with PDD for the detection of penile carcinoma, prostate cancer, kidney tumours, and urethral condylomata are promising. CONCLUSIONS To determine the actual impact of PDD on recurrence and progression rates of bladder cancer, further long-term observational studies are necessary. These studies also will clarify whether PDD is cost efficient.
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Schmidbauer J, Marberger M. Recent developments in fluorescence cystoscopy: do novel agents bring a benefit? Curr Opin Urol 2007; 17:347-51. [PMID: 17762629 DOI: 10.1097/mou.0b013e3282c8c73f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In flat bladder cancer and carcinoma in situ, and in multifocal papillary cancer, some smaller lesions may be overlooked at cystoscopy. For 10 years fluorescence cystoscopy has been promoted to solve these problems without wider acceptance. New fluorophobes now promise better clinical applicability. RECENT FINDINGS In prospective multicenter studies fluorescence cystoscopy shows significant improvement in the detection of flat bladder cancer and carcinoma in situ. It also permits more reliable identification of all neoplastic lesions with multifocal tumors, hence more precise removal and as a consequence lower recurrence rates. SUMMARY New agents bring a significant benefit. Hexyl-aminolevulinate offers more rapid urothelial accumulation, better fluorescence contrast and less photobleaching than previously used fluorophobes. It is simple to use in everyday practice and has a favorable toxicity profile.
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Affiliation(s)
- Jörg Schmidbauer
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Jakse G. Editorial comment on: The use of local anesthesia with N-DO injector (physion) for transurethral resection (TUR) of bladder tumors and bladder mapping: preliminary results and cost-effectiveness analysis. Eur Urol 2007; 52:1412-3. [PMID: 17507154 DOI: 10.1016/j.eururo.2007.04.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mathers MJ, Lazica DA, Klotz T, Sommer F, Roth S. [Secondary prevention after urological tumor diseases. Focusing on the kidneys, testes, and bladder]. Urologe A 2007; 46:636-41. [PMID: 17487469 DOI: 10.1007/s00120-007-1353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
It is generally agreed upon that patients require a caring as well as careful medical follow-up after cancer treatment. The goal of secondary prevention is to recognize a recurrence at an early stage and to use the curative chance while the tumor mass is still small. There is evidence of a medically effective and successful follow-up for tumors of the testicle and the bladder. For quality reasons, these follow-up regimes should be adhered to for quality reasons. In other diseases, e.g., renal cell carcinoma, prospective randomized studies are missing which demonstrate the effectiveness of follow-ups. In these cases asymptomatic patients should be stratified to individualized follow-up care.
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Affiliation(s)
- M J Mathers
- Urologische Gemeinschaftspraxis, Kooperationspraxis der Klinik für Urologie und Kinderurologie, Klinikum Wuppertal, Universität Witten/Herdecke, Fastenrathstrasse 1, 42853 Remscheid, Germany.
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Rioja Zuazu J, Bandrés Elizalde E, Rosell Costa D, Rincón Mayans A, Zudaire Bergera J, Gil Sanz M, Rioja Sanz L, García Foncillas J, Berián Polo J. Expresion del receptor de esteroides y xenobioticos (SXR) y del gen de multirresistencia drogas (MDR1) y de los polimorfismos de las enzimas GSTs, SULTs y CYP en tumores vesicales profundos, analisis de su expresion y correlación con otros factores pronósticos. Actas Urol Esp 2007; 31:1107-16. [DOI: 10.1016/s0210-4806(07)73772-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kamel MH, Daly PJ, Khan MF, Kay EW, O'Kelly P, Hickey DP. Survival and progression in high grade tumour subset of G2 and G3 pT1 bladder transitional cell carcinoma. Eur J Surg Oncol 2006; 32:1139-43. [PMID: 16784833 DOI: 10.1016/j.ejso.2006.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 04/06/2006] [Indexed: 11/18/2022] Open
Abstract
AIMS The newer 1998 WHO/ISUP grading system for bladder transitional cell carcinoma combined grade 3 (G3) and high grade tumour subset of grade 2 (G2) of the older 1973 WHO grading system into one homogenous high grade group. We evaluated for possible differences in survival and progression between these 2 grades in pT1 bladder tumours. METHODS From Jan 1(st) 1991-Dec 31(st) 2003, 105 (61 G2 and 44 G3) pT1 bladder tumours fulfilled the 1998 WHO/ISUP high grade criteria. Survival and progression of these tumours were assessed. RESULTS Of the 44 patients with G3 tumours, 20 are alive versus 22 of the 61 patients with high grade tumour subset of G2 (P=0.04). Of the 44 patients with G3 tumours, 13 progressed versus 12 of the 61 patients with high grade tumour subset of G2 (P=0.02). In multivariate analysis, G3 was a significant predictor of tumour progression (P=0.05) and marginally non-significant predictor of poor patient survival (P=0.056). CONCLUSIONS A notable difference in survival and progression between high grade tumour subset of G2 and G3 is observed.
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Affiliation(s)
- M H Kamel
- Department of Urology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
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Yuasa T, Tsuchiya N, Narita S, Inoue T, Saito M, Kumazawa T, Horikawa Y, Matsuura S, Satoh S, Nanjo H, Habuchi T. Radical nephroureterectomy as initial treatment for carcinoma in situ of upper urinary tract. Urology 2006; 68:972-5. [PMID: 17095072 DOI: 10.1016/j.urology.2006.05.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 04/20/2006] [Accepted: 05/31/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Transitional cell carcinoma in situ (CIS) of the upper urinary tract is a relatively rare disease, and treatment guidelines remain to be defined. In this study, we evaluated the outcomes after radical nephroureterectomy as the initial therapy for upper urinary tract CIS. METHODS Eight patients treated with radical nephroureterectomy after the diagnosis of upper urinary tract CIS from December 1999 to May 2004 were entered in this study. The diagnosis criteria included positive voided urinary cytology; negative multiple random biopsies of the bladder; negative radiographic studies, including retrograde pyelography and computed tomography; and serial positive cytology results in selective ipsilateral urine samples. RESULTS The median follow-up period was 56 months. The presence of CIS was confirmed pathologically in all patients. Two patients had more invasive lesions (pT1 and pT2), although retrospective evaluation revealed no infiltrative lesions. Intravesical recurrence was found in 5 patients, whose median recurrence-free period was 16 months. These heterotopic urothelial recurrences did not affect patient survival, and all 8 patients were alive without disease at last follow-up. CONCLUSIONS Although radical nephroureterectomy may be overtreatment for some patients with upper urinary tract CIS, excellent survival outcomes can be accomplished. In addition, the presence of concomitant invasive lesions, which cannot be identified on pretreatment examination in a substantial subset of patients with CIS, should be taken into account. Although the number of patients in this study was small, the results support the view that nephroureterectomy should remain a standard option for the initial treatment of this disease.
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Affiliation(s)
- Takeshi Yuasa
- Department of Urology, Akita University School of Medicine, Akita, Japan
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Frampton JE, Plosker GL. Hexyl aminolevulinate in the detection of bladder cancer: profile report. BioDrugs 2006; 20:317-20. [PMID: 17025378 DOI: 10.2165/00063030-200620050-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- James E Frampton
- Wolters Kluwer Health, Adis, 41 Centorian Drive, Mairangi Bay, Auckland 1311, New Zealand.
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Colapaoli L, Thorsen J, Nopp A, Guttormsen AB. A case of anaphylactic shock possibly caused by intravesical Hexvix. Acta Anaesthesiol Scand 2006; 50:1165-7. [PMID: 16987348 DOI: 10.1111/j.1399-6576.2006.01110.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND We report a case of a 69-year-old Caucasian male who experienced a severe drop in blood pressure and a skin rash after fluorescence cystoscopy and transurethral resection of the prostate. The diagnostic agent used for fluorescence cystoscopy and suspected of causing the anaphylaxis was hexaminolevulinate hydrochloride (Hexvix). INCIDENT A profound fall in blood pressure associated with atrial fibrillation, the appearance of a rash, vomiting and transient loss of consciousness occurred immediately after surgery. The hypotension persisted for several hours despite intensive treatment. The reaction commenced approximately 5 h after exposure to Hexvix. There was an increase in serum tryptase (almost nine-fold) and a positive skin prick test to undiluted Hexvix. CONCLUSION The mechanism of the anaphylaxis is uncertain, but is considered likely to be a non-immunoglobulin E-mediated allergic reaction possibly caused by Hexvix. This is the first reported case of a severe allergic reaction after intravesical instillation of Hexvix.
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Affiliation(s)
- L Colapaoli
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
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Gasión JPB, Cruz JFJ. Improving Efficacy of Intravesical Chemotherapy. Eur Urol 2006; 50:225-34. [PMID: 16793196 DOI: 10.1016/j.eururo.2006.05.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 05/18/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This paper reviews the most relevant findings published recently on intravesical chemotherapy for superficial bladder tumours and provides recommendations based on documented research. METHODS The evidence was categorised according to the North of England Evidence Based Guideline Development Project. Levels of evidence were based on the source of the information, meta-analyses, systematic reviews, well-designed randomised or nonrandomised controlled clinical trials, and uncontrolled studies or consensus. Three levels of recommendations were assigned to the evidence obtained. RESULTS Despite intravesical chemotherapy being used prophylactically after endoscopic resection of superficial bladder tumours, the recurrence rate is still 36-44%. Researchers have focused on improving the effectiveness of intravesical chemotherapy, each adopting a different strategy. Some have aimed to identify the optimum timing for instillations and others to improve the pharmacokinetics of agents by avoiding their dilution, increasing their stability, or improving the absorption of the drug by bladder mucosa. Some researchers are looking into new, single chemotherapeutic agents or combinations for intravesical use and others into avoiding chemoresistance with resistance-reverting agents (modulating agents) or by using in vitro chemosensitivity tests to identify the most sensitive drug. CONCLUSION Progress has been made in optimising intravesical chemotherapy for timing of instillations and pharmacokinetic interventions. Simple and inexpensive approaches may have a widespread, practical acceptance by urologists, but it is more difficult to extend new techniques requiring more complex and sometimes expensive instrumentation to the urologic community. Further research into finding more effective cytotoxic drugs, combinations, or modulating agents should be encouraged.
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Hofmann T, Knüchel-Clarke R, Hartmann A, Stöhr R, Tilki D, Seitz M, Karl A, Stief C, Zaak D. Clinical Implications of the 2004 WHO Histological Classification on Non-Invasive Tumours of the Urinary Bladder. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.eeus.2006.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Witjes JA. Management of BCG Failures in Superficial Bladder Cancer: A Review. Eur Urol 2006; 49:790-7. [PMID: 16464532 DOI: 10.1016/j.eururo.2006.01.017] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Accepted: 01/10/2006] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Review management of bacillus Calmette-Guérin (BCG) failures in superficial bladder cancer. METHOD Search of published literature and meeting abstracts. RESULTS Patients in whom BCG fails are not a uniform group. Failure cannot be predicted but high-risk patients can be identified. In case of failure and progression the outcome is bad. Conservative but investigative alternatives are BCG/interferon-alpha, intravesical hyperthermia/chemotherapy, or photodynamic therapy. Standard treatment in failing patients remains cystoprostatectomy. CONCLUSION BCG failures need careful and individualized therapy in experienced hands.
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Affiliation(s)
- Johannes A Witjes
- Department of Urology, University Medical Centre St. Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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