The Journal of urology
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The Journal of urology · Jun 2005
ReviewRenal cell carcinoma 2005: new frontiers in staging, prognostication and targeted molecular therapy.
Renal cell carcinoma (RCC) has traditionally been staged using a purely anatomical staging system. Although current staging systems provide good prognostic information, data published in the last few years has led to significant controversies as to whether further revisions are needed and whether improvements can be made with the introduction of new, more accurate and predictive prognostic factors not currently included in traditional staging systems. This review highlights such controversies and provides an update on current staging modalities, prognostic factors and targeted molecular therapy for RCC. ⋯ Staging systems for RCC serve as a valuable prognostic tool. Several new patient and tumor characteristics have been reported to be important prognostic factors and they have been integrated into current staging systems. In addition, the field of RCC is rapidly undergoing a revolution led by molecular markers and targeted therapies. With this information urologists will be updated with the most current and comprehensive staging strategies, and be provided with a glimpse of the molecular and patient specific staging and treatment paradigms that will in our opinion transform the future management of this malignancy.
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The Journal of urology · Jun 2005
A clinical pathway for laparoscopic pyeloplasty decreases length of stay.
Benefits of minimally invasive procedures include decreased hospitalization and recovery times. Decreased length of stay (LOS) improves hospital efficiency and decreases costs. However, decreasing the LOS at the expense of patient care and satisfaction is not acceptable. A clinical pathway (CP) with structured order sets and imaging was developed for patients undergoing laparoscopic pyeloplasty. This pathway includes a cascade of activities managed closely by the health care team. This study assesses the safety and patient satisfaction with this clinical pathway. ⋯ The implementation of a CP at our institution has standardized patient care in this population and decreased LOS in comparison to the literature. This improves bed use and hospital efficiency while maintaining a high degree of patient satisfaction. We conclude that with intensive patient care and education most patients undergoing laparoscopic pyeloplasty may be discharged home safely on postoperative day 1.