American Urological Association (AUA) / American Society Of Clinical .
1Approved by the AUABoard of DirectorsDecember 2020Authors’ disclosure ofpotential conflicts ofinterest and author/staffcontributions appear at theend of the article. 2020 by the AmericanUrological AssociationThe Practice GuidelinesCommittee would like toacknowledge thecontributions of Drs.Christopher Anderson andJohn Gore to the 2020Guideline Amendment.American Urological Association (AUA) / American Society of Clinical Oncology (ASCO) /American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO)TREATMENT OF NON-METASTATIC MUSCLE-INVASIVEBLADDER CANCER: AUA/ASCO/ASTRO/SUOGUIDELINE (AMENDED 2020)Sam S. Chang, MD, MBA; Bernard H. Bochner, MD, FACS; Roger Chou, MD;Robert Dreicer, MD, MS, MACP, FASCO; Ashish M. Kamat, MD, MBBS, FACS; SethP. Lerner, MD, FACS; Yair Lotan, MD; Joshua J. Meeks, MD, PhD; Jeff M. Michalski,MD, MBA; Todd M. Morgan, MD; Diane Z. Quale; Jonathan E. Rosenberg, MD;Anthony L. Zietman, MD; Jeffrey M. Holzbeierlein, MD, FACSPurposeAlthough representing approximately 25% of patients diagnosed with bladdercancer, muscle-invasive bladder cancer (MIBC) carries a significant risk of deaththat has not significantly changed in decades. Increasingly, clinicians and patientsrecognize the importance of multidisciplinary collaborative efforts that take intoaccount survival and quality of life (QOL) concerns. For the first time for any typeof malignancy, the American Urological Association (AUA), the American Society ofClinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO),and the Society of Urologic Oncology (SUO) have formulated an evidence-basedguideline. This guideline provides a risk-stratified clinical framework for themanagement of muscle-invasive urothelial bladder cancer and is designed to beused in conjunction with the associated treatment algorithm.MethodologyThe systematic review utilized to inform this guideline was conducted by amethodology team at the Pacific Northwest Evidence-based Practice Center. Theoriginal review was funded by the Agency for Healthcare Research and Quality(AHRQ), and a subsequent supplemental report was funded by the AUA to addressadditional key questions and more recently published literature. A researchlibrarian experienced in conducting literature searches for comparativeeffectiveness reviews searched in Ovid MEDLINE (January 1990 to October2014), the Cochrane Central Register of Controlled Trials (through September2014), the Cochrane Database of Systematic Reviews (through September 2014),Health Technology Assessments (through Third Quarter 2014), the National HealthSciences Economic Evaluation Database (through Third Quarter 2014), and theDatabase of Abstracts of Reviews of Effects (through Third Quarter 2014) tocapture published and gray literature. The methodology team searched forunpublished studies in clinical trial registries (ClinicalTrials.gov, Current ControlledTrials, ClinicalStudyResults.org and the World Health Organization InternationalClinical Trials Registry Platform) and regulatory documents (Drugs@FDA.gov andFDA Medical Devices Registration and Listing). A supplemental search of OvidMEDLINE and Cochrane Central Register of Controlled Trials was conducted tocapture additional published literature through February 2, 2016. The guidelineunderwent review in 2020. The updated search (July 1, 2016 to May 18, 2020)identified 2,005 abstracts, of which 38 met inclusion criteria. When sufficientevidence existed, the body of evidence for a particular treatment was assigned astrength rating of A (high), B (moderate) or C (low) for support of Strong,Moderate, or Conditional Recommendations. In the absence of sufficient evidence,additional information is provided as Clinical Principles and Expert Opinions.Copyright 2020 American Urological Association Education and Research, Inc.
2American Urological Association (AUA) / American Society of ClinicalMuscle-InvasiveOncology (ASCO) / American Society for Radiation Oncology (ASTRO) /Bladder CancerSociety of Urologic Oncology (SUO)GUIDELINE STATEMENTSINITIAL PATIENT EVALUATION AND COUNSELING1. Prior to treatment consideration, a full history and physical exam should be performed, including an exam underanesthesia, at the time of transurethral resection of bladder tumor for a suspected invasive cancer. (ClinicalPrinciple)2. Prior to muscle-invasive bladder cancer management, clinicians should perform a complete staging evaluation,including imaging of the chest and cross sectional imaging of the abdomen and pelvis with intravenous contrast ifnot contraindicated. Laboratory evaluation should include a comprehensive metabolic panel (complete bloodcount, liver function tests, alkaline phosphatase, and renal function). (Clinical Principle)3. An experienced genitourinary pathologist should review the pathology of a patient when variant histology issuspected or if muscle invasion is equivocal (e.g., micropapillary, nested, plasmacytoid, neuroendocrine,sarcomatoid, extensive squamous or glandular differentiation). (Clinical Principle)4. For patients with newly diagnosed muscle-invasive bladder cancer, curative treatment options should bediscussed before determining a plan of therapy that is based on both patient comorbidity and tumorcharacteristics. Patient evaluation should be completed using a multidisciplinary approach. (Clinical Principle)5. Prior to treatment, clinicians should counsel patients regarding complications and the implications of treatmenton quality of life (e.g., impact on continence, sexual function, fertility, bowel dysfunction, metabolic problems).(Clinical Principle)TREATMENTNEOADJUVANT/ADJUVANT CHEMOTHERAPY6. Utilizing a multidisciplinary approach, clinicians should offer cisplatin-based neoadjuvant chemotherapy to eligibleradical cystectomy patients prior to cystectomy. (Strong Recommendation; Evidence Level: Grade B)7. Clinicians should not prescribe carboplatin-based neoadjuvant chemotherapy for clinically resectable stage cT2T4aN0 bladder cancer. Patients ineligible for cisplatin-based neoadjuvant chemotherapy should proceed todefinitive locoregional therapy or clinical trial. (Expert Opinion)8. Clinicians should perform radical cystectomy as soon as possible following a patient’s completion of and recoveryfrom neoadjuvant chemotherapy (ideally within 12 weeks unless medically inadvisable). (Expert Opinion)9. Eligible patients who have not received cisplatin-based neoadjuvant chemotherapy and have non-organ confined(pT3/T4and/or N ) disease at cystectomy should be offered adjuvant cisplatin-based chemotherapy. (ModerateRecommendation; Evidence Level: Grade C)RADICAL CYSTECTOMY10. Clinicians should offer radical cystectomy with bilateral pelvic lymphadenectomy for surgically eligible patientswith resectable non-metastatic (M0) muscle-invasive bladder cancer. (Strong Recommendation; Evidence Level:Grade B)11. When performing a standard radical cystectomy with curative intent, clinicians should remove the bladder,prostate, and seminal vesicles in males; clinicians should remove the bladder in females and should considerremoval of adjacent reproductive organs based on individual disease characteristics and need to obtain negativemargins. (Clinical Principle)12. Clinicians should discuss and consider sexual function preserving procedures for patients with organ-confineddisease and absence of bladder neck, urethra, and prostate (male) involvement. (Moderate Recommendation;Evidence Level: Grade C)URINARY DIVERSION13. In patients undergoing radical cystectomy, ileal conduit, continent cutaneous, and orthotopic neobladder urinarydiversions should all be discussed. (Clinical Principle)Copyright 2020 American Urological Association Education and Research, Inc.
3American Urological Association (AUA) / American Society of ClinicalMuscle-InvasiveOncology (ASCO) / American Society for Radiation Oncology (ASTRO) /Bladder CancerSociety of Urologic Oncology (SUO)14. In patients receiving an orthotopic urinary diversion, clinicians must verify a negative urethral margin. (ClinicalPrinciple)PERIOPERATIVE SURGICAL MANAGEMENT15. Clinicians should attempt to optimize patient performance status in the perioperative setting. (Expert Opinion)16. Perioperative pharmacologic thromboembolic prophylaxis should be given to patients undergoing radicalcystectomy. (Strong Recommendation; Evidence Level: Grade B)17. In patients undergoing radical cystectomy µ -opioid antagonist therapy should be used to accelerategastrointestinal recovery, unless contraindicated. (Strong Recommendation; Evidence Level: Grade B)18. Patients should receive detailed teaching regarding care of urinary diversion prior to discharge from the hospital.(Clinical Principle)PELVIC LYMPHADENECTOMY19. Clinicians must perform a bilateral pelvic lymphadenectomy at the time of any surgery with curative intent.(Strong Recommendation; Evidence Level: Grade B)20. When performing bilateral pelvic lymphadenectomy, clinicians should remove, at a minimum, the external andinternal iliac and obturator lymph nodes (standard lymphadenectomy). (Clinical Principle)BLADDER PRESERVING APPROACHESPATIENT SELECTION21. For patients with newly diagnosed non-metastatic muscle-invasive bladder cancer who desire to retain theirbladder, and for those with significant comorbidities for whom radical cystectomy is not a treatment option,clinicians should offer bladder preserving therapy when clinically appropriate. (Clinical Principle)22. In patients under consideration for bladder preserving therapy, maximal debulking transurethral resection ofbladder tumor and assessment of multifocal disease/carcinoma in situ should be performed. (StrongRecommendation; Evidence Level: Grade C)MAXIMAL TURBT AND PARTIAL CYSTECTOMY23. Patients with muscle-invasive bladder cancer who are medically fit and consent to radical cystectomy should notundergo partial cystectomy or maximal transurethral resection of bladder tumor as primary curative therapy.(Moderate Recommendation; Evidence Level: Grade C)PRIMARY RADIATION THERAPY24. For patients with muscle-invasive bladder cancer, clinicians should not offer radiation therapy alone as a curativetreatment. (Strong Recommendation; Evidence Level: Grade C)MULTI-MODAL BLADDER PRESERVING THERAPY25. For patients with muscle-invasive bladder cancer who have elected multi-modal bladder preserving therapy,clinicians should offer maximal transurethral resection of bladder tumor, chemotherapy combined with externalbeam radiation therapy, and planned cystoscopic re-evaluation. (Strong Recommendation; Evidence Level:Grade B)26. Radiation sensitizing chemotherapy should be included when using multimodal therapy with curative intent.(Strong Recommendation; Evidence Level: Grade B)27. Following completion of bladder preserving therapy, clinicians should perform regular surveillance with CT scans,cystoscopy, and urine cytology. (Strong Recommendation; Evidence Level: Grade C)BLADDER PRESERVING TREATMENT FAILURE28. In patients who are medically fit and have residual or recurrent muscle-invasive disease following bladderpreserving therapy, clinicians should offer radical cystectomy with bilateral pelvic lymphadenectomy. (StrongCopyright 2020 American Urological Association Education and Research, Inc.
4American Urological Association (AUA) / American Society of ClinicalMuscle-InvasiveOncology (ASCO) / American Society for Radiation Oncology (ASTRO) /Bladder CancerSociety of Urologic Oncology (SUO)Recommendation; Evidence Level: Grade C)29. In patients who have a non-muscle invasive recurrence after bladder preserving therapy, clinicians may offereither local measures, such as transurethral resection of bladder tumor with intravesical therapy, or radicalcystectomy with bilateral pelvic lymphadenectomy. (Moderate Recommendation; Evidence Level: Grade C)PATIENT SURVEILLANCE AND FOLLOW UPIMAGING30. Clinicians should obtain chest imaging and cross sectional imaging of the abdomen and pelvis with CT or MRI at6-12 month intervals for 2-3 years and then may continue annually. (Expert Opinion)LABORATORY VALUES AND URINE MARKERS31. Following therapy for muscle-invasive bladder cancer, patients should undergo laboratory assessment at three tosix month intervals for two to three years and then annually thereafter. (Expert Opinion)32. Following radical cystectomy in patients with a retained urethra, clinicians should monitor the urethral remnantfor recurrence. (Expert Opinion)PATIENT SURVIVORSHIP33. Clinicians should discuss with patients how they are coping with their bladder cancer diagnosis and treatmentand should recommend that patients consider participating in cancer support groups or consider receivingindividual counseling. (Expert Opinion)34. Clinicians should encourage bladder cancer patients to adopt healthy lifestyle habits, including smokingcessation, exercise, and a healthy diet, to improve long-term health and quality of life. (Expert Opinion)VARIANT HISTOLOGY35. In patients diagnosed with variant histology, clinicians should consider unique clinical characteristics that mayrequire divergence from standard evaluation and management for urothelial carcinoma. (Expert Opinion)Copyright 2020 American Urological Association Education and Research, Inc.
5American Urological Association (AUA) / American Society of ClinicalMuscle-InvasiveOncology (ASCO) / American Society for Radiation Oncology (ASTRO) /Bladder CancerSociety of Urologic Oncology (SUO)INTRODUCTIONPURPOSEAlthough representing approximately 25% of patientsdiagnosed with bladder cancer, muscle-invasive bladdercancer (MIBC) carries a significant risk of death thathas not significantly changed in decades. Increasingly,clinicians and patients recognize the importance ofmultidisciplinary collaborative efforts that take intoaccount survival and quality of life (QOL) concerns. Forthe first time for any type of malignancy, the AmericanUrological Association (AUA), the American Society ofClinical Oncology (ASCO), the American Society forRadiation Oncology (ASTRO), and the Society ofUrologic Oncology (SUO) have formulated a consensus,evidence-based guideline. This guideline provides a risk-stratified, clinical framework for the management ofmuscle-invasive urothelial bladder cancer.METHODOLOGYSystematic Review. The systematic review utilized toinform this guideline was conducted by a methodologyteam at the Pacific Northwest Evidence-based PracticeCenter. The original review was funded by the Agencyfor Healthcare Research and Quality (AHRQ),1 and asubsequent supplemental report was funded by theAUA to address additional key questions and morerecently published literature. A research librarianexperienced in conducting literature searches forcomparative effectiveness reviews searched in OvidMEDLINE (January 1990 to October 2014), theCochrane Central Register of Controlled Trials (throughSeptember 2014), the Cochrane Database ofSystematic Reviews (through September 2014), HealthTechnology Assessments (through Third Quarter 2014),the National Health Sciences Economic EvaluationDatabase (through Third Quarter 2014), and theDatabase of Abstracts of Reviews of Effects (throughThird Quarter 2014) to capture published and grayliterature. The methodology team searched udyResults.organdtheWorldHealthOrganization International Clinical Trials RegistryPlatform) and regulatory documents (Drugs@FDA.govand FDA Medical Devices Registration and Listing).Reference lists of relevant studies and previoussystematic reviews were hand-searched for additionalstudies. Scientific information packets were solicitedfrom drug and device manufacturers and via a noticepublished in the Federal Register. Initial Databasesearches resulted in 3,921 potentially relevant articles.After dual review of abstracts and titles, 295 articleswere selected for full-text dual review, and 39 studies(in 41 publications) were determined to meet inclusioncriteria and were included in this review. Asupplemental search of Ovid MEDLINE and CochraneCentral Register of Controlled Trials was conducted tocapture additional published literature through February2, 2016.In 2020, the MIBC guideline was updated through theAUA amendment process in which newly publishedliterature is reviewed and integrated into previouslypublished guidelines in an effort to maintain currency.The amendment allowed for the incorporation ofadditional literature released since the initial publicationof this guideline in 2017. For this literature review themethodology team searched Ovid MEDLINE(R) ALL fromJuly 1, 2016 to May 18, 2020 (overlapping with searchdates for the 2016 review ending October 6, 2016), andeliminated duplicate abstracts reviewed for earlierreports. The literature search identified 2,005 abstracts,of which 38 met inclusion criteria. Two of thesecitations were from secondary publications of anotherstudy included in this update or a previous report.Seven abstracts reported RCTs, 29 observationalstudies, and 2 systematic reviews.Data Extraction and Data Management. Themethodology team extracted the following informationinto evidence tables: study design; setting; inclusionand exclusion criteria; dose and duration of treatmentfor experimental and control groups; duration of followup; number of subjects screened, eligible, and enrolled;population ES-5 characteristics (including age, race/ethnicity, sex, stage of disease, and functional status);results; adverse events; withdrawals due to adverseevents; and sources of funding. Methodologists verifiedor calculated relative risks and associated 95%confidence intervals (CIs) based on the informationprovided (sample sizes and incidence of outcomes ineach intervention group). Methodologists noteddiscrepancies between calculated and reported resultswhen present. Data extraction for each study wascompleted by one investigator and independentlyreviewed for accuracy and completeness by a secondinvestigator.Assessment of the Risk of Bias of IndividualStudies. The methodology team assessed the risk ofbias for randomized controlled trials (RCTs) andobservational studies using criteria adapted from thosedeveloped by the U.S. Preventive Services Task Force.2These criteria were applied in conjunction with theapproach recommended in the AHRQ Methods right 2020 American Urological Association Education and Research, Inc.
6American Urological Association (AUA) / American Society of ClinicalMuscle-InvasiveOncology (ASCO) / American Society for Radiation Oncology (ASTRO) /Bladder CancerSociety of Urologic Oncology (SUO)independently assessed the risk of bias of each study.Discrepancies were resolved through discussion andconsensus. Each study was rated as low, medium, orhigh risk of bias. Methodologists rated the quality ofeach RCT based on the methods used forrandomization, allocation concealment, and blinding;the similarity of compared groups at baseline; whetherattrition was adequately reported and acceptable;similarity in use of co-interventions; compliance withallocated treatments; the use of intent-to-treatanalysis; and avoidance of selective outcomesreporting.2 Methodologists rated the quality of eachcohort study based on whether it enrolled a consecutiveor random sample of patients meeting inclusion criteria;whether it evaluated comparable groups; whether ratesof loss to follow up were reported and acceptable;whether it used accurate methods for ascertainingexposures, potential confounders, and outcomes; andwhether it performed adjustment for importantpotential confounders (defined as a minimum of age,sex, tumor stage, and tumor grade).2 Studies rated lowrisk of bias were considered to have no more than veryminor methodological shortcomings with their resultslikely to be valid. Studies rated medium risk of biashave some methodological shortcomings, but no flaw orcombination of flaws judged likely to cause major bias.In some cases, the article did not report importantinformation, making it difficult to assess its methods orpotential limitations. The category of medium risk ofbias is broad, and studies with this rating vary in theirstrengths and weaknesses; the results of some studiesassessed to have medium risk of bias are likely to bevalid, while others may be only possibly valid. Studiesrated high risk of bias have significant flaws that mayinvalidate the results. They have a serious or fatal flawor combination of flaws in design, analysis, orreporting; large amounts of missing information(including publication of only preliminary results in asubgroup of patients randomized); or seriousdiscrepancies in reporting. Methodologists did notexclude studies rated as having high risk of bias apriori, but they were considered the least reliable pancies between studies were ization of evidence strength is conceptuallydistinct from the quality of individual studies. Evidencestrength refers to the body of evidence available for aparticular question and includes not only individualstudy quality but consideration of study design,consistency of findings across studies, adequacy ofsample sizes, and generalizability of samples, settings,and treatments for the purposes of the guideline. TheAUA categorizes body of evidence strength as Grade A(well-conducted and highly-generalizable RCTs stent findings), Grade B (RCTs with someweaknesses of procedure or generalizability ormoderately strong observational studies with consistentfindings), or Grade C (RCTs with serious deficiencies ofprocedure or generalizability or extremely small samplesizes or observational studies that are inconsistent,have small sample sizes, or have other problems thatpotentially confound interpretation of data). Bydefinition, Grade A evidence is evidence about whichthe Panel has a high level of certainty, Grade Bevidence is evidence about which the Panel has amoderate level of certainty, and Grade C evidence isevidence about which the Panel has a low level ofcertainty.4AUA Nomenclature: Linking Statement Type toEvidence Strength. The AUA nomenclature systemexplicitly links statement type to body of evidencestrength, level of certainty, magnitude of benefit orrisk/burdens, and the Panel’s judgment regarding thebalance between benefits and risks/burdens (Table 1).StrongRecommendationsaredirectivestatements that an action should (benefits outweighrisks/burdens) or should not (risks/burdens outweighbenefits) be undertaken because net benefit or netharm is substantial. Moderate Recommendations aredirective statements that an action should (benefitsoutweigh risks/burdens) or should not (risks/burdensoutweigh benefits) be undertaken because net benefitor net harm is moderate. Conditional Recommendationsare non-directive statements used when the evidenceindicates that there is no apparent net benefit or harmor when the balance between benefits and risks/burdenis unclear. All three statement types may be supportedby any body of evidence strength grade. Body ofevidence strength Grade A in support of a Strong orModerate Recommendation indicates that the statementcan be applied to most patients in most circumstancesand that future research is unlikely to changeconfidence. Body of evidence strength Grade B insupport of a Strong or Moderate Recommendationindicates that the statement can be applied to mostpatients in most circumstances but that better evidencecould change confidence. Body of evidence strengthGrade C in support of a Strong or ModerateRecommendation indicates that the statement can beapplied to most patients in most circumstances but thatbetter evidence is likely to change confidence. Body ofevidence strength Grade C is only rarely used inCopyright 2020 American Urological Association Education and Research, Inc.
7American Urological Association (AUA) / American Society of ClinicalMuscle-InvasiveOncology (ASCO) / American Society for Radiation Oncology (ASTRO) /Bladder CancerSociety of Urologic Oncology (SUO)support of a Strong Recommendation. ConditionalRecommendations also can be supported by anyevidence strength. When body of evidence strength isGrade A, the statement indicates that benefits andrisks/burdens appear balanced, the best action dependson patient circumstances, and future research isunlikely to change confidence. When body of evidencestrength Grade B is used, benefits and risks/burdensappear balanced, the best action also depends onindividual patient circumstances and better evidencecould change confidence. When body of evidencestrength Grade C is used, there is uncertainty regardingthe balance between benefits and risks/burdens,alternative strategies may be equally reasonable, andbetter evidence is likely to change confidence.Where gaps in the evidence existed, the Panel providesguidance in the form of Clinical Principles or ExpertOpinion w ith consensus achieved using a modifiedDelphi technique if differences of opinion emerged.5 AClinical Principle is a statement about a component ofclinical care that is widely agreed upon by urologists orother clinicians for which there may or may not beevidence in the medical literature. Expert Opinion refersto a statement, achieved by consensus of the Panel,that is based on members' clinical training, experience,knowledge, and judgment for which there is noevidence.Process. The Muscle-Invasive Bladder Cancer Panelwas created in 2014 by the American UrologicalAssociation Education and Research, Inc. (AUA). ThePractice Guidelines Committee (PGC) of the AUAselected the Panel Chair who in turn appointed the ViceChair. In a collaborative process, additional Panelmembers, including additional members of theAmerican Society for Radiation Oncology (ASTRO), theAmerican Society of Clinical Oncology (ASCO), andSociety of Urologic Oncology (SUO), with specificexpertise in this area were then nominated andapproved by the PGC. The AUA conducted a thoroughpeer review process. The draft guideline document wasdistributed to 128 peer reviewers, 67 of whichsubmitted comments. The Panel reviewed anddiscussed all submitted comments and revised the draftas needed. Once finalized, the guideline was submittedfor approval to the PGC and Science and Quality Council(S&Q). Then it was submitted to the AUA, ASTRO,ASCO, and SUO Board of Directors for final approval.Panel members received no remuneration for theirwork. This represents the first joint guidelines by theseorganizations.The 2020 amendment also underwent peer review. Thedraft amendment was distributed to 69 peer reviewers,18 of whom submitted 38 comments. The Panelreviewed and discussed all submitted comments andrevised the draft as needed. Once finalized, theamendment was submitted for approval in the samemanner as with the full guideline.BACKGROUNDEPIDEMIOLOGYThere are 79,030 new cases of bladder cancer and16,870 bladder cancer deaths predicted for 2017 in theU.S.6 Approximately 25% of newly diagnosed patientshave muscle-invasive disease,7,8 a rate that has notchanged over the last 10 years based on data from theSurveillance, Epidemiology, and End Results (SEER)registry.9 In addition, up to 50% or more patients withhigh-risk non-muscle invasive bladder cancer (NMIBC)can progress to invasive disease. The male to femaleratio is 3:1, and disease incidence increases with age.While rates of bladder cancer are higher in Caucasiansthan other ethnicities, disease specific survival is worseoverall for African-Americans.6,8ETIOLOGYAll of the factors that contribute to the development ofbladder cancer are not completely understood, butexposure to carcinogens (e.g. tobacco smoke) is theprimary cause with some impact from geneticsusceptibility. Smoking tobacco is the most importantand common risk factor and is estimated to contributeto the development of 50% of bladder tumors, withcurrent smokers at higher risk than formersmokers.10,11 Former smoking increases the risk ofbladder cancer by a factor of 2.2 (95% CI 2.0-2.4), andcurrent smoking by a factor of 4.1 (95% CI 3.7-4.5)compared to never having smoked.10 Second handsmoke can also increase the risk for the development ofbladder cancer.12 Following smoking, another risk factorthat predisposes to bladder cancer is occupationalexposure to carcinogens, namely aromatic amines(benzidine, 4-aminobiphenyl, 2-naphthylamine, 4chloro-o-toluidine), polycyclic aromatic hydrocarbons,and chlorinated hydrocarbons, which contribute toapproximately 20% of all bladder cancers.13-15Occupational exposure accounts for 25% of bladdercancer diagnoses in men and 11% in women.16There are several other well-documented risk factors.Pelvic radiation for other malignancies increases thelikelihood of developing bladder cancer with a hazardratio of 1.7.17 In addition, exposure to S. haematobiuminfection is predominantly associated with an increasedrisk of squamous cell carcinoma of the bladder and is aCopyright 2020 American Urological Association Education and Research, Inc.
8American Urological Association (AUA) / American Society of ClinicalMuscle-InvasiveOncology (ASCO) / American Society for Radiation Oncology (ASTRO) /Bladder CancerSociety of Urologic Oncology (SUO)TABLE 1: AUA Nomenclature Linking Statement Typeto Level of Certainty, Magnitude of Benefit or Risk/Burden, and Body of Evidence StrengthStrongRecommendation(Net benefit or harm substantial)ModerateRecommendation(Net benefit or harmmoderate)ConditionalEvidence Strength AEvidence Strength BEvidence Strength C(High Certainty)(Moderate Certainty)(Low Certainty)Benefits Risks/Burdens(or vice versa)Benefits Risks/Burdens(or vice versa)Benefits Risks/Burdens (orvice versa)Net benefit (or net harm)is substantialNet benefit (or net harm)is substantialNet benefit (or n
Urological Association The Practice Guidelines Committee would like to acknowledge the contributions of Drs. Christopher Anderson and John Gore to the 2020 Guideline Amendment. American Urological Association (AUA) / American Society of Clinical Oncology (ASCO) / American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO)
Urological Association American Urological Association (AUA) / Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) SURGICAL TREATMENT OF FEMALE STRESS URINARY INCONTINENCE: AUA/SUFU GUIDELINE Kathleen C. Kobashi, MD, FACS, FPMRS; Michael E. Albo, MD; Roger R.
30 THURSDAY, MAY 16: AUA AUA 2019 ANNUAL MEETING 12:15 pm - 1:15 pm Av. Van-Horne AUA President's Lunch (invitation only) 1:15 pm - 1:30 pm Break 1:30 pm - 3:00 pm Av. Viger AUA President's Panel The Reproducibility Crisis in the Era of Precision Medicine Moderated by Michael Avidan, MBBCh, Washington University School of Medicine, AUA
Urological Association American Urological Association (AUA) Optimizing Outcomes in Urologic Surgery: Pre-Operative Care for the Patient Undergoing Urologic Surgery or Procedure John T. Stoffel, MD (Chair), Jeffrey S. Montgomery, MD, Anne M. Suskind, MD, MS, FACS, Christopher Tucci, MS, RN, BC, CURN, Alex J. Vanni, MD (Co-Chair)
the first time for any type of malignancy, the American Urological Association (AUA), the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), and the Society of Urologic Oncology (SUO) have formulated a consensus,
, AUA's new online student newspaper is launched. AUA wins First Place in the 2015 annual conference photo contest of the American Schools and Hospitals Abroad (ASHA). The "AUA for Syrian Armenians" campaign is launched, raising over 12,000 toward AUA Extension's "Learning for a Better Future" assistance program, which provides
For Medical Students Lesson 6 Nuclear Renography - Part 2 American Urological Association . Nuclear Renography - Review . -Cortical imaging - Shows scaring and renal mass 3 panels of a nuclear renogram . more about other urologic imaging techniques on the AUA website [www.auanet.org]. Title: Slide 1
American Urological Association Peyronie's Disease SECTION 1: PURPOSE This guideline's purpose is to provide direction to clinicians and patients regarding how to recognize Peyronie's disease (PD), conduct a valid diagnostic process, and approach treatment with the goals of maximizing symptom control, sexual function, and
Basu, Rumki (2008) Public Administration: Concepts and Theories. Sterling Publishers: New Delhi Bhagwan, Vishnoo; Bhushan, Vidhya and Mohla, Vandana (2010) Public Administration. S. Chand: Jalandhar Bhambri, C. P. (2010) Public Administration Theory and Practice(21stEdition). Educational Publishers: Meerut Bhattacharaya, Mohit (2008) New Horizons of Public Administration. Jawahar Publishers .
