Trisha N. Branan, PharmD, BCCCP
 https://rx.uga.edu/faculty-member/trisha-branan-pharm-d/ Differential expression of matrix metalloproteinase-2 expression in disseminated tumor cells and micrometastasis in bone marrow of patients with nonmetastatic and metastatic prostate cancer: theoretical considerations and clinical implications-an immunocytochemical study allergy underwear cheap benadryl 25mg without a prescription. Natural history of rising serum prostate-specific antigen in men with castrate nonmetastatic prostate cancer allergy testing in adults benadryl 25 mg lowest price. Disease and host characteristics as predictors of time to first bone metastasis and death in men with progressive castration-resistant nonmetastatic prostate cancer allergy medicine dosage buy benadryl 25 mg on-line. Challenges and recommendations for early identification of metastatic disease in prostate cancer allergy symptoms pet dander order cheapest benadryl. Recent progress and pitfalls in testing novel agents in castration resistant prostate cancer. The assessment of treatment outcomes in metastatic prostate cancer: changing endpoints. Prostate-specific antigen: an evolving role in diagnosis, monitoring, and treatment evaluation in prostate cancer. Trimetrexate in prostatic cancer: preliminary observations on the use of prostate-specific antigen and acid phosphatase as a marker in measurable hormone-refractory disease. Change in serum prostate-specific antigen as a marker of response to cytotoxic therapy for hormone-refractory prostate cancer. Androgen priming and chemotherapy in advanced prostate cancer: evaluation of determinants of clinical outcome. Importance of continued testicular suppression in hormone-refractory prostate cancer. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. Prediction of survival following first-line chemotherapy in men with castration-resistant metastatic prostate cancer. Multiple cycles of intermittent chemotherapy in metastatic androgen independent prostate cancer. Second-line chemotherapy with docetaxel for prostate-specific antigen relapse in men with hormone refractory prostate cancer previously treated with docetaxel based chemotherapy. Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty. Time of survival and quality of life of the patients operatively treated due to pathological fractures due to bone metastases. Segmental polymethyl methacrylate-augmented pedicle screw Fixation in patients with bone softening caused by osteoporosis and metastatic tumor involvement: a clinical evaluation. Functional and oncological outcome of acetabular reconstruction for the treatment of metastatic disease. Randomized trial of short versus long-course radiotherapy for palliation of painful bone metastases. A randomized, placebo-controlled trial of zoledronic acid in patients with hormone refractory metastatic prostate carcinoma. Guidance on the use of bisphosphonates in solid tumours:recommendations of an international expert panel. Definitions of biochemical failure that best predict clinical failure in patients with prostate cancer treated with external beam radiation alone: a multi-institutional pooled analysis. Defining biochemical recurrence of prostate cancer after radical prostatectomy: a proposal for a standardized definition. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. Ultrasensitive serum prostate specific antigen nadir accurately predicts the risk of early relapse after radical prostatectomy. Prognostic implications of an undetectable ultrasensitive prostate-specific antigen level after radical prostatectomy. Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. Evaluation of serum prostate-specific antigen velocity after radical prostatectomy to distinguish local recurrence from distant metastases. The incidence of prostate cancer progression with undetectable serum prostate specific antigen in a series of 394 radical prostatectomies. Prostate specific antigen after radiotherapy for prostate cancer: a reevaluation of long-term biochemical control and the kinetics of recurrence in patients treated at Stanford University. Digital rectal examination is no longer necessary in the routine follow-up of men with undetectable prostate specific antigen after radical prostatectomy: the implications for follow-up. Prostate specific antigen: a prognostic marker of survival in good prognosis metastatic prostate cancer? Prediction of survival of metastatic prostate cancer based on early serial measurements of prostate specific antigen and alkaline phosphatase. Prostate-specific antigen nadir and cancer-specific mortality following hormonal therapy for prostate-specific antigen failure. The prognostic value of hemoglobin change after initiating androgen-deprivation therapy for newly diagnosed metastatic prostate cancer: A multivariate analysis of Southwest Oncology Group Study 8894. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. Androgen deprivation therapy in prostate cancer and metabolic risk for atherosclerosis. For the 2015 guideline update, the panel incorporated a patient advocate to provide a consumer perspective for its guidelines. All experts involved in the production of this document have submitted potential conflict of interest statements. The panel is most grateful for the methodological and scientific support provided by the following individuals in specific parts of the guideline document: Of particular note is the inclusion of the new Vancouver Classification in the Histology section [4, 5]. Staging and grading classification systems Updated using a traditional narrative review. Prognosis Updated using a traditional narrative review, based on a structured literature search. Treatment (Disease management) Updated using a systematic review mostly based on a literature search from 2000. Surveillance following radical or partial Updated using a traditional narrative review, based on a nephrectomy or ablative therapies structured data search. Elements for inclusion and exclusion, including patient population, intervention, comparison, outcomes, study design, and search terms and restrictions were developed using an iterative process involving all members of the panel, to achieve consensus. Individual literature searches were conducted separately for each update question, and in most instances the search was conducted up to the end of November 2013. Two independent reviewers screened abstracts and full texts, carried out data abstraction and assessed risk of bias. The results were presented in tables showing baseline characteristics and summaries of findings. The remaining sections of the guidelines were updated using a traditional narrative review strategy. Structured literature searches using an expert information specialist were designed. Searches of the Cochrane Database of Systematic Reviews, the Cochrane Library of Controlled Clinical Trials, and Medline and Embase on the Dialog-Datastar platform were performed. The controlled terminology of the respective databases was used, and both MesH and Emtree were analysed for relevant entry terms. The majority of studies in this guideline update are retrospective analyses that include some larger multicentre studies and well-designed controlled studies. Proportion of patients with T1aN0M0 tumours undergoing nephron sparing surgery as first treatment. Proportion of patients who undergo minimally invasive or operative treatment as first treatment who die within 30 days. Mortality has decreased since the 1980s in Scandinavian countries and since the early 1990s in France, Germany, Austria, the Netherlands, and Italy.
On the left allergy medicine germany purchase benadryl online now, our male patient with severe familial hemophilia A due to a missense mutation had a daughter with severe hemophilia A allergy testing places purchase benadryl 25mg line. The patient had a de novo inversion mutation together with skewed inactivation of the non-mutant chromosome allergy vodka symptoms buy benadryl 25 mg free shipping. Proven carrier A woman with both an antecedent and a descendant relative with hemo philia allergy treatment ayurvedic purchase benadryl 25 mg with amex. The causative mutation can female relatives of a male with hemophilia are be identified in over 95% of affected males. However, mutation analysis is the Laboratories with a strong focus on hemophilia gold standard! Hence the name, A gene may be tracked through a kindred using restriction fragment length polymorphism. The factor level in identification of sex-linked hemophilia A in related one carrier in a family does not predict the factor affected males. A carrier with a low factor level is not more likely to have a son with hemo Factor levels alone are rarely used nowadays to philia than a carrier with a high factor level. Mistaken diagnosis of Von Willebrand Disease in a carrier despite familial hemophilia A. Her eldest uncle and a hemophilic cousin had died young at other hospitals, their diag nosis not well understood by the family. Another hemophilic cousin was adopted at birth; the fact that he had hemophilia was not known to the family at the time. Un activity, then a given woman is considered likely fortunately, many women were told their test re to be a carrier. This test is occasionally useful in sults in convoluted language and believed that unusual situations, (see figure 41). Note that data on a few carriers fell within the normal range and that a few more were not far from the normal range. If a woman is the mother of just one son with he mophilia, the first in the family, an isolated case, We have encountered two undiagnosed hemo it is possible that the mutation arose in just one philic fathers through their daughters. In another in cluding some of her oogonia (egg-producing stance, our infant patient with severe hemophilia cells). When we tested white blood cells of moth and turned out to have previously-undiagnosed ers of isolated cases, we found the mutation in severe hemophilia A. If, after all the investigation, the suspicion she is a carrier and that she might have another strongly remains that the woman is a carrier, a hemophilic child with another pregnancy. Amniocentesis is cumcision is delayed until the diagnosis of hemo performed later in gestation, when the factor lev philia is excluded or until plans are made for ap els have started to rise. In most in through the abdominal and uterine walls to sam stances, a carrier chooses to have a girl (who ple fetal blood, usually from the umbilicus at its might be a carrier) instead of a boy (who might junction with the placenta. Gender selection is sometimes attempted by sorting sperm into mostly X-bearing and mostly Y A possible consequence of any of these invasive -bearing before insemination. Gender selection procedures is an unintended spontaneous mis can be done with greater accuracy using the carriage, up to 1% with amniocentesis and 1 to techniques of in vitro fertilization. Techniques to isolate them are improv Nowadays, prenatal diagnosis is made by obtain ing rapidly. At the present, it is possible to use ing fetal cells to look for the hemophilia mutation them to determine sex. Some women midline abdominal wall and uterine wall into the also want more time to adjust psychologically to fetal sac and a sample of fluid is withdrawn. Some is performed either by putting a needle through times a woman who originally intended to abort the abdominal and uterine walls or by putting a an affected fetus changes her mind when the di catheter through the cervix of the uterus. A decade later, the process health is prematurity, which is more common with was refined to allow diagnosis of some chromo twins and other multiple births than with single somal or genetic disorders. Unused embryos can be frozen for a sec succeeded in giving an unaffected child, a boy, to ond attempt or for a sibling. At this is about 30%, but it approaches 50% in the most stage, the egg is not quite mature. Analysis of though high, is a small fraction of the cost of car polar bodies sometimes is used alone for X ing for a child with hemophilia. Genetic counseling After fertilization, the combined egg and sperm, the zygote, grows and divides into more cells. At Information about the inheritance of hemophilia about 48 hours after fertilization, when about can and should be made available to patients eight cells are present, one cell can be taken for and their relatives whether or not they choose to genetic analysis. Fertility specialists prefer to take have carrier testing or intervention with pregnan this cell, in addition to the polar bodies, for confir cies. Professional counselors present information mation of the polar-body diagnosis, and to make in a non-judgmental manner, that is, without sug sure the zygote has the right number of chromo gesting what the listener should do with the infor somes (euploidy). Some men with hemophilia are uncom If the woman is at a distance from the expert di fortable with the implication that genetic informa agnostic laboratory, the polar bodies and the cell tion might have prevented their own births, or that from the zygote are sent by rapid courier to the a boy with hemophilia is less desirable than an laboratory. They sometimes say, ?Coping or two days while the zygotes still grow in the cul with hemophilia has strengthened me. Then one or two healthy-looking zy gotes, or embryos, diagnosed as free of the rele Women tend to accept genetic information very vant disorder, are introduced into the uterus. Some car the diagnostic laboratory has the responsibility of riers may worry about being stigmatized by po providing swift and accurate diagnosis. Some feel that they carry an un stetrician tries to achieve a good probability of welcome burden of responsibility for decisions pregnancy by choosing healthy-looking embryos. The biopsy pipette, right, breaks through the zona pellucida and sucks off the polar bod ies, shown on top of the egg. A single cell is removed from a two-day zygote consisting of about eight cells for analysis for a mu tation and for euploidy. The pipette on the left holds the embryo steady as the one on the right sucks off one cell. The sex of each early em bryo and the presence or absence of the relevant mutation is known at age five days. The discussion of reproduction provokes a lot of Historical Aspects & the Royal Hemophilia anxiety. Explanations of risks and possible ac tions involves the use of concepts and vocabu the practice of circumcision may have made lary that may be new to the family. They may not early Jewish authorities more aware of the inheri understand it all at once. They may reject, deny tance pattern of hemophilia than other contempo or forget distressing information. The oldest rabbinical view is attributed to seling takes time, empathy and repetition. In the 12th cen emphatically that nothing they did, or did not do, tury, Moses Maimonides expanded the ruling, caused the mutation. A hemophilic man may unwittingly Hay, of a large kindred with mild to moderate he marry a carrier (see Willliams et alia, J Thomb mophilia, transmitted by females but expressed in Haemost 2007; 5:210). The inheritance pattern of erage, half her sons are likely to have hemo hemophilia was also described in Germany in the philia, but each pregnancy is a fresh toss of the mid-19th century. Thus, she might have a streak of offspring heritance pattern spread gradually and was well with the mutant gene or a streak of offspring with understood by the beginning of the 20th century. Queen Victoria and Prince Albert were first cousins, however, consanguinity was not the source of the sex-linked hemophilia in their descendants. Of their nine children, a son, Leopold, had hemophilia, and two daughters proved to be carriers. Her daughter Alice, who married son, Juan, who was unaffected, was the father of the Duke of another German principality, Hesse King Juan Carlos of Spain. His life story is reminiscent of scendants died as small boys, one (Alexis) was that of many men with hemophilia born a century murdered as a teen-ager, three died in their early later. Determined to set up his own Victoria probably was a mutant thanks to a recent independent household, he traveled to the conti mutation in the germline of her mother or father. Clinical Molecular Diagnostic Laboratory Fox South Second Floor City of Hope National Medical Center, Dr. Chromatid: one of two identical strands formed from a chromosome during cell division. Autosome: any chromosome other than the sex chro Codon: a sequence of three adjacent nucleotides, a mosomes X and Y. Autosomal dominant: an inheritance pattern in which a gene on one of the autosomes is fully manifested in Compound heterozygote: a person with an auto a heterozygote. 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In the non-curative setting and where symptoms are present allergy testing procedure order genuine benadryl on line, palliative external beam photon radiation therapy may be medically necessary allergy medicine 12 hour order benadryl from india. Key Clinical Points Within the United States in 2018 allergy shots kenalog best order benadryl, 13 allergy medicine eyes discount 25 mg benadryl mastercard,240 new cases of cervical cancer are projected resulting in approximately 4,170 deaths. The prognosis of an individual with cervical cancer is markedly affected by the extent of disease at the time of diagnosis. Brachytherapy (internal radiation) Brachytherapy is an important component of the radiation therapy regimen in the curative treatment of cervical cancer. Dose recommendations are available in the literature of the American Brachytherapy Society. It is recognized that disease presentations and anatomic deformity may result in less than optimal dosimetry using conventional radiation applicators, and that supplementary interstitial brachytherapy may be required on an individual basis to achieve optimal therapeutic effect. The type of implant may include tandem and ovoids, tandem alone, ovoids only, interstitial, or vaginal cylinder only. Page 115 of 311 Electronic/kilovoltage brachytherapy will be approved for a vaginal cylinder. Surgical findings of clinical relevance include the size of the primary tumor, depth of stromal invasion, and presence of lymphovascular invasion. Positive pelvic and/or para-aortic nodes, surgical margins, and involvement of the parametrium are also important. When indicated, postoperative radiation therapy typically is delivered using up to 30 fractions. An intracavitary boost may be clinically appropriate in the setting of positive surgical findings. Management of the para-aortic nodes the treatment of para-aortic nodal regions may be indicated in the following clinical situations: A. Positive para-aortic lymph nodes on surgical staging if lymph nodes are less than 2 cm and are below L3 B. Positive para-aortic lymph nodes on surgical staging and all macroscopic para aortic nodes are removed C. When treatment of the para-aortic nodes is indicated, treatment may be concurrent or sequential. For concurrent treatment, up to 6 gantry angles are approved, and a conedown (additional phase) may be appropriate. For sequential treatment, up to 6 gantry angles, 1 conedown, and up to 28 additional fractions may be appropriate. Devices for the immobilization of the cervix are considered experimental at this time. Palliative therapy In the non-curative setting and where symptoms are present, palliative external beam photon radiation therapy may be medically necessary. Chemotherapy Randomized trials have shown an overall survival advantage for cisplatin-based therapy given concurrently with radiation therapy, while one trial examining this regimen demonstrated no benefit. Although the positive trials vary in terms of the stage of disease and incorporate varying radiation treatment regimens with chemotherapy schedules of cisplatin alone or combined with fluorouracil, the trials demonstrate significant survival benefit for this combined approach. Based on these results, strong consideration should be given to the incorporation of concurrent chemotherapy with radiation therapy in women who require radiation therapy for the treatment of cervical cancer. Cervix moves significantly more than previously thought during radiation for cancer. Prospective clinical trial of positron emission tomography/computed tomography image-guided intensity-modulated radiation therapy for cervical carcinoma with positive para-aortic lymph nodes. Clinical outcomes of definitive intensity-modulated radiation therapy with fluorodeoxyglucose-positron emission tomography simulation in patients with locally advanced cervical cancer. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. Pelvic radiotherapy for cancer of the cervix: is what you plan actually what you deliver? Cervical carcinoma: postoperative radiotherapy: fifteen-year experience in a Norwegian health region. Combined intensity-modulated radiation therapy and brachytherapy in the treatment of cervical cancer. Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: a Gynecologic Oncology Group Study. Preliminary outcome and toxicity report of extended-field, intensity modulated radiation therapy for gynecologic malignancies. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Effect of intensity-modulated pelvic radiotherapy on second cancer risk in the postoperative treatment of endometrial and cervical cancer. Postoperative brachytherapy (alone) is considered medically necessary for any of the following: A. Pelvic external beam photon radiation therapy (alone) is considered medically necessary for either of the following: A. Postoperative pelvic external beam photon radiation therapy and brachytherapy are considered medically necessary for any of the following: A. Para-aortic lymph node radiation treatment with pelvic external beam photon radiation therapy with or without brachytherapy is considered medically necessary for either of the following: A. Tumor directed radiation therapy is considered medically necessary for any of the following: A. Electronic/kilovoltage brachytherapy is considered medically necessary when utilizing a vaginal cylinder B. Endometriod (tumors resembling the lining of the uterus; adenocarcinomas) are the most prevalent subtype. Adverse risk factors include advancing age, lymphovascular extension, tumor size, lower uterine involvement classified as cervical glandular involvement (newly classified as Stage I). For cases that are not completely surgically staged, radiologic imaging plays an important role in selecting a treatment strategy. Should treatment rather than observation be decided upon for these same groups, radiation techniques are stratified in the preceding guideline statements. With more advanced clinical state and/or radiological presentations, more extended external beam photon radiation fields with or without brachytherapy may be medically necessary. In advanced disease, the increased utilization of adjuvant chemotherapy has called into question the magnitude of the added benefit of adjuvant radiation therapy. We are awaiting the results of some recent trials that may help to answer some of these questions. Patients younger than age 60 who received external beam treatment did not have a survival benefit but did suffer an increased risk of secondary cancers with subsequent increased mortality. For all other stages and those with positive radiologic imaging, surgical restaging or pathologic confirmation of more advanced disease is recommended (image directed biopsy). Individuals then enter the fully surgically staged treatment recommendations with their newly assigned stage. Palliation/Recurrence: Either brachytherapy or pelvic external beam photon radiation therapy alone or combined treatment may be considered based on the clinical presentation. In the non-curative setting and where symptoms are present, palliative external beam photon radiation therapy may be appropriate. Additional information is available from the American Brachytherapy Society Survey (Small et al. Brachytherapy should be initiated as soon as the vaginal cuff has healed or no later than 12 weeks following surgery a. Following the performance of a hysterectomy, brachytherapy using a vaginal cylinder is generally limited to the upper vagina with the dose prescribed at the vaginal surface or to a depth of 0. External beam photon radiation therapy doses to the pelvis and tumor volume for microscopic disease A. For concurrent treatment, up to 6 gantry angles are approved, and a conedown (additional phase) may be appropriate C. For sequential treatment, up to 6 gantry angles, one conedown, and up to 28 additional fractions may be appropriate D. There is solid evidence that the risk of severe small bowel injury after conventional radiotherapy for postoperative patients with gynecologic cancer is 5 to 15% (Corn et al. The use of chemotherapy and radiation treatment in the management of endometrial cancer either concurrently or sequentially remains for the most part the object of clinical study and investigation B.
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Evaluation of the effects of relationships between main spatial lower pole calyceal anatomic factors on the success of shock-wave lithotripsy in patients with lower pole kidney stones. Extracorporeal shock wave lithotripsy of lower calyx calculi: how much is treatment outcome influenced by the anatomy of the collecting system? Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Do anatomic factors pose a significant risk in the formation of lower pole stones? Predictors of lower pole renal stone clearance after extracorporeal shock wave lithotripsy. Impact of lower pole renal anatomy on stone clearance after shock wave lithotripsy: fact or fiction? Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. 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Alfuzosin stone expulsion therapy for distal ureteral calculi: a double-blind, placebo controlled study. Tamsulosin versus Alfuzosin in the Treatment of Patients with Distal Ureteral Stones: Prospective, Randomized, Comparative Study. Medical expulsive therapy using alfuzosin for patient presenting with ureteral stone less than 10mm: a prospective randomized controlled trial. Efficacy of selective alpha1D-Blocker Naftopidil as medical expulsive therapy for distal ureteral stones. Comparing efficacy of < (1)D-receptor antagonist naftopidil and < 1A/Dreceptor antagonist tamsulosin in management of distal ureteral stones. Naftopidil vs silodosin in medical expulsive therapy for ureteral stones: a randomized controlled study in Japanese male patients. Comparing the efficacy of tamsulosin and silodosin in the medical expulsion therapy for ureteral calculi. A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin simplified treatment regimen and health-related quality of life. Effect of tamsulosin on stone expulsion in proximal ureteral calculi: an open label randomized controlled trial. Adjunctive tamsulosin improves stone free rate after ureteroscopic lithotripsy of large renal and ureteric calculi: a prospective randomized study. Extracorporeal shock wave lithotripsy in impacted upper ureteral stones: a prospective randomized comparison between stented and non-stented techniques. Treatment of large impacted proximal ureteral stones: randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. Evaluation of the impact and need for use of a safety guidewire during ureteroscopy. Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculi. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis. Working tools in flexible ureterorenoscopy-influence on flow and deflection: what does matter? Holmium laser lithotripsy for ureteral calculi: predictive factors for complications and success. Ureteroscopic laser lithotripsy versus ballistic lithotripsy for treatment of ureteric stones: a prospective comparative study. Systematic evaluation of ureteral occlusion devices: insertion, deployment, stone migration, and extraction. Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis. Effects of specific alpha-1A/1D blocker on lower urinary tract symptoms due to double-J stent: a prospectively randomized study. Solifenacin improves double-J stent-related symptoms in both genders following uncomplicated ureteroscopic lithotripsy. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study. Indications, prediction of success and methods to improve outcome of shock wave lithotripsy of renal and upper ureteral calculi. 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