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EDITORIAL
Year : 2015  |  Volume : 31  |  Issue : 4  |  Page : 271
 

Is there a need to make multiple guidelines for management?


Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication1-Oct-2015

Correspondence Address:
Apul Goel
Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.166454

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How to cite this article:
Goel A. Is there a need to make multiple guidelines for management?. Indian J Urol 2015;31:271

How to cite this URL:
Goel A. Is there a need to make multiple guidelines for management?. Indian J Urol [serial online] 2015 [cited 2019 Nov 15];31:271. Available from: http://www.indianjurol.com/text.asp?2015/31/4/271/166454


Guidelines play an integral part in the clinical practice and help the clinicians to make informed choices about managing their patients. They have become increasingly important due to the availability of a large amount of literature in every field, often with contrasting results. In urology, a number of societies and associations have developed recommendations that change from time to time. These guidelines are made by a team of experts after reviewing recent literature. However, the recommendations offered by different associations often vary.

In medicine, the maximum amount of robust and reliable scientific data has emerged from America and Europe. Therefore, guidelines are geared toward population living in those geographical areas. There are three major races in the world; Caucasian, Mongoloid, and Negroid. However, there are many more subraces or ethnic groups. A number of diseases have genetic modifiers and whether these guidelines apply uniformly to all ethnic groups is a matter of debate. Moreover, economic and social conditions and medical resources are not uniform in the world. Therefore, a “recommended treatment”based on evidence and guidelines may not be feasible in many geographical areas. For example, at many centers in Asia, patients do not come for regular cystoscopies after management of nonmuscle invasive bladder tumor. The reasons include lack of money, long distances for travel, waiting times, and possibly suboptimal procedures such as rigid cystoscopies under local anesthesia which is more painful than flexible cystoscopy but is more routinely available.

This heterogeneity in guidelines has additional implications including medico-legal issues. Variations also create confusion regarding the ideal management. Despite these limitations, guidelines serve an important role in standardizing management. They form the basic structure which the physician can modify to suit the requirements of his patient.

This has prompted many countries and societies to develop their own recommendations to suit their populations. In this issue of the journal, Gregg et al.[1] compare various important guidelines available for nonmuscle invasive bladder cancers (NMIBC) and highlight the similarities and differences among them. This issue of the journal has a number of reviews on NMIBC, put together by Dr. Badrinath Konety, Professor and chair of Urology at the University of Minnesota, USA. NMIBC forms a significant part of the practice of most urologists. The high recurrence rates, as well as the morbidity and mortality from invasive disease, makes it imperative that the disease is treated appropriately at every instance. We hope that the comprehensive reviews that cover all aspects of management of NMIBC will prove useful to our readers.

 
   References Top

1.
Gregg JR, Dahm P, Chang SS. Guideline based management of non-muscle invasive bladder cancer. Indian J Urol 2015;31:320-6.  Back to cited text no. 1
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