UNASSIGNED: Management of bilateral @entity3969 is particularly challenging, considering the chances of recurrence and long-term renal function for affected @entity1 . Aggressive surgical resection to prevent recurrence must be balanced with the desire to preserve renal function. We evaluated our experience in the management of bilateral @entity3969 stressing the challenges encountered in decision making and the role of nephron sparing surgery. We had four @entity1 presenting with bilateral @entity3969 . All of them were appropriately staged and given standard chemotherapy as per NWTS-5 guidelines. @entity5 were considered to have a 'good' response to chemotherapy if sufficient @entity5 shrinkage was observed so that renal hilum was seen free of @entity5 and vice versa. Nephron-sparing surgery was considered in all and was performed when feasible, followed by completion adjuvant chemotherapy. All @entity1 were followed up with serial ultrasound scans (3-6 monthly) and CECT abdomen (yearly once). Blood @entity1133 and serum @entity1011 , @entity101 , and @entity644 were assessed during follow-up visits. All four @entity1 received neo-adjuvant chemotherapy as per NWTS-5 guidelines. The first @entity1 had poor response to chemotherapy and was considered for left radical and right partial nephrectomy. However, @entity1 attenders refused any surgical intervention and the @entity1 was taken home. The second @entity1 had a 'good' response on left side and was planned for left partial and right radical nephroureterectomy based on pre-operative imaging analysis. However, intra-operatively, bilateral partial nephrectomy with good margins was feasible. The third @entity1 though, showed 'poor' response to pre-op chemotherapy and warranted bilateral nephroureterectomy, right partial and left radical nephroureterectomy was feasible. However, in the fourth @entity1 , we were not able to perform nephron sparing surgery and left nephroureterectomy with right @entity5 biopsy was done. Following this, @entity1 was started on 2nd-line chemotherapy, now awaiting right partial nephrectomy. The second @entity1 is on follow up for 1.5  years, doing well. However, the third @entity1 expired 1.5  years following surgery due to recurrence (lung metastasis). Management of bilateral @entity3969 is challenging and nephron-sparing surgery should be considered in all @entity1 having bilateral @entity3969 with favorable histology, even if pre-operative imaging studies suggest that the lesions are unresectable.

Management of Bilateral XXXX : Our Experience.

@entity1 :: ('9606', 'Species') :: ['children', 'patients', 'patient', 'child'] @entity644 :: ('MESH:D011507', 'Disease') :: ['proteinuria'] @entity101 :: ('MESH:D006973', 'Disease') :: ['hypertension'] @entity1133 :: ('MESH:D014508', 'Chemical') :: ['urea'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'Tumors'] @entity1011 :: ('MESH:D003404', 'Chemical') :: ['creatinine'] @entity3969 :: ('MESH:D009396', 'Disease') :: ["Wilms' tumor", "Wilm's tumor"]
@entity3969 :: (MESH:D009396,Disease) :: ['Wilms' Tumor']
