Overdiagnosis and overtreatment of bladder and kidney lesions: Ethical and clinical lessons from past experience

What is it about?

Background: This review summarizes previously published and recently reported findings on overdiagnosis and overtreatment with special reference to the bladder and kidney. Among others, the following is discussed: (i) overuse of cystoscopy with biopsy associated with the overdiagnosis of malignant and premalignant urinary bladder lesions after the Chernobyl accident, (ii) suppositions about increased aggressiveness of renal tumors from radiation-contaminated areas potentially conducive to overuse of nephrectomy instead of kidney-preserving surgery, (iii) wedge biopsies from the renal cortex and medulla during lithotomy, and (iv) overuse of renal biopsy and overtreatment related to it. Objective: The objective was to update the previously reported information based on the international and Russian-language literature, as well as the author’s observations. Conclusion: In conditions of paternalism, misinformation and persuasion of patients are regarded to be permissible. Suboptimal practices have been used in accordance with instructions by healthcare authorities and publications by leading experts. Collection of specimens is associated with risk, while the reliability of some studies is questionable. High quality of specimens and their examination must be a prerequisite for the use of biopsy in research and practice. In the author’s opinion, biopsy of internal organs should not be performed merely for research purposes; it must always be performed according to clinical indications. If a patient provides informed consent for research on tissues obtained for diagnostic purposes, it can be done, provided that sufficient material remains for the diagnosis. International trust and cooperation are needed to reassess potentially outdated and suboptimal methods. Authorized foreign advisors should be engaged in Russia. The book: https://cambridgescholars.com/product/978-1-0364-1329-3/

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