Actos Bladder Cancer Legal Broadcast
Actos Bladder Cancer : Recently, a number of clinical studies have demonstrated that in select individuals with muscle invasive bladder cancer, utilization of three modes of therapy can be effective in controlling invasive bladder cancer. These bladder preservation protocols have found those individuals that do best have smaller, invasive bladder cancers that can be completely resected. Resection is followed by radiation, which is then followed by chemotherapy. Those that fail the initial treatment go on to cystectomy. Long term bladder preservation in some studies is achieved in approximately 40%.
It should be noted however, this high rate of success may be contingent on choosing patients with less serious disease than the average patient undergoing cystectomy. Platinum based chemotherapy appears to offer the best results; however, the best combination regimen of chemotherapy is still being studied. Individuals with large, invasive canccrs and those with associated CIS or hydronephrosis secondary to cancer are not considered good candidates for bladder preserving therapy. Side effects of therapy are predominately the effects of chemotherapy, and include nausea, vomiting, diarrhea, fatigue, and sepsis secondary to lowered immunity.
After removal of the bladder, an approximately 6 inch piece of small intestine from the ileum (the final section of small intestine) is surgically separated from the rest of the small intestine. This section of bowel is used to create an ileal loop diversion. The ileum is the best section of small bowel to use since it has the lowest rate of electrolyte (body salts) disturbances afterwards. The ileum from which this section is removed is reconnected via suturing or staples.
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The future ileal loop is flushed clean and the base of the loop is sewn shut. The ends of both ureters are then carefully sewn to a small opening made close to the base of the ileal loop. The opposite end of the ileal loop is brought out through the skin and secured. The end of the loop is everted and tied down to the skin to create a raised stoma. Usually, small plastic tubes called stents are placed through the ileal loop, up the ureters, with their ends curling in the kidneys. These stents are temporary, generally left in for several weeks. Stents serve the purpose of decreasing urinary leakage at the anastomosis (the connection of the ureter to the ileal loop) and serve to allow the anastomosis to heal in an open fashion, thereby reducing the incidence of scarring. The ileal loop is the simplest and quickest form of urinary diversion. Post-operative complications are infrequent. Given these advantages, it remains the most common form of urinary diversion.
Although one can bring a ureter directly to the skin surface, it is generally not a good form of diversion. The ureters are flimsy, making them prone to obstruction if they are brought out directly. It may also be difficult to bring both ureters to the same place, thus necessitating two drainage bags. The ileal loop serves as a conduit and not a reservoir. The ureters are attached to it at its base. The ileal loop then traverses the skin and underlying tissues to allow unimpeded flow of urine. Urine flows continually through the loop and is collected in a bag attached over the exit of the loop, called the stoma.
Flernia: During the formation of an ileal loop or continent diversion, the ileal loop is brought out through a peritoneal opening, then through fascia (a thick supporting layer) out through the skin. If a gap exists or develops through the fascia, a parastomal hernia can develop. A hernia represents an abnormal pocket of peritoneum and possibly includes bowel. In addition, a hernia may develop through the surgical incision, which is called an incisional hernia. There is also a higher incidence of inguinal hernia (groin hernia) developing after surgery. Malnutrition, obesity, and lung diseases resulting in labored breathing all increase the risk for a hernia occurring. Many hernias require surgical correction.
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Kidney deterioration: If an individual faces recurrent urinary infections involving the kidneys, or has kidney stones, the kidneys may gradually lose function. Fortunately, this complication is rare. Your urologist will aggressively treat uninary infections, stones or deal with other complications which can impair kidney function.
Kidney stones: There is a small but real increased rate of kidney stones after an ileal loop diversion. Kidney stones are most often treated with ESWL (extracoporeal shock wave lithotripsy, a machine that can focus shock waves through the body to break up the stones).
Skin irritation: The skin surrounding the stoma and sometimes the skin beneath the collection bag may become reddened and irritated. By working with your enterostomy nurse, you will learn how to make your ostomy appliance more adherent. Sometimes, application of an ointment to the skin to protect it from the irritating effect of urine is required.
Stomal stenosis: Sometimes the stoma may be too tight, causing urine to pool in the ileal loop, leading to a urinary infection. This can be determined via a loopogram (an X ray study of the loop filled with contrast). Surgical correction of the loop is often required to resolve this problem.
Urinary infection: The ileal loop often can become colonized with bacteria. Colonization does not result in inflammation or any symptoms. However, bacteria may invade the wall of the ileal loop or travel up to the kidneys, resulting in infection. Symptoms may occur, including pain in the loop, kidney pain, blood in the urine, or increased sediment. A fever may occur, especially with kidney infection. To test for infection, urine is collected for culture directly from the loop. Appropriate antibiotics are then used to resolve the infection.
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