Mind Injury

Actos Lawsuit : You can live without a bladder. However, you still need something that can perform the two basic func­tions of the bladder: storing and emptying of urine. Physicians have come up with many ways over the years to accomplish these tasks, many of which are still used today. The simplest alternative is to place drainage tubes into the kidneys that come out through the skin and connect to bags on the abdomen. These tubes are known as nephrostomy tubes. Nephrostomy tubes are typically inserted into a person in the X-ray department by an interventional radiologist who uses some light sedation. For the patient, the bag provides an easy way to store urine and can be drained several times a day when convenient by opening a small valve on the bag. These tubes can be uncomfortable, however, and may also be easily removed if tugged; therefore, they are only reasonable solutions for a short period of time or for patients who are too ill to undergo surgery. It is also possible to surgically bring the ureters directly to the skin surface (called a cutaneous ureterostomy). The urine then can be collected with a bag attached to the skin around the opening. Unfortunately, the ureters are rela­tively small, and thus any scarring or narrowing of the opening can cause a blockage of urine. This tendency to get blocked also makes cutaneous ureterostomies a poor long-term solution.

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To provide a good long-term solution, surgeons most commonly use a portion of the small bowel to act as the new bladder. The identified piece of small bowel is removed from the main portion and is fashioned for its new use (see Question 79 for details). The urine that collects within this piece of bowel will ultimately be drained in one of three ways. First, the bowel can simply be left open at the skin for the urine to drain passively out into a bag that is attached to the abdomen. This type of drainage is known as a conduit, and the opening onto the skin is called a urostomy. Urine collects in the bag, which is then drained into a toilet several times each day. Second, the bowel can be sewn into a rough sphere con­nected to the skin by only a small, long channel. This channel prevents urine from leaking out but easily accommodates a small catheter. This is called a conti­nent urinary diversion. With this type of diversion, you must pass a catheter into the new bladder several times a day to drain the urine. This allows you to live without an ostomy bag, but for some patients, passing the catheter several times a day may be difficult or impossible. Third, the new bladder can be directly reattached to the urethra (called an orthotopic neobladder). This allows you to urinate almost normally, although you do need to learn to use different muscles, as the new bladder replacement.

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To understand cancer, we must first understand nor­mal functioning of the body. The body is made up of billions of cells. Each organ of the body is made up of several different types of specialized cells. For example, the liver has cells that filter toxins from the blood, and the brain has nerve cells (called neurons) that are able to conduct electrical signals. Perhaps the most familiar cells are skin cells. Every flake of dry skin is made of millions of cells that are constantly dying and being replaced with new cells. The growth of new cells is care­fully balanced to occur at the same rate as the death of old cells. Your body has many mechanisms in place to regulate the timing of the birth and death of cells. Unfortunately, if one of these mechanisms malfunc­tions, the careful balance can be disrupted. Environ­mental toxins such as cigarette smoke, chemicals, and radiation can damage DNA and can disrupt these control mechanisms. A tumor may develop when new cells are created faster than old cells die. Tumors can be either benign or malignant. A benign tumor is an overgrowth of cells that is unchecked by the body’s normal mechanisms; thus, it will keep getting bigger. It is called benign because it does not cause you illness. Some benign tumors can get to be so large that they do cause problems, especially if they are in a confined space, such as your skull. A malignant tumor is also an overgrowth of cells. The tumor is considered malignant, however, because the cells are no longer confined to the tumor. Cells may spread from the main tumor through the blood and lymph system or grow directly into nearby structures. As the cells begin to grow unchecked in new organs, they gradually cause dysfunction all over the body and may eventually even cause death.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Lawsuits : The stage is very important in determining the treatment that you will receive. There is a good barrier between the urothelium and the muscle of the bladder wall. If the tumor is kept within this barrier, the tumor can usually be completely removed with a transurethral resection of bladder tumor (TURBT) (Question 38). If the tumor has become more aggressive, it may figure out how to pass through this barrier. When the tumor has gotten through the protective layer, it becomes much more likely to spread outside of the bladder to other organs or lymph nodes. Once the tumor has gotten through the urothelium, simple scraping of the tumor is not likely to get all of the tumor out, and further therapy will be necessary—either surgery, chemotherapy, or radiation. The option that you and your doctor choose will depend on the extent of spread of the tumor and your overall health status.

Over the years, several different systems have been used to stage cancers. In an effort to ease confusion between different systems, doctors around the world met and decided to create a new staging system that would be relevant for all different types of cancer. This system is called TNM. The letters stand for Tumor size, lymph Node status, and the extent of Metastases.

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“Upper tract studies” are evaluations that your doctor does of your kidneys and ureters. The lining of the bladder is the urothelium. The same urothelium also lines the ureters and the inside of the kidneys. The kidneys and the ureters are then also potential locations of transitional cell cancer. The study that your doctor chooses depends on his or her personal opinion as well as the availability of each test at your hospital. Even if the upper tract study is negative, you will likely need to repeat the studies periodically. Patients with low-grade tumors have a low risk (approximately 2%) of developing upper tract tumors. The presence of a high-grade tumor or of diffuse carcinoma in situ, however, carries up to a 40% lifetime risk of developing an upper tract tumor.

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An ultrasound is often the easiest test to obtain and is therefore popular as a first study. Ultrasound technology generates sound waves and then measures their reflections off of internal structures to produce an image. The same imaging is used for obstetric ultrasounds to produce an image of the fetus. There is no radiation with an ultrasound. An ultrasound is very good for showing tumors and stones in the kidneys and for showing obstruction of the ureter causing hydronephrosis. It is not as good for showing small tumors inside the ureter or renal pelvis, and thus a second kind of study is usually needed in addition to the ultrasound.

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Actos Lawsuit : Cigarette smoking accounts for 25% to 65% of all cases of bladder cancer in the United States. It increases the risk of bladder cancer by up to four times compared with someone who has never smoked. As you might expect, the risk increases as the number of cigarettes increases, the number of years of smoking increases, and by the degree of inhalation with each puff. This applies to both men and women. The risk is even higher with the use of air-cured “black” tobacco because it has a higher concentration of chemicals than flue- cured “blond” tobacco. The good news is that quit­ting smoking decreases your risk; thus, it is never too late to quit. Other forms of tobacco, such as cigars and smokeless tobacco, also increase the risk of cancer, although to a lesser degree. It is not clear what chemical in the cigarette smoke is responsible for bladder cancer. Some people clear the chemicals from cigarette smoke more slowly than others do. These people, called slow acetylators, appear to be at increased risk for bladder cancer.

Chemotherapy with the drug cyclophosphamide (cytoxan) is asso­ciated with up to a ninefold increased risk of developing bladder cancer. These cancers tend to be more aggressive as a group. The use of the medication MESNA at the time of cyclophos­phamide administration helps protect the bladder from irritation and decreases the risk of developing bladder cancer. A similar chemotherapy agent, ifos- famide (Ifex) is also associated with increased risk of developing bladder cancer. Also, patients who have had a kidney transplant or other organ transplants and are on immunosuppression (steroids and other medications) are known to have a higher risk for bladder cancer.

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The risk of developing bladder cancer appears to corre­late with fat and cholesterol intake. Some studies have suggested that eating a low-fat, low-cholesterol diet that is high in fruits and vegetables may decrease your risk of developing bladder cancer. A recent study from Japan showed a decreased risk of bladder cancer in patients who had diets that were high in green vegetables or carrots. Those who ate five or more servings per week were half as likely to develop bladder cancer, as were those who ate one to three servings per month. Soy protein and garlic intake may also decrease the risk. Garlic has been shown to have a direct toxic effect on bladder cancer cells grown in a culture dish in the laboratory. This effect may be due to stimulating the body’s natural defenses to kill cancerous cells.

The overall chance of developing bladder cancer dur­ing your lifetime is 3% to 4%. This type of number, however, lumps the entire world into one group. In order to create a more meaningful number, researchers try to identify who is at a higher or lower risk. Factors in the environment or one’s lifestyle that increase the risk of developing cancer are called risk factors. There are two types of risk factors. Risk factors that we are born with, such as our family genetics or race, are called unmodifiable risk factors because we cannot change them. For example, a man is two and a half times more likely to develop bladder cancer than is a woman, and there is no way for him to decrease this risk. The second type of risk factor is called a modifiable risk factor. You can change these risk factors to decrease your odds of developing cancer. The most obvious modifiable risk factor is tobacco. Smoking dramatically increases your risk of developing cancer, and quitting smoking dramatically decreases that risk. The next two questions discuss these risks in more detail.

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For those patients with tumors that have invaded the bladder muscle, cure is still possible. Either part or all of the bladder can be removed. If the surgeon is able to remove the entire tumor, then you are said to be cured of the cancer. Surgery will cure approximately 80% of the tumors that are confined to a person’s bladder. Unfortunately, again, it is impossible to know for certain that the entire tumor has been removed. Microscopic amounts of tumor may have escaped the bladder, and the surgeon has no way of detecting when this happens. In cases in which this is suspected, such as the presence of tumor cells at the edge of the removed tissue, chemotherapy or radiation may be added to improve the chances of curing the microscopic tumor that remains in the body. Patients with locally advanced cancer have only about a 20% to 30% chance of cure with surgery alone. Surveillance by a urologist after surgery is always important to ensure that the tumor does not recur.

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Actos Lawsuit : During a cystectomy, an incision is made through the abdominal wall, so you can expect some mild discomfort at the incision site. The incision will be covered after the sur­gery is finished, and you probably wont be able to shower or get the incision wet for about a week to 10 days. Your surgeon may have inserted a drain from the incision site, a flexible tube with a hollow bulb on the end that you will remove, empty, flush out, and reattach as needed. Your doc­tor will remove the drain (a painless procedure) and any stitches or staples in a follow-up visit to his or her office 10 days or so after your surgery.

Cystectomy has some possible complications, including infection, bleeding, blood clots, or intestinal obstruction. You may experience some difficulties with your urinary diversion system. (See the section about urinary diversion systems later in this chapter.) It is also likely that you will have a permanent scar in the abdominal wall—-you should ask your surgeon how big that scar is likely to be.

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You will be instructed to wait for a few weeks after sur­gery before you resume driving, and your doctors are likely to want you to refrain for several weeks from doing anything that strains your abdomen, such as pushing and pulling a vacuum cleaner or lifting heavy objects or engaging in any other activity that might damage the scar or even pull the scar tissue apart, thereby risking the formation of a hernia. A hernia occurs when your surgical scar pulls apart under the skin and allows a part of the underlying bowel to poke forward, creating a noticeable lump. Hernias can interfere with the functioning of the bowel and must be repaired, either with an external truss or support, or possibly through another surgical operation. It is smarter to avoid the risk in the first place by not stressing the scar soon after surgery. This is the time to take it easy and, when possible, allow friends or family to pamper you by helping with chores and housework. Just don’t get too used to having someone bring you the morning newspaper and a cup of coffee! Generally it is a good idea to review your postoperative instructions with your surgeon so you understand what you can and can­not safely do.

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Cystectomy has some negative consequences that you should discuss thoroughly with your medical team. As mentioned above, there may be changes in urinary func­tion. What type of change takes place depends largely on the type of surgery and on whether an artificial bladder has been created. Sometimes while the abdominal tissues are healing after surgery there will be a period of irregular bowel function, during which you will unexpectedly have to deal with diar­rhea or constipation. Occasionally there will be some swelling in one or both legs, due either to fluid retention or the formation of scar tissue around the lymph vessels that drain the legs. Often there will be the presence of an asymptomatic, low-grade chronic urinary tract infection that will be iden­tified upon routine testing. This occurs because of the changed pattern of emptying the new bladder. Usually it causes no problems and doesn’t require active treatment with antibiotics.

Other issues may also arise. Worries about possible changes in sexual function are common, and very normal. Sexual function often does change after cystectomy. That doesn’t mean you can’t have an active, playful, pleasurable sex life with your partner. It does mean that you’ll probably explore innovative strategies as you seek comfortable ways to experience fulfillment.

Men experience more extreme changes in sexual func­tion after surgery than women do. About half the men who undergo cystectomy experience nerve damage that leaves them impotent after the surgery, a serious lifestyle change that is not only physical but emotional, requiring much thoughtful discussion among you, your partner, and your medical team both before surgery and after.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Lawsuit : While still awake, you will be transferred onto the operating room table and secured on it. If an epidural has not already been placed, one may be inserted. You may have an additional intravenous line placed. Next, your anesthesiologist will have you breathe through a mask placed over your nose and mouth. You will be given a mixture of agents which will allow you to become relaxed. Further anesthetics will result in an unconscious state. At this time, an endotracheal tube will be passed down your windpipe to provide oxygen, which is delivered automatically by a respirator, controlled by the anesthesiologist. The anesthesiologist will continuously monitor your heart rate, blood pressure, electrocardiogram, and tissue oxygenation throughout your operation. Fluid balance may also be measured via an intravenous line passed close to your heart. Urine output will be followed. Antibiotics will be infused intravenously.

Usually, compression stockings will be secured around your legs. These stockings periodically squeeze the legs to prevent blood from becoming stagnant, lowering the risk of blood clots forming in your legs, which can occur when you lie completely motionless for extended periods of time. A nasogastric tube will be passed through your nostril down your esophagus into the stomach, draining the stomach secretions during and after the surgery. A grounding pad will be placed on your side to allow for the safe use of electric current which is used to sometimes cut tissue and often in the cauterization of small bleeding vessels to stop bleeding.

Your abdomen will be prepared for surgery by shaving any hair and prepping the skin with an antiseptic solution. Female patients will have the vagina prepped with antiseptics as well. The surgical field will then be draped with sterile towels and sheets to prevent contamination from surrounding non-sterilized areas. Your upper body may be kept warm with a warming blanket. Your surgical nurse, surgeon, and assistant will all have thoroughly cleaned their hands and arms (scrubbed) and will then don a sterile gown and gloves. Their hair will be covered with a surgical cap, and they will be wearing masks over their mouths to prevent any contamination of the sterilized surgical field.

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After transfer to the floor from the recovery room, the patient is often kept on bed rest for the rest of the day. The nasogastric tube is left in and placed to gentle suction to remove excess stomach fluids. Initially, nothing is allowed by mouth other than ice chips or sips of water. Adequate fluids and some nutrition are given via an intravenous catheter. By the following day, patients are often out of bed and sometimes walking with assistance. Sequential stockings on the lower legs are removed while ambulating, and discontinued once the individual is able to move about well. Traditionally, nasogastric tubes have been left in until the bowel activity returns (generally 3-4 days). This is generally heralded by the passing of flatus (gas) or the presence of active bowel sounds, which will be checked by your urologist with a stethoscope. Recent studies have indicated nasogastric drainage for this length of time may not be necessary and may impede normal breathing, leading to other problems. Some urologists are therefore removing the tubes earlier. Feeding is gradually introduced however, once bowel activity has returned.

The patient will be encouraged to do deep breathing exercises to prevent lung collapse. This process is generally assisted with a small device called a spirometer. If the individual has a history of lung disease or is congested post-operatively, respiratory treatments with inhaled medication may be instituted and provided by a respiratory therapist.

Pain post-op is initially treated often via the epidural catheter. Intravenous medication may be given as an alternative and switched to oral pain meds once the individual is tolerating liquids. Many physicians order a PCA (patient controlled anesthesia) in which the patient pushes a button that releases pain medication via an intravenous line into the blood stream. Maximal amounts of drug administered are carefully controlled by settings on the PCA to allow safe, effective analgesia.

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Bowel leak: When the bowel is reconnected after removing the section for the urinary diversion, healing may not be adequate and bowel contents may leak into the abdomen. A bowel leak often will present as a failure of the bowel to return to normal function, resulting in a distended abdomen with poor bowel sounds. Distention, ileus (poor bowel function) may occur after the bowels are working well and feeding has been going on for some time. Evaluation is usually accomplished with CT Scan and oral contrast. Immediate surgical correction may be necessary. Left untreated, a bowel leak will generally lead to an abscess or possibly a fistula (a drainage tract from the bowel which may extend out through the incision or drain). The incidence of bowel leak is increased if bowel has been exposed to prior radiation, most often from radiation used to treat prostate cancer in men and uterine cancer in women.

Bowel obstruction: When a piece of bowel is separated from the intestine to create the new urinary drainage system, the remaining bowel must be reanastomosed (brought back together). This may be accomplished via sewing the bowel together or through the use of staples. Sometimes the opening of the bowel connection may be obstructed secondary to swelling. If an obstruction does not clear after a reasonable time, reoperation may be required.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Lawsuit : After bladder removal surgery, you will first become accustomed to your stoma, and the mechanics of keeping your collection appliance in place. The stoma is composed of the end of ileal loop (urostomy) which is brought out through the skin and everted (folded back) and secured to the skin. The location of the future stoma is usually determined prior to surgery. Ideally, it will be below your “belt line,” and definitely away from any skin indentations which can occur from body fat or scars. The stoma is red in appearance, moist, and has no sensation when you touch it. It measures approximately 1-1 Vz inches across and has been described as looking like a “rosebud.” It will be the only visible manifestation of your ileal loop diversion.

Getting used to a urostomy takes time. One must overcome issues with altered body image. Real izing the removal of your bladder was necessary to preserve your life, most individuals readily accept the urostomy and its care as the price for surviving and getting on with living.

The next step is to learn how to care for it and the collection appliance. Many individuals now use a collection bag which fits directly over the urostomy with the base of the bag adherent to the surrounding skin, accomplished with a hypoallergenic adhesive. Care of the urostomy can be as simple as gently washing the skin around the stoma and then applying the adhesive bag. A seal can last around four days. Once the seal is deficient, a new bag is applied. Most collection bags snap 011 and off the underling adhesive base, which makes changing a bag possible without removing the adhesive seal. Depending on your urostomy and your preferences, your enterostomy nurse will work with you to figure out which device works best for you. Some individuals benefit by having an elastic strap secured to the bag and around their waist. Separate stretch belts are also available to help keep the ostomy bag in place.

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During the day time, the urine drains directly into the bag attached over the stoma. Bags can either be transparent or opaque. Depending on bow much fluid you are drinking and how physically active you are, the bag may need to be drained approximately every four hours. Emptying the bag is accomplished easily by opening the drainage port and allowing the urine to empty directly into a toilet. If you don’t want to bother getting up in the middle of the night to drain the bag, the collection bag can be drained via a tube to a larger capacity bed side bag. This bag can be disconnected in the morning from the collection pouch.

Immediately after formation of an ileal loop, there may be much sediment in the urine. This material is a by product of the ileal loop surface lining. Over time, this sediment decreases and with good hydration, the urine takes on a normal appearance. A urostomy and its collection bag are not apparent under someone’s clothing. Usually there is minimal or no odor. An individual with a urostomy can continue to enjoy all physical activities.

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The actual surgery to form the continent diversion may take several hours more to accomplish compared to an ilea) loop. This additional surgical time is not a problem as long as the individual is in good health, and the surgery has gone well. Not all urologists do continent diversions on a regular basis. If a urologist does not do this operation regularly, you will be better off finding a urologist that does, since complications related to this part of the surgery will be increased by inexperience. Because different techniques exist and the level of expertise and experience of each urologist is different, it is important to ask the urologist about the complications that may occur and the general frequency of occurrence he has seen in his patients. Complications unique to this diversion as compared to the ileal loop may occur, requiring reoperation in up to 20% of patients. If the complication rate is unacceptable, consider an ileal loop. The most common complications are:

Difficulty with catheterization: After the surgery the pouch may become increasingly difficult to empty. Surgical reconstruction is mandatory if a pouch cannot be readily emptied. Incontinence: During surgery, the continence mechanism is checked. However, at some time after surgery, incontinence may occur, necessitating the wearing of a collection device. In addition, the pouch may still need to be catheterized. Surgical reconstruction is required to reformat the continence mechanism.

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Actos Lawsuit : 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.

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.

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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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Ureteral-Ileal anastomotic stenosis: The ureters are carefully attached to the base of the ileal loop. Stents are placed at the time of surgery to allow the connection to heal in an open fashion. Nevertheless, the ureteral anastomosis may scar over time, leading to blockage of the ureter and its respective kidney. The kidney becomes swollen with a dilation of its drainage system (hydronephrosis). It is routine to periodically check the condition of the kidneys after ileal loop diversion to make sure the kidneys are not becoming obstructed. Obstruction, if present, will become apparent on follow up studies. If hydronephrosis develops, a loopogram is then obtained. In a normal ileal loop, there should be free reflux of urine up the ureters. If this reflux is gone and the kidney has recently become hydronephrotic, often an anastomotic obstruction has developed. These obstructions can form because of lack of blood flow to the end of the ureter. If the individual has had prior radiation to the pelvis, the rate of blockage is increased. On occasion, obstruction may be secondary to recurrent transitional cell cancer at the end of the ureter. This complication is either handled via an endoscopic method (using a balloon to dilate the ureter or a scope passed to the site and an incision made) or by open surgical revision and correction.

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Actos Lawsuit :  As with any major surgery, there is potential for bleeding during your surgery. Twenty-five to 50 percent of patients need a blood transfusion either during surgery or in the immediate postoperative period. Your surgeon may ask you to donate your own blood before surgery, so that it can be given back to you at the time of your operation. This is to minimize the risk of infection with transfusion-related bloodbome illnesses such as HIV and hepatitis. Because this risk is extremely low, many surgeons do not require you to donate your own blood. Your blood count will be monitored for the first several days after surgery because in rare circumstances bleeding can occur after surgery. Depending on your blood count at the time of discharge, your physician may send you home on iron supplementation.

There is a small risk of infection after surgery. Post- surgical infections can occur in the abdominal wound, intra-abdominally at the site of bladder removal, and also in the urine (urinary tract infection) or kidney (pyelonephritis). Most infections can be successfully treated with antibiotics. Wound infections can require a portion of your incision to be opened to allow drainage of infected material. This is easily done at the bedside and is not painful. Once the infection clears, the wound heals on its own without any further therapy.

Gastrointestinal (GI) complications and side effects are extremely common after cystectomy, mainly due to the bowel surgery that is required for urinary diversion. Anywhere from 30-60 percent of patients will have a postoperative ileus. Ileus occurs when there is temporary decreased motility of the intestine after surgery. Common causes of ileus are edema related to the bowel anastomosis, electrolyte imbalances and fluid shifts that can occur with surgery, anesthetic effects on the bowel, and retraction of the bowel at the time of surgery. The symptoms of ileus are abdominal bloating, decreased appetite, inability to pass gas, nausea, and vomiting with food intake. The treatment for ileus is to not eat or drink anything until GI motility returns. In doing so, abdominal distention, nausea, and vomiting can be minimized. Most cases of ileus resolve within a few days. Small bowel obstruction, which has similar symptoms to that of ileus, can occur early in the postoperative period or many years after your initial surgery. In this case there is an actual obstruction of the bowel, generally at the site of the anastomosis.

Occasionally, this can be managed conservatively in much the same manner as described with an ileus, but often surgery is required to relieve the obstruction. Bowel habits can also change after cystectomy. This can range from constipation, to loose stools, to frank diarrhea. These symptoms are caused by the removal of the portion of intestine that is used for urinary diversion. As one can imagine, these symptoms tend to be worse in patients who have continent urinary diversions because larger segments of bowel are used. Many of these symptoms can be treated successfully with over-the-counter medications that either help with constipation or add bulk to the stool in cases of diarrhea.

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There are medical risks associated with any major surgery, and cystectomy is no exception. These risks include deep vein thrombosis (blood clots in the legs), pulmonary embolism (blood clots migrating to the lungs), heart attack, stroke, and even death. Your overall health status going into surgery can increase your risk for certain medical complications. Your surgeon my require you to undergo a preoperative medical evaluation and clearance before surgery. This is very important because optimizing your medical status before surgery can minimize your risk for such complications.

Sexual function is often affected after cystectomy and is a major quality of life issue for both men and women undergoing this procedure. In men, the vas deferens (the tubes that carry sperm from the testicles) are cut, resulting in infertility. Although infertility is not a major issue for most men undergoing cystectomy, you should discuss this with your urologist before surgery if you are planning to have children in the future. Because the nerves responsible for erection are located along the base of the prostate, erectile dysfunction is a common side effect after surgery. In highly selected cases, these nerves can be spared at the time of surgery, leading to improved potency outcomes. Erectile function after surgery depends on three main factors: age, preoperative function, and nerve sparing at the time of surgery.

Young men who have good erectile function before surgery are much more likely to have erectile function afterward than older men or those with preexisting erectile dysfunction. There are a variety of options to help with ED following surgery including the use of vacuum devices, oral medications (i.e., Viagra, Levitra, or Cialis), injection of medications directly into the penis, or a penile implant. In recent years there has been a trend toward preservation of the female sexual organs at the time of cystectomy, including the uterus, ovaries, fallopian tubes, and vagina. Such organ preservation strategies have also led to improved sexual function in women undergoing radical cystectomy.

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There are both short-term and long-term complications associated with urinary diversion. In the immediate postoperative period, urine can leak from the site where the ureters were sewn into the bowel. This is generally self- limiting and heals on its own several days to a week after surgery. Very rarely is any intervention required. If you do have a urine leak after surgery, your physician will likely monitor this by the output of your drains that were placed at the time of the operation. When the drain output decreases, this is a sign that the leak has healed.

The majority oflong-term complications patients experience after cystectomy are related to the urinary diversion. In fact, 10-20 percent of patients will need an additional procedure at some point over their lifetime to correct a problem with the urinary diversion. Over time, scar tissue can form at the site where the ureters were attached to the bowel, narrowing the lumen (cavity of the tube) that urine drains through. This is called a stricture. If a stricture occurs, it can inhibit the drainage of urine from the kidney, causing an obstruction. If this happens to you, you may feel pain in your back similar to that of a kidney stone, but some patients have no symptoms whatsoever if the stricture occurs slowly over time. Your physician will periodically evaluate your kidneys with CTs or ultrasound to ensure proper drainage. Treatment for anastomotic strictures involves opening up this narrowed area to its previous size to allow the normal flow of urine into the ileal conduit or urinary reservoir.

This can often be accomplished endoscopically without intra-abdominal surgery, but if such conservative measures fail, open surgery with anastomotic revision may be warranted. Fortunately, anastomotic strictures only occur in 3-7 percent of patients, and open surgery for such strictures is even rarer. Similarly to the narrowing that can occur at the connection between the ureters and the bowel, patients with ileal conduits can experience narrowing of the stoma at the level of the skin, which can impede the drainage of urine into the bag. This is known as stomal stenosis. Although this can be managed in the short term by simply placing a catheter into the stoma to allow drainage of urine, a surgical procedure is often necessary to revise the stoma. This procedure can generally be done on an outpatient basis.

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Actos Lawsuit 12/23/2011: Roughly 5-10 percent of patients experience a fever after a transurethral procedure. This is almost always due to a urinary tract infection. The most common symptoms of a urinary tract infection in this setting are fever, chills, side pain, and frequent or painftil urination. If you experience a fever postoperatively, you should contact your physician immediately. The vast majority of infections can be treated as an outpatient with oral antibiotics and resolve in several days. Most urologists give you antibiotics during your procedure and for a few days thereafter to prevent infection, but unfortunately a small percentage of patients will still experience an infection despite taking antibiotics. It is important to note that most patients have lower urinary tract symptoms after surgery. This is directly related to the manipulation from the cystoscope and any biopsies or resection that were performed.

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Actos Lawsuit 12/23/2011: Urinary retention (inability to pass the urine) is another uncommon and generally self-limiting complication one can experience after surgery. In men, this is often caused by swelling of the prostate due to manipulation from the cystoscope. Excessive bleeding may also result in clot formation that can obstruct the flow of urine. Patients who experience this side effect urinate in small volumes or not at all, even though their bladder is uncomfortably full. The treatment for this is simple; a catheter is placed in your bladder for a few days to allow any edema (swelling) to resolve. The catheter can then be removed several days later and most patients void without difficulty at that point.

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Our use of the Terms Lawsuit, Lawsuits, and Attorney is not intended to imply or insinuate that there is any relationship or connection between Best Legal Source and the maker of Acts. Actos is a trademark of its manufacturer, Takeda Pharmaceutical Company Limited. Best Legal Source is not the maker of Actos nor do we have any connection with Takeda Pharmaceutical Company Limited.

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