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Actos Lawsuit: For women, a cystectomy includes the removal of the uterus and part of the vaginal wall. What does that mean for you? Well, for one thing, your vagina may be narrower as a result of the surgery. Usually it is possible to continue to have intercourse, although sometimes there can be some pain involved. Be sure to talk to your doctor if you do expe­rience pain, as there are methods of reducing this.

Most women diagnosed with bladder cancer already have experienced menopause. For younger women, that may not be the case. (Typically, women who receive diagno­ses of bladder cancer are older.) The removal of the uterus and possibly of other female organs near the bladder brings an abrupt end to the childbearing years. It may also set off typical menopausal symptoms such as hot flashes or mood swings if the ovaries have been removed at surgery (removal of ovaries is unusual). If you find yourself feeling depressed or blue or uncomfortable from hot flashes, talk to your doc­tor. You don’t have to feel that way; there are options avail­able for you to consider.

As is recommended for men, talking with your partner and your medical team about the physical and emotional changes that you may experience after a cystectomy is an important part of the process, one that deserves as much consideration as the more immediate decisions about which treatment options you want to pursue.

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Keep in mind that cystectomy is a life-preserving weapon against invasive cancer. That doesn’t mean you cant or shouldn’t consider the possibility of impotence or altered sexual function with your partner, or the inability to carry a child. It does offer the hope that you can celebrate many more years of healthy, loving life with your friends and fam­ily. That’s an important thing to remember at a time when life may seem to be serving you big helpings of despair. Drink lots of water. If you have a neobladder or reser­voir formed from your intestine, mucus will continue to be excreted from the intestinal tissue and must be flushed regularly to prevent infection. Regular con­sumption of fluids helps flush out the mucus. Maintain good personal hygiene in bathroom habits, hand washing, and/or the care and cleaning of your stoma or reservoir.

Sometimes an internal bladder connected to the urethra (the tube that carries urine to the outside of the body) isn’t possible and you will instead be fitted with a continent urinary diversion system. This means that you will have a pouch or reservoir, either external or more commonly inter­nal, that collects your urine, and you will have to empty the pouch. Your doctor, may, however, recommend an external pouch that is situated outside your body and attaches to your abdomen through a stoma. You must manually empty the external pouch and cleanse the stoma. Either alternative sounds unpleasant, but having a pouch (particularly an internal reservoir) wont interfere with your life or self-image as much as you might expect, if at all.

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You can still snorkel and swim. You can dance in a clingy, swingy dress or bike in Spandex shorts. You can do your job, whether it’s manning a drill press or managing a Fortune 500 company. And you can still look and feel sexy and enjoy a satisfying intimate relationship with your partner. External pouches are designed to lie flat against your body and can be discreetly worn under most clothing (even body-shaping underwear for women or athletic supporters for men). Pouches are available in different sizes and with waterproof or protective coverings. Internal reservoirs are even easier to conceal. Your nurse and doctor can give you tips and instructions. Don’t hesitate to talk to them and ask questions. You will want to know what the signs of infection are, whether there are any restrictions on your activities (e.g., some contact sports are restricted), and what diet or exercise constraints you might have.

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Actos Lawsuit: 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.

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.

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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).

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Bladder cancer is a malignant overgrowth of the cells of the bladder. Most commonly, the growth occurs in cells that are in the urothelium. The lining of most hollow spaces in the body is made of epithelial cells. The lining of the inside of your cheek, for instance, is an epithelial cell lining. Also, the lining of your stomach, bowels, gallbladder, and—you guessed it—the bladder is made of epithelial cells. Each organ has its own subset of epithelial cells. In the bladder, the lining cells are called transitional epithelial cells. The cancer that grows from these cells is then called transitional cell cancer; 90% to 95% of all bladder cancers are of this type. If the cancer grows from a different type of cell in the bladder, it is given a different name. Other types of uncommon cancers in the bladder include squamous cell carcinoma and adenocarcinoma.

It is also possible that cancer in the bladder did not begin there but spread to the bladder from somewhere else. The bladder is an uncommon place for other tumors to “seed” (or metastasize), but it does occasionally occur. Although metastases are uncommon, tumors can occa­sionally grow directly into the bladder from an adjacent organ, such as the prostate, colon, rectum, or cervix. Bladder cancer is the fourth most common type of cancer in men and the eighth most common in women. The American Cancer Society estimated that in 2009, there would be about 70,980 new cases of bladder cancer diagnosed in the United States. In 2009, 14,330 deaths were expected from bladder cancer. In spite of the increased incidence of bladder cancer over the years, the rate of people dying from bladder cancer has decreased over the past 20 years.

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 : TURBT is often the first procedure you will have once diagnosed with a bladder tumor. This surgery is typically performed under general or spinal anesthesia as an out­patient procedure and without any incision, endoscopically through the urethra, which means a cystoscope is placed through the urethra and into the bladder. Through this scope your urologist can see the inside of your bladder and has the ability to resect, or remove, tumors in the bladder under direct vision using electrocautery. The electrocautery is also used to control bleeding after the resection is com­pleted. TURBT is extremely important for the staging of bladder tumors but can also be therapeutic for lower stage bladder cancers. Once the tumor has been removed, it can be analyzed under the microscope by a pathologist. The pathological findings dictate further treatment decisions. If the tumor is low grade and noninvasive, you will likely not need any further therapy at this point except for close follow-up.

By and large, you can expect to go home the same day that this procedure is performed. Depending on the extent and depth of resection, your urologist may decide to send you home with a Foley catheter in place for a few days to allow time for your bladder to heal. Generally, this procedure is well tolerated, but it is not uncommon to see blood in the urine for several days after the procedure. Many patients also experience lower urinary tract symptoms, including painful urination, frequency, and urgency for up to several weeks following the procedure.

Radical cystectomy is the gold standard treatment for muscle-invasive bladder cancer and is also the procedure of choice for individuals with high-grade recurrent bladder tumors. Radical cystectomy has proven to provide excellent long-term cancer-free survival in individuals whose bladder cancer has not spread beyond their bladders or into their lymph nodes. Radical cystectomy is the therapy by which all other treatments are compared and judged.

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Technically speaking, radical cystectomy for men involves removal of the bladder and prostate and also includes removal of the pelvic lymph nodes. In women, the bladder and typically the uterus, ovaries, fallopian tubes, and por­tions of the vagina are removed, although more recently surgeons have been moving toward preservation of some of these structures to improve quality of life. Because the main function of the bladder is to store urine that is made by the kidneys, a mechanism for diversion of urine outside of the body or storage of urine in a newly created reservoir must be performed in the same setting. Various types of urinary diversion are discussed below.

Traditionally, the surgery is performed through a lower abdominal incision in the midline from just below the umbilicus (i.e., “belly button”). Hospitalization for this procedure is generally between 5 and 10 days, and up to 6 weeks are needed for complete recovery. In recent years minimally invasive surgical approaches that replicate the technique of open radical cystectomy have been developed. Both laparoscopic and robotic-assisted radical cystectomies are currently being performed at highly specialized cen­ters. The principles of the surgery are the same, but the procedure is performed through smaller incisions using laparoscopic instruments. Using robotic assistance, your surgeon is able to perform complex operations with higher precision, under magnification. These approaches offer die potential advantage of a shorter recovery time, less blood loss, and less postoperative pain.

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A pelvic lymph node dissection should be performed at the time of your surgery. This involves removal of the lymph node tissue in the most common areas of bladder cancer metastasis (spread of the cancer). The pelvic lymph node dissection has two important roles: to stage the cancer and to guide therapy. Individuals who are found to have cancer in the lymph nodes at the time of surgery generally require additional therapy such as chemotherapy. Studies have shown that up to 30 percent of patients with disease- positive lymph nodes who undergo a pelvic lymph node dissection will be free of disease at 5 years. Although there is debate among urologists as to exactiy how extensive ofapelvic lymph node dissection should be performed, there is no de­bate that one should be performed. Although a pelvic lymph node dissection can add an additional 30-90 minutes to your procedure time, there is little additional morbidity associ­ated when performed by an experienced surgeon.

Regardless of the approach, anyone who undergoes a radical cystectomy will require a form of urinary diversion because the bladder will no longer be there to store urine. This can have a significant psychological and functional impact on an individual’s quality of life. Patients are often hesitant to undergo definitive surgery because of the anxiety associated with long-term urinary diversion. There are two main types of urinary diversion: continent and noncontinent. Both forms require surgically removing a segment of bowel (most commonly the small bowel) from your gastrointestinal (GI) tract and plugging the ureter from each kidney into this segment of bowel to provide drainage of urine.

Noncontinent diversions (ileal conduit) are those in which the piece of bowel is brought up through the abdominal wall to a stoma and the urine drains contin­uously into a drainage bag. This is die most common type of urinary diversion performed in the United States. This procedure requires approximately 8 to 10 centimeters (3 to 4 inches) of small bowel, which is far less than that used for continent urinary diversions. Although the obvious dis­advantage of this procedure is its lack of continence and need for a continuous drainage bag, it has less short- and long-term complications than that of the continent diver­sion. An external urinary drainage appliance is very well tolerated and patients adapt to them very quickly.

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Actos Lawsuit : A history of radiation therapy for a pelvic cancer may increase your risk of bladder cancer. Radiation has a role in the treatment of prostate, cervical, and ovarian cancers. Although the radiation is focused on the involved organ, the bladder and other surrounding structures also absorb radiation that sometimes damages the urothelium and leads to cancer.

Much attention has been paid to the influence of diet on cancer risk and treatment. Thus far, some scientists have suggested that vegetables, fresh fruits, and some fermented milk products appear to decrease one’s risk of developing bladder cancer. A few foods thought to increase the risk of developing bladder cancer are foods rich in animal fat, diose containing a lot of cholesterol, fried foods, and pro­cessed meat with various additives. We are not sure of the exact influence of diet on bladder cancer at this point in time. Scientists around the world are working on uncover­ing potential links between diet and bladder cancer.

As with other cancers that affect different body parts, there are multiple types of bladder cancer. To better understand them, let’s separate bladder cancer into two different groups: primary tumors that originate in the bladder and secondary tumors that spread to the bladder from other places.

Primary bladder cancers form within the bladder. Over 90 percent of primary bladder cancers in the United States are of the urothelial or transitional subtype. These form along the inner lining of the bladder. The second most common type of primary bladder cancer in the United States is squa­mous cell carcinoma, making up approximately 5 percent of all cancers diagnosed. These are often diagnosed in indi­viduals whose bladder has been chronically irritated by an infection, stones, or an indwelling catheter. The third most common subtype of bladder cancer in the United States is adenocarcinoma, accounting for approximately 2 percent of all diagnosed cases. These typically form near the dome of the bladder. There are other types of primary bladder cancer, but these are very rare. If necessary, your urologist will speak to you about these rare types.

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A biopsy is a small piece of tissue obtained during cystos­copy when a urologist looks inside of your bladder. This tissue sample is then sent to the laboratory and looked at under a microscope by a pathologist. Although there are standards that all pathologists follow, there can be small differences that can be seen by a trained eye. This is why it’s important to obtain actual slides and not just the report.

In addition to biopsies, pathologists often look at urine specimens or bladder washings for the presence of abnor­mal cells. It’s important to bring this report to your first appointment as well.

Before youx referral to a bladder cancer specialist, your primary care provider or urologist may order one of a few radiology exams to help evaluate the extent of cancer. We’ll briefly discuss those tests commonly ordered during the workup of someone with bladder cancer. These tests help determine someone’s cancer stage. Again, it is very impor­tant to obtain copies of your images (the actual films or CDs) along with reports.

An ultrasound is a noninvasive test used to evaluate the kidneys and bladder. Ultrasounds are painless and don’t have any associated side effects. Ultrasounds are per­formed by either a radiologist or radiology technician and take approximately 30 minutes to complete. An ultrasound allows doctors to image your kidneys to determine wheth­er or not they are normal in size. An ultrasound can also determine if one of your lddneys is not draining properly, which can occur with bladder cancer. Although images of your bladder can be obtained, an ultrasound cannot rule out evidence of cancer. Ultrasound was a primary test used in the past to evaluate patients with bladder cancer; how­ever, we now have better tests that allow us to image your entire urinary tract in greater detail. Ultrasound pros in­clude its noninvasiveness and lack of radiation, whereas its cons remain its lack of fine details and the fact that some very small tumors can be missed.

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An intravenous pyelogram, or IVP, is a test used to define the anatomy of your urinary tract using intravenous dye and an x-ray machine. Doctors order this test to determine whether or not there are any blockages or tumors in the renal pelvis, ureter, or bladder. Often, patients are asked to have a light meal the night before an IVP and to skip break­fast the morning of the exam. You may be given instruc­tions to perform a bowel prep using magnesium citrate, a laxative available in your local pharmacy or supermarket, This clears out your small intestine and colon as these may interfere with visualization of your urinary tract. If you have diabetes and are using Glucophage (metformin), you may need to stop these medications several days in ad­vance. This should be coordinated by your urologist and primary care physician.

IVPs can take an hour to perform because images are tak­en of your abdomen at various time points. You may feel a warm sensation, become nauseated, or have a metallic taste in your mouth when the dye is injected.

There are several reasons why you should not have an IVP performed, and these will be explained by your doctor. If you have an allergy to IV dye, you could have a potentially severe allergic reaction. In some cases, steroids are given to prevent this from occurring. Either way, this is some­thing that must be discussed with your doctor before the exam. If you have abnormal kidney function, another test will most likely be performed instead of an IVP. This is because the IV dye can worsen your kidney function. If you are pregnant, another test will be performed because of the potentially small risk that the radiation from the x-ray machine poses to the developing fetus. If you have asthma, multiple myeloma, sickle cell disease, pheochromocytoma, or a tumor of your adrenal gland, your physician may order another test because you may also be at greater risk of com­plications from the exam.

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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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