Actos Class Action and other Bladder Cancer information:
ARE ALL INDIVIDUALS WHO HAVE THEIR BLADDER REMOVED CANDIDATES FOR A NEOBLADDER? Since urine is stored in a bowel pouch, there is an increased likelihood of metabolic abnormalities occurring compared to the ileal loop, which functions as a conduit. Therefore, those individuals with liver disease or significant renal disease are not candidates. Also, since self catheterization may be required, the individual must have the coordination to accomplish this. Catheterization may be uncomfortable as the catheter is passing through the urethra. The absolute contraindication to the formation of a neobladder is the presence of cancer at the urethral margin. During the cystectomy, the urethral margin is checked by the pathologist for evidence of cancer. If cancer is found at the surgical margin, a urethrectomy is
performed, and a continent diversion or ileal loop is accomplished for diversion.
WHAT ARE THE DISADVANTAGES OF HAVING A NEOBLADDER?
There are a number of issues which need to be reviewed. Cancer recurrence in the urethra after the formation of a neobladder would likely require surgery to remove the urethra and a new form of urinary diversion. After cystectomy, urethral recurrence of cancer can be expected in approximately 10% of patients. Those with multifocal disease and especially with disease near the bladder neck will likely have a higher recurrence rate in the urethra. For those with a
neobladder, the urethra must be carefully followed for possible cancer recurrence. Monitoring is accomplished by washings of the urethra for cytology or by visual inspection with a scope. if there is a concern for an increased risk of urethral recurrence given the nature
of the individual’s bladder cancer, the formation of a neobladder should be avoided. Urinary incontinence may occur after the formation of the
neobladder because of damage to the continence mechanism of the urethra. The nerves to the urethral sphincter travel deep in the pelvis and generally are not injured during surgery. However, meticulous care must be taken in handling the urethra and the sphincter muscle
Bladder Cancer around it. Complications resulting in scar tissue may also jeopardize the continence mechanism leading to leakage. Marked scarring between the neobladder and the urethra may occur, but is readily handled via an incision or dilation of the blockage accomplished through a cystoscope. Even in those with an intact sphincter, especially in females, leakage often occurs at night, necessitating the wearing of a pad.
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