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Actos Lawsuit : Laser therapy can be used to destroy superficial bladder cancers. It can prove particularly useful for treatment of tumors that cannot be reached with a standard resectoscope (such as tumors on the dome of the bladder in an obese individual). Generally, it is well tolerated with minimal bleeding. The disadvantage is the lack of pathologic specimen.
Another modality, photodynamic therapy, was first reported in 1976. A photosensitizer is injected intravenously followed by whole bladder laser light therapy. Photofrin is approved by the FDA as a photosensitizer. It accumulates at a higher rate in rapidly dividing cells (the norm for cancer). When activated by light energy, the photosensitizer causes cell destruction. This therapy can eradicate superficial disease and CIS refractory to BCG therapy. Unfortunately, the therapy causes severe local inflammation and can lead to bladder contracture (shrunken bladder) in up to 20% of patients. It is accomplished under general anesthesia. Also, because the skin is also sensitized, the individual having treatment needs to avoid sun light or bright light for approximately 6 weeks. This therapy is available in only limited tertiary care centers. It may be justified as a last option in the hopes of avoiding cystectomy. Initial response rates may be as high as 50%.
If you are still smoking, quit! Studies have shown those patients with bladder cancer that continue to smoke do worse than those who quit. Likewise, avoid exposure to any toxins which can lead to bladder cancer. Additionally, megadoses of vitamins in conjunction with BCG have been shown to reduce recurrence rates by as much as 40%, primarily in low grade, superficial disease. Antioxidant vitamins in combination were used.
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Radical cystectomy is a major surgery with potential complications. You therefore, need to be in the best possible medical condition prior to surgery. Your health care history will be reviewed by your urologist. If you have specific medical conditions such as heart disease or respiratory disease, a referral to the specialist or primary care physician overseeing management of these conditions is usually warranted to make sure your risk factors have been corrected or improved, to allow for safe surgery. If you have a medical condition which places you at substantial risk of a major complication, it should be addressed prior to proceeding with a surgery of this extent. For example, if you have a heart condition, such as an irregular heart beat, medication may need to be adjusted. Some patients may need to go on lung medication to improve their lung function. On occasion, an individual may need to even have surgery for a blocked heart vessel prior to going ahead with a radical cystectomy. If you still are smoking, you should definitely stop at least two weeks prior to surgery.
You will need to discontinue any medications that can affect your ability to clot during surgery. These may include coumadin and aspirin and other medications which keep your blood from readily clotting. Some vitamins such as Vitamin E can also affect clotting and should be stopped. Herbal remedies will also need to be reviewed with your urologist, as some may affect your ability to clot. Your urologist will go over the medications and let you know which will need to be discontinued prior to surgery. If you drink more than the equivalent of 2 ounces of alcohol per day, it is important to stop drinking alcohol preferably at least a week or more prior to surgery. If you are an alcoholic and drink large quantities of alcohol on a regular basis, you will face the possibility of delirium tremens (DTs) after surgery when you cannot drink alcohol. DTs is a serious medical complication with a high mortality rate. If you have any doubts regarding your consumption of alcohol, you should discuss this with your urologist.
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You may wish to donate blood which will be held in the blood bank for you exclusively during or after surgery. These units of blood are called autologous units and may be transfused only into you. Your urologist will advise you if it is necessary for you to donate blood. If you do choose to donate blood, generally a unit can be given every 7-10 days. It is advisable to take iron supplements during donation so your body can quickly rebuild its blood supply prior to surgery.
If you have experienced a recent illness which has weakened you, it is important to be fully recovered prior to proceeding with the operation. Illness may result in a state of malnutrition. If you have experienced recent weight loss, it may be important to take protein supplements to build up your body prior to surgery.
Because your urologist will be using a piece of your bowel to create a new urinary drainage system, your small and large bowel will need to be thoroughly cleaned out prior to surgery. Your urologist will prescribe cleansing agents such as Golytely or Fleet Phospho-soda the day before surgery to rid the bowel of fecal contents. It is also standard to take a number of antibiotic pills the day before surgery to reduce the bacterial count in the bowel. You will be on “clear liquids” the day before with nothing to eat or drink after midnight. Your urologist will give you detailed instructions regarding the bowel prep and a prescription for the antibiotics.
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