Actos and Bladder Cancer
Actos and Bladder Cancer : CAN ALL BLADDER TUMORS BE REACHED WITH A RESECTOSCOPE?
On occasion, a urologist may face an individual with a bladder tumor that cannot be reached. This is usually much more of an issue with male patients since the scope is required to pass through a much longer urethra to begin with, therefore reducing the amount of instrument available to work within the bladder. Contributing factors include:
Tumor location: tumors loeated at the dome (the very top part of the bladder or those just inside the bladder neck) may be extremely difficult to remove.
Body size: individuals who are markedly obese have distorted internal anatomy. Instruments may not be long enough to reach all bladder tumors.
Enlarged bladders: individuals with abnormally large bladders may have tumors beyond the reach of the resectoscope.
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Bladder diverticulum: some bladders have an abnormal cavity called a diverticulum. If the opening to the diverticulum is small or if the diverticulum is large, bladder tumor removal may be difficult. In addition, the walls of the diverticulum are quite thin, making tumor removal more hazardous, as perforation is more likely to occur.
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WHAT CAN MY UROLOGIST DO TO ENHANCE HIS ABILITY TO REMOVE TUMORS IN DIFFICULT LOCATIONS?
The experienced urologist uses several techniques to improve his chances of removing tumors that are difficult to reach. He will often keep the bladder under filled. Although this may reduce visibility, it will allow the tumor to be closer to the resectoscope. Another technique is to place manual pressure on the bladder from above. This is done by an assistant or by the urologist himself. By pushing down from above, tumors at the dome are displaced downwards. An additional technique, for the male patient, is operating through a perineal urethrostomy. The urologist makes a surgical opening into the urethra between the scrotum and rectum, allowing the resectoscope to move further into the bladder, bypassing much of the urethra.
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