Health news blog

Inability to pass urine can be due to weakness of the bladder muscle or blockage of the passage running from the bladder to the outside. Weakness of the bladder muscle can arise from damage to or pressure on the nerves of the bladder—the trouble spot could be in the spinal cord or the pelvis. Such nerve damage usually causes loss of feeling in the bladder as well, so that you can’t tell when it is full. You may also become unable to empty your bladder properly as a result of certain drugs such as the chemotherapy drug vinblastine, some anti-depressants and some drugs which are used to control diarrhoea or urinary incontinence (inability to hold the urine).

Cancer of the cervix or prostate can block the urinary passage. So can non-cancerous enlargement of the prostate gland. If you »re unable to pass any urine at all naturally, it can be released either by passing a soft plastic tube (catheter) up through the urinary passage from the outside or by inserting a small tube through the skin of the lower part of your abdomen. Either of these can be comfortably done with the help of some local anaesthetic. The catheter may only be needed temporarily while the cause of the problem is tackled. If the cause cannot be corrected, or you decide that the cost of doing so would be greater than the benefit, you might have to keep a catheter permanently in place. This carries a risk of infection, but could still be the best alternative for you.

There are medications which can stimulate the bladder muscle to work better, for example, bethanechol chloride. With or without their help, you may be able to train yourself to empty a partially paralysed bladder naturally, so ask about this if the idea appeals to you.

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There have always been conflicting views amongst members of the medical profession about how to treat breast cancer. Some specialists believe that radical treatment is best, others that a combination of less surgically aggressive treatments is as effective, and others that treatment has no effect on the course of the disease in some forms of cancer. Some specialists still always offer mastectomy to women with certain types of breast cancer; others do so as a last resort. To try to deal with this problem, nationwide trials were set up in the UK some years ago into which women with breast cancer were entered, with their informed consent. Many surgeons throughout the UK – and many in other countries – are still taking part in these trials and may no longer choose a treatment regime for their breast cancer patients. Instead, each surgeon follows a predetermined plan which provides a particular type of treatment for a particular type of cancer. Once enough information has been gathered from these trials, better treatment decisions may be able to be made in the future.

There are several different operations for the surgical treatment of breast cancer. The operation undertaken will depend on the stage at which the tumour is first detected and on which parts of the body are involved.

As well as removing the tumour, the lymph nodes in the armpit may also have to be removed to stage the disease. The more nodes that are affected by malignancy, the worse the prognosis.

Women can, of course, choose to have no treatment, although without it the tumour may eventually erupt through the skin, forming ulcers on the breast and metastatic spread.

Lumpectomy

This operation involves the removal of the lump itself rather than of the entire breast. For single tumours up to 2 cm (about 3/4 inch) in diameter, lumpectomy with or without the removal of the auxiliary lymph nodes and radiotherapy may be the treatment of choice.

Following this type of operation, some 1 to 2 per cent of tumours may recur in the parts of the breast or auxiliary nodes which remain. Long-term follow-up is therefore necessary.

The cosmetic appearance following lumpectomy is usually good, as there is often only a small scar. If the auxiliary lymph nodes have been completely removed, swelling of the arm and hand (known as lymphoedema) may result as the lymph is no longer able to drain away. For this reason, radiotherapy must be avoided when there has been radical removal of the auxiliary lymph nodes.

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