International Journal of Radiation Oncology*Biology*Physics
CLINICAL INVESTIGATIONTemporal resolution of urinary morbidity following prostate brachytherapy
Introduction
Over the past decade, transperineal ultrasound guided prostate brachytherapy has been increasingly utilized as definitive management for early stage carcinoma of the prostate gland. The results of prostate brachytherapy have been reported to be as favorable as the most positive radical prostatectomy series with a decreased incidence of urinary incontinence and sexual dysfunction 1, 2, 3, 4, 5. In addition, significant rectal injury is rare (6). A paucity of data, however, has been published regarding the short-term urinary morbidity following prostate brachytherapy. Almost all patients experience some degree of urinary irritative/obstructive symptomatology including urinary frequency, dysuria, urgency, interruption of the stream, incomplete voiding, straining, and nocturia; 3%–22% of patients develop acute urinary retention following prostate brachytherapy 4, 7, 8, 9, 10, 11. Terk et al. (7) were able to correlate the risk of urinary retention with the preimplant international prostate symptom score (IPSS). A recent controlled study concluded that peri-operative dexamethasone does not significantly alter short-term urinary morbidity (12).
The IPSS was developed by the American Urological Association (AUA) in 1992 as a measure of symptomatic relief following prostatectomy for benign prostatic hypertrophy. The generated score resulted in excellent test-retest reliability and was sensitive to change (13). Recently, the reproducibility of the IPSS index was revalidated (14). Barry et al. (13) reported “the AUA symptom index as clinically sensible, reliable, valid and responsive. It is practical for use in practice and for inclusion in research protocols.” The IPSS index has also been proven a useful tool for evaluating urinary symptomatology following prostate brachytherapy (7).
Herein, we report the short-term urinary morbidity for 170 consecutive prostate brachytherapy patients without a preimplant history of a transurethral resection of the prostate gland. α-blockers may decrease radiation-induced urethritis by relaxing urinary smooth muscle tone with a subsequent reduction in urinary flow resistance. In all patients, prophylactic α-blockers were initiated 2–3 weeks prior to implantation and continued until the IPSS declined at least as low as its preimplant value. Multiple clinical and treatment parameters were evaluated to identify factors associated with increased acute urinary morbidity.
Section snippets
Materials and methods
One hundred seventy consecutive patients without a prior history of a transurethral resection of the prostate gland underwent transperineal ultrasound guided prostate brachytherapy from December 1997 through early April 1999 using either 125I or 103Pd for clinical T1c–T3a carcinoma of the prostate gland. The choice of isotope was dependent upon Gleason score. Because of well-documented inaccuracies in Gleason grading, all cases originating from outside institutions were reviewed prior to the
Results
Table 2 details the clinical and treatment parameters of the evaluated patient population. The urinary catheter was removed on the day of implantation in 150 of the 170 implanted patients (88.2%). The pie chart in Fig. 1 illustrates that 10 of the 170 patients (6%) required a urinary catheter for > 2 days, and 5 of these patients (3%) required a catheter beyond 3 days. One patient was catheter-dependent for > 5 days (5 months). This patient, and one other, subsequently underwent a
Discussion
Over the past decade, prostate brachytherapy has been increasingly utilized as definitive management for early stage carcinoma of the prostate gland. The results of prostate brachytherapy have been reported to be as favorable as the most positive radical prostatectomy series with a decreased incidence of urinary incontinence and sexual dysfunction 1, 2, 3, 4, 5. A paucity of data, however, has been published regarding the short-term urinary morbidity following prostate brachytherapy. Almost all
Conclusions
One hundred fifty (88.2%) of the 170 patients in our series had the urinary catheter permanently removed on day 0, and 169 (99.4%) by day 5 following implantation. The mean patient IPSS values peaked at 2 weeks and returned to antecedent values on average at 13 weeks, with a median of 6 weeks. This return is significantly more rapid than what has previously been reported. The 1.2% incidence of transurethral resections also compares favorably with the published literature. Multivariate analysis
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2019, Abeloff’s Clinical OncologyClinical factors and dosimetry associated with the development of prostate brachytherapy–related urethral strictures: A matched case–control study
2017, BrachytherapyCitation Excerpt :In the earlier days of LDR prostate BXT, the incidence of stricture was reported as high as 12% (8), which has dropped to as low as 3.6% in more recent series (9), perhaps because of improvements in the dosimetric distribution of radioactive sources. Several studies have implicated clinical and treatment factors, such as preimplant urinary symptom score (10, 11), supplemental EBRT (12), adjuvant hormonal manipulation (13), age, prostate-specific antigen level, Gleason score (14), and cigarette smoking with urinary morbidity. Dosimetric studies have suggested that the region around the prostatic apex receiving high doses of radiation can contribute to urethral stricture formation.