Urinary Retention After Brachytherapy

Urinary retention affects 1.5%-22% of men within a median of 2 months following prostatic brachytherapy (Stone and Stock 2002; Flam et al. 2004). Identified preimplant risk factors include an International Prostate Symptom Score above 20 and a prostate volume larger than 35 cm3 (Terk et al. 1998; Gelblum et al. 1999). Attempts to reduce the risk of urinary retention with prophylactic a-adrenergic blockade (Flomax) have thus far been unsuccessful (Elshaikh et al. 2005).

The majority of cases respond to conservative measures such as catheter drainage plus or minus a-block-ade, those that do not require TURP. According to a recent meta-analysis, up to 8.7% of brachytherapy patients undergo TURP after implantation; however, large contemporary series report a lower rate of 1.1 % — 2 % (Stone and Stock 2002; Allen et al. 2005; Kollmeier et al. 2005). Urinary incontinence, while uncommon after TURP performed for BPH (1%-5%), is reported in up to 70 % of brachytherapy patients who undergo TURP (Foote et al. 1991; Hu and Wallner 1998). The results of more recent series suggest the rate of post-TURP incontinence is 0 % -18 % (Stone and Stock 2002; Kollmeier et al. 2005). Radiation dose, pre-implantation prostate volume, and hormonal therapy do not appear to be predictive of subsequent incontinence; however, TURP performed more than 2 years after implant does appear to be a risk factor.

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