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Brachytherapy - urine retention problem after 4 weeks

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Posted 7/4/2018 8:20 PM (GMT 0)
I am on cath for 4.5 weeks now after brachytherapy... I know this is not common but checking for
any others who may have had this condition... I did find the one other thread 8 yrs old and did not
get much response so I decided to start a new thread
1st 5 days torture...Dr said I was constipated not urine retention
went to dr begging for help put in cath and drained 1200ml another 400 shortly after.
1st week after cath voiding test failed 2 drops of blood after 4 hours 350 ml urine drained
2nd week after cath voiding test failed 2 drops urine after 8 hours 670ml urine drained
40 days post implant did urodynamic test bladder is fine. Dr thinks there is a restriction thru prostate.
they put in 280 ml of sterile water - very painful to try to pee about 40 ml came out but 15 min later
I was now able to get a very fine stream another 70 ml no pain but failed the test as 200ml was still
there when they reinserted the cath. Has anyone been diagnosed with a stricture
or a swollen prostate that blocked the urine flow? It seems other urine retention issues were fixed with self cath eventually and no surgery was required. I urologist friday and Radiation Dr on Wed the next week
Meds AM= proscar .4mg cialis 5mg Armour thyroid 90mg PM= Flomax 5mg
Prostate size 35 cm Stage T1C Gleason 7 30% 1 core - 20% of it pattern 4
Thanks for your help
Posted 7/4/2018 8:27 PM (GMT 0)
An alpha blocker (Rapaflo, Flomax, etc,) may help with the flow issues. Avoid cystoscopy and other instrumentation - treat conservatively.
Posted 7/4/2018 10:30 PM (GMT 0)
1200 ml ???!!! That would have killed me. I had several bouts with urinary retention after surgery, and it was the worst pain I have ever experienced. I feel for you! After my third episode of retention I read that it is, along with child-birth and kidney stones, one of the most painful things that happen to people. My wife has had two kids and one bout with kidney stones. I told her we were now tied at three each. She disagreed. I have no advice, but hope you solve this fast.
Posted 7/4/2018 11:15 PM (GMT 0)
Tall Allen - An alpha blocker (Rapaflo, Flomax, etc,) may help with the flow issues. Avoid cystoscopy and other instrumentation - treat conservatively.

What is your suggestion under treat conservatively - I am guessing the cystoscopy side effects can be bad. By treat conservatively... do you think I should just keep cath in for another month or 2 to let the urethra get stretched out more, double meds ?? What do you think about urethra gram die and xray or trying self cath - I do not plan any surgery...
i also searched threads and found Rapaflo med, cystogram and (urethragram which a friend recommended.)

Thanks
Posted 7/5/2018 12:42 AM (GMT 0)

fiddlecanoe said...
1200 ml ???!!! That would have killed me. I had several bouts with urinary retention after surgery, and it was the worst pain I have ever experienced. I feel for you! After my third episode of retention I read that it is, along with child-birth and kidney stones, one of the most painful things that happen to people. My wife has had two kids and one bout with kidney stones. I told her we were now tied at three each. She disagreed. I have no advice, but hope you solve this fast.


When I was in ER with a shattered pelvis from getting wacked by a car. I was in that same pain, the opiates didn't touch it . The nurses kept checking my bladder with some electronic handheld scanner and said nothing there, just pain from accident. As the pain got worse and I got angry head nurse said to go get another scanner, to shut me up. Yup, first one was busted, cathed me and got 1000 ml out.
Posted 7/5/2018 2:08 AM (GMT 0)
1200 ml is really impressive. Once in the hospital years ago, anesthesia temporarily took away my ability to pee, but the nurses though I just wasn't willing to pee in a bottle in bed. So they put mint drops in the bottle. I begged for a catheter and finally the did it, and were amazed to get a liter out. I'm pretty sure that wasn't all of it, but that was all the container in the catheter kit could hold. Enough for relief anyway.

After RP, my wife was driving me to the ER as I had just had my catheter out, but wasn't able to pee. Apparently was clogged up with a blood clot or maybe tissue. Anyway, that ride to the ER was nuts. So much pain that every little bump in the car was torture. Also, even though it was dead quiet at 5 am, everything sounded painfully noisy.

brachy, sorry you're having so much trouble.
Posted 7/5/2018 2:15 AM (GMT 0)
Flomax should do the deed but Rapaflo is more favorable for some patients. A talk with your RO about the right dosage of one of these beta blockers should be in order.
Posted 7/5/2018 2:24 AM (GMT 0)
Sorry to hear of these issues. That sounds pretty rough.

Urinary strictures are a known risk with radiation therapy. Ask Tall Allen for latest studies if you're interested in the rates and so on for EBRT vs brachy, or the combo. Some online searches can point you to studies.

Talk to your RO about dealing with it. This is not an unexpected issue with RT.
Posted 7/5/2018 3:34 AM (GMT 0)
I would love to see some links to these latest studies...
Posted 7/5/2018 3:47 AM (GMT 0)

CAdogsRus said...
I would love to see some links to these latest studies...


I'll venture just one here. There are multiple opinions on this forum about this topic, and I don't want to invite attack again.

This was published in 2016, so it's reasonably current. It's all retrospective, a study of studies really, so take it with a grain of salt;

Urethral strictures after radiation therapy for prostate cancer
CHARACTERISTICS OF URETHRAL STRICTURE AFTER RADIOTHERAPY
The overall reported incidence of urethral stricture after RT for PCa varies between 0%–18 % [4,19]. The majority of series report rates after BT between 3%–10% [8,20], 1%–12% after EBRT [4,21,22] and higher rates after the combination of both. However, more recent data using modern LDR-BT and IMRT techniques describe lower rates down to 3% [23,24]. In a series by Mohammed et al. [18] stricture rates after high dose BT were higher (11%) compared to LDR-BT (4%) and EBRT (2%). Reported stricture rates also increase with longer follow-up periods. Results from the CaPSURE database published by Elliott et al. [19] revealed a correlation of stricture incidence and time showing that the stricture rate increased from 1% directly after treatment to 16% after 4 years (Table 1).
Posted 7/5/2018 5:10 AM (GMT 0)
can you message a member on this board or you only wait for a response to your thread?
Posted 7/5/2018 6:54 AM (GMT 0)
The tissues can get friable right after radiation, so pushing instrumentation through them can tear holes - not what you want So best is to manage the symptoms with medication if you can until the inflammation subsides.
Posted 7/5/2018 7:24 AM (GMT 0)

brachyi125 said...
can you message a member on this board or you only wait for a response to your thread?


If the envelope icon above "Date Joined" in the member's ID box is lit up blue and yellow, you can click on it and send the member an email.
Posted 7/5/2018 2:44 PM (GMT 0)
Thank you Saipan and Tall Allen -
Any success stories on resolving long term urine retention after Brachytherapy - I would love to hear what you did ...
Posted 7/5/2018 5:03 PM (GMT 0)
lots of success stories. My brother had issues early on and 5 years later it's all fine.

I know it seems like it will never get better, but most guys eventually do just fine.

Hang in there - it's not easy to go through.
Andrew
Posted 7/5/2018 7:51 PM (GMT 0)
New to the forum.

Currently having the same issue after Brachytherapy on 5/21/18. My urine retention started about 3 weeks following surgery. My radiation doctor didn't offer much other than pain pills and a double dose of Flomax. I ended up going to my Urologist and he was up front and said this happens where the prostate is still enflamed and constricts the urethra. After pulling out 900ml told me either I had to go on a full time catheter or self catheter and I opted for the self catheter. Frankly, its rather easy to do and only the first two times did it really hurt. Plus it gives me a lot more freedom to swim and get out. Highly recommend it. My urologist told me he expects me to be on it for another 2 months as I hopefully start beam radiation next week.

Cheers!
Posted 7/6/2018 1:22 AM (GMT 0)
BMurph , I have had some similar problems , I just finished my radiation after having Brachy in Jam , I have frequent urination problems but at most get 50 - 100ml per go ,and am going about every 15- 30 min or every Hr .. Don't have any abdominal pain , I wasn't drinking much went to the Ro I was sure I had retention and he did a sonogram to check muy prostate and said my prostate was still inflamed from the Radiation and the SpaceOr was also pushing into my bladder... he looked at my bladder and to my surprise said was pretty empty and showed me the pics .... he fig I went so frequent I was more empty than full plus I wasn't drinking a lot , maybe ill make an apt to see the uro and see what he says … but im so frustrated and its working my imagination…. I wish you so much luck I just been having problems …I had thought about the self cath but he said I needed to be patient and things will bet better which is a common reply here form the experienced users. IF you want to correspond or anything my email is listed...
Posted 7/6/2018 5:00 PM (GMT 0)
JohnMorales, I was having sever pain when urinating, up every 15 min and not fully voiding my bladder. My nights were a disaster as I was up almost every hour and it was taking a toll on my mental health so in the end the move to see my Urologist was the right decision. For me it wasn't getting better. Been on the self cath for 8 days and it's been a great relief both physically and mentally. I do the self cath about 4 times a day and still dribble/weak stream in-between. Good luck
Posted 7/6/2018 9:40 PM (GMT 0)
BMurph , im not having severe pain, or abdominal pain, went to the RO again today he thinks its post radiation flare up and should state to get better …. so im going to go with him hes been pretty good with me and always there when I needed , that being said doest help the 15-30 min peeing ...feel like I've peed so much im getting sore... Good luck with everyting .. they keep telling me your killing the cancer , the self cath sounds scary from here..

John
Posted 7/7/2018 2:56 AM (GMT 0)
7/6/18 Update
I was able to pass the voiding test today - they put in 300ml water and I was able to urinate 270 ml back out. I was able to pee a very slow stream which was a big improvement over last Friday's test which was only about 60 ml back. However over the next 6 hours I took in about 1000ml of water and was only able to urinate 350ml and as it was getting late on a Friday I decided to have the cath put back in and they drained out the 400 ml that was being retained. I see the Brachy Dr on Wed. so I will see what they say then and give my prostate more time to stop swelling and the urethra to heal. I will probably start the self cath in about a week after talking to DR... I too have a dribble/weak stream like BMurph so we are in the same boat at this point... Thanks for your posts they are encouraging to know I am not alone..
Posted 7/7/2018 7:07 PM (GMT 0)
Great now I’m scared crapless ....
Before I started IMRT my scorecard was 23....you know the urinary evaluation sheet you fill out 20-30 is severe ..I told my dr I was worried about complete blockage he said that won’t happen ....after my first 2 treatments I could not go ...I would dribble and the tip of my dick would hurt and burn ...if I walked around for about 10 minutes I would go but never empty my bladder ...would be up 45 minutes later ....I tried flowmax and I was surprised it worked right away ...but I don’t want to be on that crap forever ...I got up fast and almost fainted ..it kinda makes me feel lightheaded all day ...I would rather stop now and hsve surgury than to live with these urinary problems forever ....if a have to wear a Catheter I swear they will have to restrain me from kicking his sss i will be pissed off because he knew about this before hand ...any suggestions
Posted 7/7/2018 9:47 PM (GMT 0)
Stan, im right there with you, I was a 25 this week with all these urinary issues , I am now done with Brachy and the 25 session of boost and im told it will get better , I am as most probably figured an obsessive and it is scary to think I have to pee every 30 - 60 min to think about a cath at all is my nightmare...

Are you drinking a lot of water or liquids how do yo know your not emptying , I drink about 1 maybe 2 bottels of water a day. do you have abdominal pain is your bladder area sensitive, this is my dilemma when I go in the toilet sometimes I think this isn't to bad then I go in a urinal and I get 50 - 100ml which doesn't seam a lot when i'm told should be 200 -300 what i read which seams a lot...

Anyway My Dr told me on friday to stop reading aobut other peoples problems that were all different think i listen im here wiht the rest of you looking for answers.. I hope everying goes well for you and you start to feel better as many will tell you here your insides are being toasted I have a 55cc Prostate but they still did the Brachy and the Boost adn put the SpaceOr I cant change the decisions I alrady made I hope hes right and this goes away or atlest gets better...


I may make an apt at uro to see aobut this and get a proper bladder void test. see if im just not drinkign enough to pee alot...


good luck Stan were all in this together..

John
Posted 7/7/2018 11:46 PM (GMT 0)
My iPSS urinary evaluation sheet score was 6-7 & I would have been delighted if symptoms remained the same - and prostate was 35 cc - supposedly per mri my prostate was somewhere between 35-40cc after 43 days. I have an "18" cath which is helping to stretch urethra and let my prostate settle down after seeds.
I know that I am in a rare case - I will give it some time...need to meet with Brachy Dr on Wed 7/11 and see what he says & report back. The urologist does not think I have a stricture as 18 cath has been going in relatively easy -i may have a urethragram to have it tested.
I do have faith in God and guys praying for me and believe that I will continue to get better with time...
Posted 7/8/2018 12:40 AM (GMT 0)
I’m in no pain except the tip of my dick...also I am not having seeds I’m doing HDR brachytherapy..crap that might be worse ...I’m worried sick ...not do I want to be on flowmax all my life
Posted 7/8/2018 1:24 AM (GMT 0)

Stan1961 said...
I’m in no pain except the tip of my dick...also I am not having seeds I’m doing HDR brachytherapy....


Quick comment - I had that happen during one of my biopsies. No anesthesia, 17 pokes for that one. about halfway through, I complained about pain where you're describing. The uro said that was "referred pain", that the nerves run through/around the prostate and you can feel prostate pain elsewhere.

It was weird, and most unpleasant. Hope this clears up for you.
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