Acute Urinary Retention post Brachytherapy

I am a 58 year old diagnosed with prostate cancer in November.  I had 5/16 positive cores with a 3+4 Gleason validated at two places.  I elected to have IMRT (I am 13/25 treatments so far) and a brachytherapy in February.

According to the literature, men that have that have several risk factors are likely to have acute urinary retention post brachytherapy. The risk assessment is based on the presence of the median lobe, prostate size and IPSS results.  I found this in an article published in the Netherlands that is regarded to be a good estimate of post-bracy AUR (acute urinary retention).  My risk is around 30-40 percent because of the median lobe that is rather large.  Surprisingly, my prostate is not very large and my IPSS is not bad. 

My question is, can men have TURPs or green light vaporization of the prostate after brachytherapy if AUR continues?

Has anyone after a brachytherapy had to self-catheterize themselves for an extended time? 

I think that the only fear I have going into brachytherapy is acute urinary retention. 

Thanks

Paul 

PDL17 said...
I am a 58 year old diagnosed with prostate cancer in November.  I had 5/16 positive cores with a 3+4 Gleason validated at two places.  I elected to have IMRT (I am 13/25 treatments so far) and a brachytherapy in February.

According to the literature, men that have that have several risk factors are likely to have acute urinary retention post brachytherapy. The risk assessment is based on the presence of the median lobe, prostate size and IPSS results.  I found this in an article published in the Netherlands that is regarded to be a good estimate of post-bracy AUR (acute urinary retention).  My risk is around 30-40 percent because of the median lobe that is rather large.  Surprisingly, my prostate is not very large and my IPSS is not bad. 

My question is, can men have TURPs or green light vaporization of the prostate after brachytherapy if AUR continues?

Has anyone after a brachytherapy had to self-catheterize themselves for an extended time? 

I think that the only fear I have going into brachytherapy is acute urinary retention. 

Thanks

Paul 

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Hey Paul,

  Are you referring to that period of time when you have to make 100ml of urine after the catheter removal and before you're released to go home?

Thanks Ed, Joe and Fox.

Hopefully you are all correct. The urinary retention, when it occurs, usually happens the first few days post brachy due to swelling and information. However, rarely, men will have this problem for months when the beads release their radiation causing enough swelling to cause retention.
I believe that I need to relax and not worry so much!!

Paul

F8 said...
....due to swelling and information.

yeah too much information !  my doctor wanted me wo wear a catheter home after brachy.  i said no.  he said i had a 50-50 chance of getting catheterized in an emergency room but if i were okay with those odds it was fine with him.

i wore the catheter home and the next morning he removed it and made sure i could pee before i went home.

ed

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We didn't have the option, no one could leave the hospital care until they could pee(100ml) in that little cup. The trick was to run water and sit down.....lol

GlennK

The possibility of urinary retention was a major concern (not mine, but the professionals) prior to my release from the clinic. They made absolutely certain that I could urinate without difficulty and empty my bladder. They gave me a cath to take home and schooled me on how to install it, although I don't know if I could actually do that. Thank God I've never had to. I still get a call every 3 months from the clinic just to check on my progress, and urinary retention is one of the things about which they are very concerned.

JYM,

I had no urinary retention issues at all. In fact, over the months, my urine stream has improved a great deal secondary to my prostate shrinking.
I worried too much about nothing.

Good luck
Paul

JYM,
I have a history of BPH (frequency and poor urine stream) and chronic prostatitis. I also have a median lobe within my prostate. This latter issue has been shown to significantly increase the risk of having post-brachytherapy acute urinary retention. Fortunately, none of these issues had led to negative results.

Paul

Although I had SRT after surgery, not BT, it made my stricture/retention issues so much worse after the SRT. It was because of the high odds, that the decision to undergo SRT with a Suprapubic catheter made sense at the time.

david

Paul
Thanks for the response, having IMRT beforehand probably shrinks the prostate some.less seeds the smaller it is. That probably also helps with AUR.

So sorry to hear about your husbands problems ‘Logans Nana’.
Just wanted to say hi.
Hang on in there and believe things will get better - it is good that you are seeing the specialist next week. Hopefully the problem will be resolved very soon – sounds like he has been extremely unlucky.
Just sending you a hug from ‘over the pond’
Susan
x

Apparently, I have AUR.

I had HDR brachy in early 2012. After each session, they removed the catheter and made sure I could pee without problems before I left. Everything seemed fine, and I assumed that urinary retention would not be a problem. My prostate size was just 33g and didn't show much swelling from the procedures.

A year and a half later, June of this year, after rapidly rising PSA indicated possible PCa metastasis, I had a bone scan done. The doctor asked if I had voided before the test, and I said yes, completely. He then said I must be having some bladder trouble because my bladder looked very, very full. He suggested that the radiation may have caused some kind of stricture, but no one said I should get it looked at.

about a month ago I started having trouble than usual with a weak stream, frequency, urgency, etc. This hadn't been much of a problem before. So this week I went to my Uro who did a bladder scan, after I had voided as much as possible. The scan said I still had over 800 mL of urine in there, when the normal full capacity of a male bladder is about 500 mL (half a liter). He said that I would probably need to self-catheterize to keep my kidneys functioning correctly. The nurse got me a couple of catheters, showed me how to insert them (really embarrassing and strange with someone watching), and we got out over a liter of fluid.

FWIW, I never felt "full" or like I wasn't emptying completely, I would never have known there was a problem if not for the bone scan or the recent urinary issues, and I've probably had this problem for many months. My advice is that if you're having urinary trouble, make sure you see a urologist. The bladder scan was quick and painless.

I'm now doing what they call Intermittent Self Catheterization, 4 times a day. I'm hoping this is not for the rest of my life, but it sounds like it probably is. I don't know if there is a way to find the "stricture" and fix it or not. It's aggravating, a little painful, and extremely weird to do (You want me to put that really long tube where??), but I can live with it. Thankfully, I work from home most days - I'm not sure how I'll deal with it when I go to the office. And travel is likely to be more difficult. You need to have very clean conditions to prevent infection and take a fair amount of paraphernalia. I can't imagine trying to do this in a bathroom stall and keep things clean. Maybe I can run, half-naked, from a sink to a stall and back.

Ahh, the joys of PCa go on and on. Still, I'm doing well in the PCa fight and really have nothing to complain about. I'll trade daily tube stuffing for more years of life without question. It's also possible that this is the result of prostititis, which could also be responsible for the rapid PSA rise I've had. So I'm back to hoping I have an bad infection - much better than metastatic cancer.

If anyone has questions about this area, just let me know. I'm reading a lot about it, and I have a follow-up with my Uro next week. I plan to ask if this is permanent.

The good news is that I lost a little over 2 pounds in just a few minutes during my visit to the Urologist. I'm counting each of those pounds as progress toward my goals, and I'm now down 24 pounds instead of just 22! :)

Greg.

Oh my gosh, this is so empowering. I am still getting the hang of using a forum and just figured out how to set up the profile etc. so now my name is different and I am hopefully on the correct thread. I'm afraid I am just now getting used to our "new normal" in terms of life events. We knew we weren't getting what we needed from his urologist all this time and the feedback you are giving me confirms our suspicions. Part of it was geographical because the urologist is clear across town. I won't go into all the other factors here but suffice it to say we we've been spinning our wheels and hubby has not been getting the care he needs. We did some research, talked to his R O's assistant and got a referral (RO was on Vacation), have had his records sent to a urologist who specializes in urethral strictures. I will say that urologist #1 mentioned at one point (as he was rushing out of the room) that he might be a candidate for a supra-pubic catheter. As it stands we are fearful that there is a secondary problem now with all the pushing, pulling, overfilling of the bladder and oh, did I mention the UTI that went undetected because of busy doctor who was more focused on telling my husband all the reasons why he shouldn't be taking anything other than Tylenol for pain? I can practically count the number of times my husband has ever asked for a so much as a Tylenol in the 35 years I've known him and now he was being treated like a drug seeker.Now I am finding out there are other drugs that could have been offered to help him with the pain, burning, bladder contractions etc. The doctor even poo pooed the rash on his leg and NEVER educated us on the care of a catheter. Enough venting...I said I wasn't going to do that. We are doing our best to stay in the solution and appreciate all the advice and positive thoughts coming our way in regard to getting another opinion.

After watching what my husband has been going through and how brave he has been and reading how well the rest of you men cope, I swear I will NEVER do the eye roll and judge a man's "plumbing problems" as if it could never be as bad as what we women go through. I would take natural child birth over this any day! My prayers are with you all and thank you so very much for the "cyber hugs".
Nan P
aka Logans Nana

Nana,

I am the "resident expert" on all things catheters, including Suprapubic catheter use. I had endless stricture problems post surgery and was made even worse post radiation. I spent 1 1/2 years on a combination of 21 catheters, including nearly a year straight with a Suprapubic one. Underwent 6 ops for stricture relief, none of them ever lasted more than a couple of months. Have been the ER route for emergency catheters, which was a huge disaster.

Finally had to have my bladder by-passed with the ileal conduit surgery, and since 2010, I urinate via a stoma (Urostomy) into a plastic bag basically. It's been a horrible journey - that part.

So if you need any help or advice, be more than happy to assist in any way. I can honestly say, I know what your poor husband has been going through. For a very small percentage of men (2-4%) stricture and retention issues can be a permanent and chronic condition, like with me. Hope that won't be the case with your husband.

Just let me know,

David in SC