Late urinary function after prostate brachytherapy

To determine the relationship between short term and longer term morbidity following prostate brachytherapy.

Patients completed the American Urological Association (AUA) questionnaire at the time of initial clinical evaluation. Most patients underwent pre-implant uroflowmetry and postvoid residual (PVR) via transcutaneous ultrasound. Seventeen patients were treated with palladium-103 (29%) and 44 were treated with iodine-125 (71%). Follow-up ranged from 31 to 35 months.

Twenty-one of 52 patients (43%) developed postimplant urinary retention, almost always within 24 h of the procedure, and were generally managed by intermittent self-catheterization. By 2 years, all cases of retention had resolved spontaneously, and no patient required a surgical procedure to relieve urinary obstruction. Preimplant AUA score, age, and transrectal ultrasound volume did not correlate with time in retention. There was no clear relationship between long-term changes in AUA scores and preimplant transrectal ultrasound volume, age, preimplant AUA scores, postvoid residual, maximum urinary flow rates, or use of beam radiation or hormonal therapy.

Although there is no shortage of unsubstantiated claims regarding predisposing factors to postimplant morbidity, the risk of urinary retention and long-term urinary dysfunction is probably multifactorial in nature and only crudely defined by known clinical variables.