Urinary side effects and complications after permanent prostate brachytherapy: the MD Anderson Cancer Center experience

Abstract

Editorial CommentThe authors describe herein their results with perineal urethrostomy as a permanent solution for complex stricture disease. In men such as those with hypospadias who have undergone multiple prior failed procedures it avoids the physical and psychological trauma of yet another attempt at repair. In men with long segment dense stricture disease, especially if due to lichen sclerosis, it avoids the morbidity of a 2-or 3-stage repair with several grafts. I have also found this procedure to be a good option in elderly men with multiple comorbidities who have moderate strictures and would not be able to tolerate a substitution urethroplasty under general anesthesia. Additionally, if suffer stenosis of their perineal urethrostomy it is far simpler for them to perform serial dilation through this short tract than through the penis. I commend the authors for working to assess patient satisfaction and quality of life. As they state, patient-derived outcomes assessment will become the standard of care in this field as it has in many others. Dr. Sean P. Elliott Department of Urology SurgeryUniversity Objectives: To evaluate acute and long-term urinary morbidity after permanent prostate brachytherapy at a single tertiary care center. To minimize the risk of long-term urinary morbidity, it is important for clinicians to be able to distinguish acute urinary side effects after prostate brachytherapy from longer-term treatment-related urinary complications. Methods: The medical records of 351 consecutive patients who underwent prostate brachytherapy at the MD Anderson Cancer Center between 1998 and 2006 were analyzed. To evaluate the short-term urinary side effects, the Expanded Prostate Cancer Index Composite questionnaire was administered at baseline and at 1,4,8, and 12 months. Long-term urinary complications were scored using a modified Radiation Therapy Oncology Group scale. Results: All 4 urinary subdomain scores evaluating acute urinary side effects after treatment (bother, function, incontinence, and irritation or obstruction) had returned to baseline levels by 8 months after implantation. At 5 years, the cumulative risks of late urinary complications by grade were 8.6% for grade 1 complications, 6.5% for grade 2, 1.7% for grade 3%, and 0.5% for grade 4. The most common grade 2 late urinary complications were urethral stricture (4 patients), incontinence requiring daily pads (3 patients), and intermittent hematuria (3 patients). Grade 3 complications were urinary retention requiring self-catheterization (2 patients) and severe frequency with dysuria (2 patients). The only grade 4 event was severe hemorrhagic cystitis. Conclusions: Short-term urinary side effects after prostate brachytherapy are common, follow a predictable course, and typically resolve within 1 year. Conservative management of short-term urinary side effects is recommended to minimize the risk of long-term urinary complications.