Seed loss through the urinary tract after prostate brachytherapy: examining the role of cystoscopy and urine straining post implant

Abstract

This study describes one institution's experience with seed retrieval through the urinary tract and makes recommendations for cystoscopy and urine straining post prostate brachytherapy (PB). 1794 patients from two separate cohorts covering different time periods (early versus late) were analyzed. All patients were preplanned with a modified peripheral loading technique and implanted with preloaded needles (125I or 103Pd) under ultrasound guidance. A catheter was used to delineate the urethra during the volume study but was not used during the implant. All patients underwent post implant cystoscopy. All patients were instructed to strain their urine for seven days post implant and return any seeds to our center. In our experience, seed loss through the urinary tract is a common event after PB, occurring in 29.7% of patients and was more common in patients from the early cohort, those implanted with 125I seeds or those patients with prior transurethral resection of the prostate. Average seed loss per case, however, represents only 0.58% of total activity. We continue to recommend routine post implant cystoscopy for seed retrieval and periprocedural management. We no longer recommend that patients strain their urine at home after documenting a low rate of seed loss after discharge.

Occupational Radiological Protection in Brachytherapy

“…Those groups using ultrasound guidance alone are expected to receive lower occupational doses. (164) There are several radiological protection considerations during permanent seed implantation, including: minimising exposure to the operator’s hands; inventory control; minimising large dose-delivery errors; detecting contamination or leaking seeds; and monitoring loading trays after seed handling. Many of these actions are integral elements of an overall brachytherapy quality management system (see Section 5.7). (165) Verification of the number of seeds used has proven to be a common problem with permanent implants (Stutz et al., 2003). Inventory control is essential at all points of pre-treatment planning through implementation.…”

“…(165) Verification of the number of seeds used has proven to be a common problem with permanent implants (Stutz et al., 2003). Inventory control is essential at all points of pre-treatment planning through implementation.…”

Prostate brachytherapy seed migration to the right coronary artery associated with an acute myocardial infarction

“…Plain film radiography of the head and abdomen did not demonstrate additional seeds. It is possible that the two seeds that remained unaccounted for could have been voided in the urine or stool or migrated to parts of the body that were not scanned (6).…”

Injectable polypeptide micelles that form radiation crosslinked hydrogels in situ for intratumoral radiotherapy

“…Improper spatial placement of seeds can also cause the unfortunate side effects of urinary incontinence, sexual discomfort, and seed migration. In addition, studies have shown that dislodged titanium seeds commonly migrate to other organs in the body, although most are safely passed in the urine with discomfort akin to a kidney stone body [13–15]. Finally, titanium seeds remain permanently implanted in the patients after completion of therapy.…”