Late urinary function after prostate brachytherapy

Purpose: To determine the relationship between short term and longer term morbidity following prostate brachytherapy. Methods and Materials: 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. Results: 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. Conclusions: 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.