Post Radiation Urinary Flow Problem

[deemac]

Three years ago, in Feb 2000, I had seed therapy followed by external beam radiation. I've had difficult and painful urination on 8mg Cardura 1xday in the evening for the most part of the past 3 yrs when it was recommended to increase my dosage to 12mg 1xday in the eveing. That worked wonderfully for awhile, no pain, good flow. My normal urinary frequency has remained steady at 8-10 episodes during the day with 2-3 in addition during the night. Three weeks ago I awoke in the morning and could not pass urine. After an hour, I took a 12mg dose of doxazosin along with 2 advil and started to flow again in 3 hours. I was pretty much back to normal that day and into the next (aside from a small blood spotting) but I had to go 10 times that night and when I woke up I had alot of difficulty so I again took another morning dose of 12mg and 2 advil and within an hour my flow was fairly normal. The next 3 days were ok and then I again awoke and could not flow. I took 8mg and 2 advil and this did not help at all so I repeated the 8mg at noon and the advil at 6pm and in an hour my flow was back to normal with no increase in nighttime voiding. My G.P. has tested for infection and found none but gave me a 7 day Cipro program which seemed to help since I had no real problems during that regimen. Last nite (2 weeks after my last shutdown) it happened again. It started at 7pm and I did not flow again until 9am the following morning without much straining and difficulty. After taking a total of 20mg during the night this did not help. A urologist has given me a post void residue test and said I was retaining alot of urine in my bladder and recomended Indigo Laser treatment because I probably have a blockage, but everything I've read about this says its for use with BPH so I'm unsure since this urologist is a surgeon who does not do radiation. Do you think this might work for me or do you recommend some other treatment?

[Kevin Pho, MD]

Hello - thanks for asking your question.

You have already been evaluated by physicians - please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only.

Late complications of seed therapy include irritative voiding symptoms, persistent urinary incontinence or retention, rectal urgency, bowel frequency, rectal bleeding or ulceration, prostatorectal fistulas, and impotence.  Persistent urinary retention, requiring intermittent or long-term urinary catheterization, and other complications such as cystitis and urethral strictures are less frequent, occurring in fewer than 5 percent.

Treatment of the urinary retention depends on the cause.  Urethral strictures is a side effect of radiation treatment.  If this is the case, then urethral dilatation may be an option.  Other options include self-catheterization or placement of a urethral catheter.  If the radioactivity from the seeds has sufficiently dissapated, then resection of the prostate may be considered.      

A recurrance of the prostate cancer should also be considered.  This is normally monitored by the PSA.  If the urologist has determined that recurrance is likely and is causing your symptoms, then salvage prostatectomy should be considered.

Most of the data regarding laser therapy is in the setting of BPH.  I cannot cite any data regarding the efficacy of laser treatment in prostate cancer.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.