Post prostrate radiation problems

  My husband had radiation implants and external radiation for prostate cancer 3 years ago.  He has had continuous bladder problems since.  Incontinence to retention requiring home catherizations.  Last Nov.  he developed a pseudomonas bladder infection.  3 doctors later and 3 rounds of antibiotics and we are still on step 1. He is allergic to quinolones.  He just finished 2 weeks tazicel IM for 2 weeks.  Followed by Piparacillin 4 gm ivpb q 6hr for 2weeks.  Followed by gentamycin 160me iv daily and geocillin 382 mg po tid for one week.  Infection still present .l  Currently awaiting next plan of care.  Any suggestions?  Are we going in the right direction?  I am completly frustrated.  Incontinence continues with hematuria and pus.  Has not needed catheterizatioon since beginning of last tx.  Thanks,  Jean

[hfhs M.D.-AK]

Dear Jean,
Incontinence is a known complication of radiation therapy for prostate cancer.  Unfortunately, there is no good method to remove the prostate without the risk of incontinence.
In regards to the bladder infection.  A good culture and sensitivity of the urine should establish an antibiotic or antibiotics that can eradicate your husbands infection, this is called a sensitivity profile of the infecting bacteria.  Certainly the medications you discussed are effective and many are effective for psudomonas, but they must be used in proper sensitive situation, at the right dose, and used for a long enough time.  Once a full course of antibiotics has been used, a repeat urine culture and sensitivity must be repeated to see if the infection was completely treated.  If it was, periodic repeat cultures should be performed.  If not treated, maybe a consultation with an infectious disease physician would be indicated.
Finally, a work-up of the urinary tract should be performed to rule out any anatomic abnormalities, stones, or potential areas of obstruction.  This may consist of an IVP and Cystoscopy, or other indicated studies.
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