PURPOSE: We assess the risk of urinary incontinence (UI) after TURP in patients previously treated with prostate brachytherapy.
MATERIALS AND METHODS: A total of 2,495 patients underwent brachytherapy with or without external beam radiation therapy for the diagnosis of prostate cancer between June 1990 and December 2009. Pre-implant patients TURP were excluded. Of these patients, 79 patients (3.3%) underwent channel TURP due to urinary retention or refractory obstructive urinary symptoms. Correlation analyses were performed using chi square (Pearson). Estimates for time to UI were determined by Kaplan Meier method with comparisons by logistic regression and Cox proportions hazard rates.
RESULTS: Median follow up after implantation was 7.2 yrs. Median time to first post-implantation TURP was 14.8 months. Twenty of the 79 (25.3%) post-implant TURP patients had UI compared with 3.1% for implantation only patients (odds ratio 10.4; 95% CI, 6-18; p< 0.001). Of the 15 patients who required more than 1 TURP, 8 (53%) developed UI compared with 19% of patients who had only 1 TURP (odds ratio 4.9; 95% CI, 1.5-16; p=0.006). Exclusion of patients with multiple TURPs still demonstrated significant differences (18.8% vs. 3.1%, odds ratio 7.1; 95% CI, 3.6-13.9; p< 0.001). Median time from last TURP to UI was 24 months. On linear regression analysis, hormone use and post-implantation TURP were associated with UI (p< 0.05). There was no correlation between timing of TURP after implantation and risk of incontinence.
CONCLUSIONS: Urinary incontinence developed in 25.3% who underwent TURP following prostate brachytherapy. UI risk correlates with the number of TURPs. Patients should be counseled thoroughly prior to undergoing post-implantation TURP.
Written by:
Mock S, Leapman M, Stock RG, Hall SJ, Stone NN. Are you the author?
Mount Sinai School of Medicine, New York, New York, United States.
Reference: J Urol. 2013 May 10. pii: S0022-5347(13)04345-0.
doi: 10.1016/j.juro.2013.05.010
PubMed Abstract
PMID: 23669568
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