Introduction and Objectives
Prostate cancer is the most common onco-urologic pathology among males after age of 50.
At the time of their referral to medical institutions, some patients with locally spread prostate cancer show distinct signs of infravesical obstruction up to acute or chronic urinary retention. Catheterisation stays a standard procedure with proven effectiveness in the treatment of the above mentioned pathology.
Materials and Methods
Patients suffering from prostate cancer accompanied by acute urinary retention were treated in the Urologic Department of Lviv Regional Hospital (Ukraine) and in the Urologic Department of Woclaw Regional Hospital (Poland). The total number of 701 patients were examined, treated and analysed over the period of 2001-2006. The average age of patients is 66, 84 ± 4, 48 years of life. The average volume of the patients’ prostates before the beginning of treatment was 66, 9±7, 3 c/c. To achieve temporary removal of acute urinary retention all the patients had Foley catheter inserted. After that all the patients had (MAB) maximal androgen blockade. (flutamid (250 mg. 3 times a day). The effect of conservative treatment was estimated in 1,5; 2; 3 and 6 months criterion of involvement in the study was diagnosed prostate cancer with present acute urinary retention. The criteria of effectiveness: 1) Renewal of urination act; 2) Number of infection complications caused by catheterization; 3) PSA level; 4) Volume of the prostate, cm3
Results
Out of 701 patients 603 (86 %) – had independent urination act completely renewed over the period of 6 months after Foley catheter removal. The fact that needs attention is that during the first six weeks after the beginning of MAB the highest percentage of patients 476 (79%)
Effectiveness Criteria
| Term | 1.5 month | 2 months | 3 months | 4 months |
| Number of the patients Criteria | 701 patients | 225 patients | 159 patients | 123 patients |
| Volume of prostate (cm3) | 70 ± 4.2 | 70 ± 5.3 | 61 ± 3.2 | 58 ± 6.7 |
| Ability to urinate independently | 387 | 54 | 29 | 20 |
| PCA level (ng/ml) | 9.2 | 7.1 | 4.9 | 4.7 |
Characteristics of complications which occurred in the group of patients during the 6 months observation period (use of conservative therapy (MAB) with the application of urethral catheter).
| Term | 1.5 month | 2 months | 3 months | 4 months |
| Number of the patients Criteria | 701 patients | 225 patients | 159 patients | 123 patients |
| Infections of urinary tracts % | 4 | 5 | 8 | 11 |
| Acute orchiepididymitis % | 0.5 | - | 1 | 1 |
| Stricture of urethra % | - | - | 0.6 | 0.8 |
| Sclerosis of the neck of the urinary bladder % |
- | 0.4 | 1.3 | 0.8 |
Conclusions
Thus, the use of permanent catheter of the Foley type with 701 patients having prostate cancer with acute urinary retention for a period of 6-8 weeks from the beginning of MAB proved to be a quite effective and safe conservative method of treatment of infravesical obstruction caused by prostate cancer with 603 patients (86 %). The use of permanent Foley catheter for a period longer than 3 months is not expedient due to the occurrence of a number of complications and rather insignificant percentage of infravesical obstruction removal. Besides, limited number of patients, 98 patient (14%) need surgical methods of correction of the above-cited pathologic state and, in number of cases, correction is aimed at the removal of severe dysuria (TURP and its methods), which is confirmed by the results of our study.
Keywords
TURP, Acute Urinary Retention, prostate cancer