Acute urinary toxicity following transperineal prostate brachytherapy using a modified Quimby loading method.

PURPOSE: To examine the acute urinary toxicity following transperineal prostate implant using a modified Quimby loading method with regard to time course, severity, and factors that may be associated with a higher incidence of morbidity. METHODS AND MATERIALS: One hundred thirty-nine patients with prostate adenocarcinoma treated with brachytherapy from 1997 through 1999 had follow-up records available for review. Patients considered for definitive brachytherapy alone included those with prostate specific antigen (PSA) < or = 6, Gleason score (GS) < or = 6, clinical stage < T2b, and prostate volumes generally less than 40 cc. Patients with larger prostate volumes were given neoadjuvant antiandrogen therapy. Those with GS > 6, PSA > 6, or Stage > T2a were treated with external beam radiation therapy followed by brachytherapy boost. Sources were loaded according to a modified Quimby method. At each follow-up, toxicity was graded based on a modified RTOG urinary toxicity scale. RESULTS: Acute urinary toxicity occurred in 88%. Grade I toxicity was reported in 23%, grade II in 45%, and grade III in 20%, with 14% requiring prolonged (greater than 1 week) intermittent or indwelling catheterization. Overall median duration of symptoms was 12 months. There was no difference in duration of symptoms between patients treated with I-125 or Pd-103 sources (p = 0.71). After adjusting for GS and PSA, multivariate logistic regression analysis showed higher incidence of grade 3 toxicity in patients with larger prostate volumes (p = 0.002), and those with more seeds implanted (p < 0.001). Higher incidence of prolonged catheterization was found in patients receiving brachytherapy alone (p = 0.01), with larger prostate volumes (p = 0.01), and those with more seeds implanted (p < 0.001). CONCLUSION: Interstitial brachytherapy for prostate cancer leads to a high incidence of acute urinary toxicity, most of which is mild to moderate in severity. A prolonged need for catheterization can occur in some patients. Patients receiving brachytherapy alone, those with prostate volumes greater than 30 cc, and those implanted with a greater number of seeds have the highest incidence of significant toxicity.

Obstructive uropathy in patients with benign prostatic hyperplasia.

In an attempt to determine the role of obstructive prostatic hyperplasia as a cause of irreversible renal function the records of 32 men with a diagnosis of benign prostatic hyperplasia and renal failure were reviewed. Patients were classified as either having a serum creatinine of more than or less than 4 mg.per 100 ml. when they were discharged from the hospital. Admission serum creatinine levels were comparable in both groups. Characteristics of the group with permanently impaired renal function included a longer mean duration of symptoms, higher incidence of urinary tract infection, lower average volume of residual urine and greater incidence of small kidneys with increased parenchymal echogenicity. These data assist in the objective prediction of patients who will have irreversible renal dysfunction when presenting with obstructive benign prostatic hyperplasia.

Urinary lithiasis in the black population: an epidemiological study and review of the literature.

A retrospective review of 199 black patients with urinary calculi and review of the census figures of the index hospitals revealed that white patients had urinary calculi 3 to 4 times as often as black subjects. The black male-to-female ratio was 1 to 1.55 compared to a ratio for white patients of 2.3 to 1. Calculi in black male subjects occur at a younger age than in black or white female or white male patients. The most common organisms cultured in black patients with stones were Escherichia coli and Proteus mirabilis. In contrast to the white population the most common type of stone formed in black patients was struvite/carbonate apatite. Stones of this type accounted for a third of all stones in male and 44 per cent in female subjects. We conclude that nephrolithiasis is an uncommon but not rare disease in the American black population.

The in vitro effects of Salmonella enteriditis on urinary stone formation.

Salmonella enteriditis has been previously found to have both unique inhibiting and augmenting properties on urinary stone formation. A series of in vitro experiments were performed in order to determine if the in vivo results could be explained in an in vitro model. Urinary phosphorus was measured before and after incubation with various bacteria, and was found to increase significantly when incubated with S. enteriditis (p less than 0.05). Urinary citrate was measured in a similar fashion following incubation with S. enteriditis and E. coli. A statistically significant decrease in urinary citrate was found in urine incubated with S. enteriditis (p less than 0.005). Based on the results of these experiments the increase in urinary phosphorus may have contributed to the inhibiting foreign body stone formation in a previous in vivo model. The decrease in urinary citrate could explain the augmentation of calcium phosphate stone formation previously reported.