However, a subset of patients experience persistent LUTS and Dr. Jerry Blavias and associates from Cornell University characterize this group of patients in a report in the BJU International.

A database of patients with LUTS persisting more than 6 months after brachytherapy was amassed from two practice settings; one community-based and one from a tertiary referral center. Patient evaluations consisted of a history, physical exam, IPSS, cystoscopy and video-urodynamics (VUDS). Bladder outlet obstruction (BOO) was defined as a grade >2 on the Schaefer nomogram.

In the community-based practice, 16 of 160 consecutive men who had brachytherapy developed troublesome LUTS persisting >6 months after treatment. In addition, 31 men in the referral practice were retrospectively identified and combined for a total of 47 men. Clinical data did not differ between the two patient groups. 79% and 71% of patients reported overactive bladder symptoms and incontinence, respectively. Obstructive symptoms existed in 44% and dysuria in 26%. Thirty-three men had VUDS and cystoscopy and 8 men had cystoscopy alone. Urethral obstruction was found in 24 of 33 men (73%) at VUDS. All 8 men who only had cystoscopy had urethral strictures increasing the total with urethral obstruction to 78%. At least 8 of 32 patients (25%) had low bladder compliance, however it was not possible to fill the bladder of most patients to capacity due to pain and thus bladder compliance could not be accurately measured in all. Cystoscopy demonstrated prostatic and/or membranous urethral strictures in 54%.

Comparing the VUDS findings in men with unselected causes of LUTS vs. LUTS caused by brachytherapy showed detrussor overactivity in 47% vs. 85%, respectively and urethral obstruction in 69% vs. 73%, respectively. The much higher finding of detrussor overactivity and urethral strictures found in brachytherapy treated patients compared to non-brachytherapy causes of LUTS is limited by the retrospective, observational study design and lack of a denominator to determine exact overall incidence. Furthermore, lack of validated outcomes measures and pre-treatment symptoms do not make risk analysis for these outcomes possible.

Jerry G. Blaivas, Jeffrey P. Weiss, Mark Jones

BJU International 98 (6), 1233-1237

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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