Cystourethroscopic findings before and after prostate brachytherapy.

Abstract

Purpose: To assess the role of cystourethroscopy in predicting the risk of postimplant urinary retention.

Materials and methods: Fifteen unselected prostate brachytherapy patients implanted with 125I or 103Pd under spinal or general anesthesia were studied. Following induction of anesthesia, the patient was placed in the lithotomy position and cystourethroscopy performed using a 17 sheath and a 30 degrees lens. Irrigation pressure was 100-cm water. A photograph was taken from the level of the verumontanum. At completion of the implant procedure, a second cystourethroscopy was performed and another photograph taken. The degree of obstruction was rated using a 3-point scale. Each patient was contacted at the time of this report to update postimplant morbidity information with follow-up from 1 to 10 months.

Results: The patients' preimplant cystourethroscopic findings ranged from minimal to complete occlusion. There was no clear relationship between the American Urologic Association (AUA) score or preimplant prostate volume and the degree of obstruction. Nearly all patients had some increased physical obstruction following completion of the procedure, but only 8 of 14 patients had an increase in obstruction grade. Six patients were completely obstructed at the completion of the implant procedure, only one of whom developed urinary retention.

Conclusions: Marked variability in cystourethroscopy findings do not appear to have a strong influence on the likelihood of postimplant urinary retention and are not a reliable predictor of retention.