Hu K, Wallner K
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, NY, USA.
Int J Radiat Oncol Biol Phys. 1998 Mar 1;40(4):783-6. doi: 10.1016/s0360-3016(97)00928-0.
To determine urinary morbidity in patients who have transurethral resection of the prostate (TURP) after 125I brachytherapy.
A total of 109 patients with Stage T1-T2 prostatic carcinoma were treated with 125I implantation from 1991 through 1995. Ten patients underwent TURP/transurethral incision of the prostate (TUIP) after brachytherapy to relieve urinary obstruction refractory to nonsurgical management.
Patients who developed refractory urinary retention had a slightly larger preimplant prostate volume than those who did not (62 vs. 54 ml; p = 0.16). Seven of the 10 patients developed some degree of permanent urinary incontinence following TURP/TUIP. Urinary incontinence was mild in three patients [Late Effects Normal Tissue Radiation Oncology Group (LENT) score = 1] and severe in four additional patients (LENT score = 3). There was no obvious relationship between the degree of incontinence and use of TURP vs. TUIP, amount of tissue resected, or time between brachytherapy and TURP/TUIP. In five patients for whom detailed urethral radiation dose information was available, the doses were higher than generally recommended.
Permanent urinary incontinence is common in patients who require a TURP or TUIP after prostate brachytherapy. Its cause is apparently multifactorial and may include the degree of physical damage to the urinary sphincters and the radiation dose to the urethral region.
确定接受¹²⁵I近距离放射治疗后行经尿道前列腺切除术（TURP）患者的泌尿系统发病率。
1991年至1995年期间，共有109例T1-T2期前列腺癌患者接受¹²⁵I植入治疗。10例患者在近距离放射治疗后接受了TURP/经尿道前列腺切开术（TUIP），以缓解非手术治疗难以控制的尿路梗阻。
出现难治性尿潴留的患者植入前前列腺体积略大于未出现者（62 vs. 54 ml；p = 0.16）。10例患者中有7例在TURP/TUIP后出现了一定程度的永久性尿失禁。3例患者尿失禁较轻[晚期效应正常组织放射肿瘤学组（LENT）评分为1]，另外4例患者尿失禁严重（LENT评分为3）。尿失禁程度与TURP与TUIP的使用、切除组织量或近距离放射治疗与TURP/TUIP之间的时间无关。5例可获得详细尿道放射剂量信息的患者，其剂量高于一般推荐剂量。
前列腺近距离放射治疗后需要进行TURP或TUIP的患者中，永久性尿失禁很常见。其原因显然是多因素的，可能包括尿道括约肌的物理损伤程度和尿道区域的放射剂量。
