Terk M D, Stock R G, Stone N N
Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York, USA.
J Urol. 1998 Oct;160(4):1379-82.
Urinary retention is a frequently reported complication following radioactive seed implantation of the prostate. If retention is refractory, a post-implant transurethral prostatic resection may ultimately be required to relieve obstruction, leading to an increased risk of urinary incontinence. In this series the incidence of prolonged urinary retention was determined, and the effect of pretreatment and treatment related factors was analyzed to identify high risk patients.
A total of 251 patients with organ confined prostate carcinoma underwent transperineal prostate seed implantation. Of the patients 114 were implanted with 103palladium (103Pd) and 137 with 125iodine seeds. Of the patients who were implanted with 103Pd 90 received 3 months of neoadjuvant hormonal therapy. All patients had International Prostate Symptom Scores (I-PSS) recorded before implantation to assess the degree of urinary symptoms. In the patients receiving neoadjuvant hormones prostate volumes and I-PSS were recorded before initiation of hormone treatment and 3 months later at the time of implant.
Urinary retention developed in 14 patients requiring catheterization for more than 48 hours. Median time to onset was 1 day after implant. Of these patients 6 ultimately required transurethral prostatic resection to relieve urinary obstruction. No patient had urinary incontinence following implantation or transurethral prostatic resection. Multivariate analysis revealed that pretreatment I-PSS, and combined treatment with hormonal therapy and 103Pd predicted for the development of retention. Patients with I-PSS 20 or greater had a 29% risk, I-PSS 10 to 19, 11% risk and I-PSS less than 10, 2% risk of retention. Neither patient age, clinical stage, prostate specific antigen, Gleason score, use of 125I nor prostate volume was significant. A subgroup analysis of patients receiving hormonal therapy and 103Pd revealed that those with persistent urinary symptoms (I-PSS 10 or greater) following 3 months of hormonal therapy had the greatest risk of prolonged retention (37%).
The overall risk of prolonged urinary retention following prostate implantation was low in our series. Using the I-PSS questionnaire, high risk patients can be identified before treatment. Patients with significant pretreatment urinary symptoms or persistent urinary symptoms following 3 months of hormonal therapy and then implantation with 103Pd have the greatest risk.
尿潴留是前列腺放射性粒子植入术后常见的并发症。如果潴留难以缓解，最终可能需要进行植入术后经尿道前列腺切除术以解除梗阻，从而增加尿失禁的风险。在本系列研究中，确定了长期尿潴留的发生率，并分析了术前及治疗相关因素的影响，以识别高危患者。
共有251例局限性前列腺癌患者接受了经会阴前列腺粒子植入术。其中114例患者植入了103钯（103Pd）粒子，137例植入了125碘粒子。在植入103Pd粒子的患者中，90例接受了3个月的新辅助激素治疗。所有患者在植入前均记录国际前列腺症状评分（I-PSS）以评估尿路症状的程度。在接受新辅助激素治疗的患者中，在开始激素治疗前及3个月后植入时记录前列腺体积和I-PSS。
14例患者发生尿潴留，需要导尿超过48小时。中位发病时间为植入后1天。其中6例患者最终需要行经尿道前列腺切除术以解除尿路梗阻。植入术后或经尿道前列腺切除术后无患者发生尿失禁。多因素分析显示，术前I-PSS以及激素治疗与103Pd联合治疗可预测潴留的发生。I-PSS为20或更高的患者发生潴留的风险为29%，I-PSS为10至19的患者为11%，I-PSS小于10的患者为2%。患者年龄、临床分期、前列腺特异性抗原、Gleason评分、125I的使用以及前列腺体积均无显著意义。对接受激素治疗和103Pd的患者进行亚组分析显示，激素治疗3个月后仍有持续性尿路症状（I-PSS为10或更高）的患者发生长期潴留的风险最高（37%）。
在我们的系列研究中，前列腺植入术后长期尿潴留的总体风险较低。使用I-PSS问卷，可在治疗前识别高危患者。术前有明显尿路症状或激素治疗3个月后仍有持续性尿路症状且随后植入103Pd的患者风险最高。
