The need for a urinary catheter after prostate brachytherapy (permanent seed implant) is a well-recognized risk and generally happens in 10% to 15% of men. The risk is higher for men who have a larger prostate, especially those who had trouble voiding beforehand. Problems such as a very slow or intermittent stream, or inability to fully empty the bladder, have been shown to increase the risk.
If one does require a catheter after the procedure, in one-third of cases it’s only for a few days. Or the problem may last between one week and a month a third of the time, and in another third of cases (as in your situation), it will last longer than a month.
The management of urinary retention following brachytherapy will vary a little from one practice to another. My own approach is to leave an in-dwelling catheter, such as you have had, for no more than three to five days. We use alpha blockers such as tamsulosin (Flomax®) or doxazosin (Cardura®) to help you recover your voiding, and also anti-inflammatories such as meloxicam (Mobicox®) or ibuprofen (Advil®, Motrin®) to reduce the swelling in the prostate. You may have to be on both types of medications for several weeks or months. If you are unable to void satisfactorily when the catheter is removed, then we teach “intermittent clean self-catheterization.” Most men master this fairly easily and avoid the discomfort of having a long-term in-dwelling catheter. You keep a record of how much you’re able to void on your own and, three or four times a day, insert a very small clean catheter to relieve the bladder of what you’re unable to pass on your own. As your urinary function improves, the number of times per day that you have to pass the catheter decreases. Physical exercise and relaxation techniques can both be helpful in improving the flow. With this regimen, the vast majority of men will be voiding spontaneously within a few weeks.
In rare cases where self-catheterization is not possible, a supra-pubic tube should be inserted. This prevents scarring of the urethra by long-term catheterization, as well as irritation and sensitivity of the penis. It also allows frequent trials to see if you can void “the normal way,” simply by clamping the supra-pubic tube. Throughout this, alpha blockers and anti-inflammatory medication should be continued.
Anyone who isn’t voiding spontaneously within six months should have a cystoscopy by an experienced urologist.
