Ask a doctor on the topic of Urology

Prostate cancer - urethral obstruction after radiation therapy

March 24, 2014 | 30,00 EUR | answered by Dr. med. Kathrin Hamann

Dear Sir or Madam,

last year my father was treated for prostate cancer. He is 70 years old. The end of the treatment was on 31.07.2013 (after 42 days of radiation).

Key points of the treatment:

- In June + July 2013: 42 days of radiation for prostate carcinoma
- After that, recurring urinary retention - initially with a urethral catheter, later with a suprapubic catheter since the beginning of September 2013
- Antibiotics were repeatedly administered due to bladder infections
- In the months of October, November, December, January, 60% of urine could be drained normally - 40% through the suprapubic catheter
- Starting from December 20, 2013, Methionine was taken - slow improvement in infections and frequent severe bleeding in urine
- Since January 25, 2014, normal urination is no longer possible - total urinary retention - everything must be emptied through the suprapubic catheter
- Since February 10, 2014, no antibiotics have been taken
- The PSA level dropped to 0.11 by March 7, 2014
- Urinary retention has been ongoing for about 8 weeks
- 8 months have passed since the end of radiation
- Pain in the perineal area has developed since the end of radiation and continues to this day
- The attending urologist is not yet ready to operate (incision or opening of the urinary retention) and recommends prioritizing a necessary surgery on the left hip (due to pain).

My father is now interested in getting a second opinion:

1. We would like your evaluation of the current course of treatment.
2. When is surgery of the urethra for urinary retention advisable, and which surgical approach offers the best chances of success nowadays?
3. Without intervention, can the urethra dry up and stick together - does surgery need to be performed soon?
4. Is there a general rule for how long one should wait after radiation before surgery, and which surgery should be prioritized (hip or urethra)?

We kindly request a detailed and informative response - thank you in advance.

Best regards,

Dr. med. Kathrin Hamann

Good day, I am happy to help you further.

1. Assessment of the current situation:
This course of events seems quite plausible to me and not necessarily unusual. Of course, the current complete urinary retention is not good, but also not uncommon after so many radiation treatments and considering the medical history.

2. When is surgery for the urethra due to urinary obstruction advisable, and which type of surgery currently offers the best chances of success?
I would wait at least 6, preferably 10 months before considering such a procedure, as the tissue is still very sensitive due to the radiation and could tear. However, surgery may not be necessary at all, as bougienage, which involves gently dilating the urethra, can be done after just six months.

3. If no intervention is done, could the urethra dry out and become stuck together, prompting the need for surgery soon?
This can happen, but often takes more than a year. Nevertheless, I would recommend bougienage to prevent this.

4. Is there a general guideline on how long one should wait after radiation treatments before undergoing surgery, and which surgery should potentially be prioritized (hip or urethra)?
As mentioned, it is advisable to wait at least 6, preferably 10 months after radiation treatments to allow the tissue to recover and stabilize. In this case, I would recommend following your urologist's advice and prioritizing the hip surgery first. This is because better mobilization can be achieved after the bladder procedure once the hip is back to normal.

Do you have any questions on this? I am happy to help.

All the best and speedy recovery!

Best regards,
Dr. K. Hamann