Low Dose Seed Brachytherapy Side Effects

[electronics-guy]

I just finished low dose seed brachytherapy six days ago. Post op I’ve had severe urinary retention issues mainly in the middle of the night, usually for just a few hours. Not bad enough to go to the ER, but a few times I wondered if I might have to. For some reason, daytime is not so bad. I was previously on alfuzosin in the evenings for about a year so the RO kept me on that pre/post op. RO has me on Cialis in the mornings post op. Today RO changed me to Flomax 0.8mg (x2 normal dose) at bedtime in the hope of helping nighttime issues. Any ideas why it’s always at night, between 2-4AM, when the alfuzosin should be at its highest blood level? Before and after that time it’s not too bad (it’s always bad, but manageable since the procedure).

My other concern (as if being in acute urinary retention isn’t bad enough) is I’m still throwing blood clots (substantial and large) once or twice a day with considerable gross hematuria a few time afterwards. My question is: has anyone had LD Brachytherapy and how many days did you throw blood clots and have periodic very heavy gross hematuria?

RO did a UA with reflex to culture today. I did a home urine dipstick today and other than heavy blood showing on the dipstick indicator, everything else seemed normal. No fever. RO didn’t seem too concerned, I’m the one who is worrying. Any comments are welcome.

UPDATE: the 0.8mg Flomax made no difference in urinary retention. There is a window of about 2-4AM that I am almost in full retention. UA came back negative except for blood (saw it online). RO hasn't called yet. My question: is there ANY way Cialis could be causing it? I know it's suppose to help, but other than sleeping/laying down, that is the only other variable I can think of. The rest of the time I'm OK. Any thoughts?

Also looking into D/C beta-blocker I'm on. Read that they can cause urinary retention.

I'm actually contemplating staying up all night if D/C the Cialis does not work.

Something specific is causing it, I just haven't found it yet. Once I found out what it is, I can maybe find a way to fix it.

[Tall_Allen]

Gravity causes urine to flow better. Try a different alpha blocker until you find one that works for you. It will all go away soon.

[electronics-guy in reply to Tall_Allen]

Good idea. Also thanks for the encouragement "that it will all go away soon." I need to look at the glass as half full, which I haven't been doing.

[addicted2cycling]

Nothing to cure the issue but just a thought that has helped me numerous times -- Go stand in a shower or tub with hot water running on back of neck while leaning against the wall and relax.

[electronics-guy in reply to addicted2cycling]

Thanks, good idea. I will try that!

[cdj70]

Sorry to hear what you are going through. Sitting down to urinate really helped me to relieve retention and get things going especially at night. I eventually went up to 1 capsule 0.4mg tamsulosin in AM and 2 in PM to help with the retention and slow flow post LDR BT for about 2 months then tapered down. I doubt the cialis is cause of hematuria. I only had a little blood in urine for 1-3 days post.

[electronics-guy in reply to cdj70]

Another good idea! Thanks! I will also look into the 1 in the morning and 2 in the evening. That might help keep things open a little more evenly during the day/night.

[PopCubby]

I had 2 high dose Brachytherapy treatments a year and a half ago and one of the needles during my first treatment punctured my bladder. I couldn't urinate when I got home and spent 3 days in the hospital with an irrigating catheter. I passed many clots during that time. After 3 days, the catheter was removed and my urine was completely clear in a couple of days. I haven't had any issues since. I was told if the problem hadn't cleared, they would be able to perform a surgical procedure to stop the bleeding. I wonder if your bladder could have been punctured during the seed insertion. I also wonder if the problem is worse at night since you are not moving much and the clots settle.

[electronics-guy in reply to PopCubby]

The clots are thankfully easing up, so hopefully that isn't/wasn't the problem or it was small enough injury that it has healed up. Good thought that I'm not moving as much at night and the clots may settle. I may adjust my sleeping habits. Thanks!

[Volcanologist]

I had HDR Brachytherapy last year. I had bleeding for several weeks after treatment, and also had bleeding/clots for several months upon ejaculation. It all cleared up eventually. I don't have any experience with retention to share.

[electronics-guy in reply to Volcanologist]

Not that misery loves company, but knowing that you had some bleeding for quite a while afterwards makes me feel MUCH better that it's not just me. The bleeding is getting better, I guess I just expect too much too soon. Thanks.

[cancerfox]

I also had low dose seed brachytherapy but never had retention or blood clot issues. It may depend on the skill of the surgeon, or possibly the number of seeds being inserted. I did, however, have OAB and loose stools issues, and still do to some extent two years later. Fun times! 🦊

[electronics-guy in reply to cancerfox]

Thanks for response. He did place a Barrigel spacer (similar to SpaceOAR spacer) just after placement of the seed implants. I'm curious, did you have a spacer placed? On a side note, I just read the literature on both and they said spacers could cause retention. Does make sense in that the spacer is pushing slightly on the prostate.

[cancerfox]

No, I didn't have any spacers inserted. I didn't even know that was ever done for brachytherapy procedures, I thought it was just for external radiation sources. 🦊