RESUMEN
An 80-year-old man with history of prostate cancer successfully treated with brachytherapy was initially thought to have Fournier's gangrene until imaging detected a rectoprostatic fistula. Although this is known to be a rare complication of prostate brachytherapy, in this case the aetiology was a new primary rectal adenocarcinoma. It was not possible to catheterise per urethra owing to the fistula, so he was fitted with suprapubic catheter, and underwent palliative loop colostomy. Brachytherapy carries a low risk of second primary cancers, although two previous cases reported such cancers as radiation induced. This is, to our knowledge, the first case of rectal adenocarcinoma following prostate brachytherapy in the literature.
Asunto(s)
Adenocarcinoma/patología , Braquiterapia/efectos adversos , Neoplasias Inducidas por Radiación/patología , Próstata/patología , Neoplasias de la Próstata/radioterapia , Fístula Rectal/patología , Neoplasias del Recto/patología , Recto/patología , Adenocarcinoma/inducido químicamente , Adenocarcinoma/diagnóstico por imagen , Anciano de 80 o más Años , Humanos , Masculino , Neoplasias Inducidas por Radiación/diagnóstico por imagen , Cuidados Paliativos , Próstata/diagnóstico por imagen , Próstata/efectos de la radiación , Fístula Rectal/inducido químicamente , Fístula Rectal/diagnóstico por imagen , Neoplasias del Recto/inducido químicamente , Neoplasias del Recto/diagnóstico por imagen , Recto/efectos de la radiación , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to identify factors at presentation that can help to predict outcomes and guide subsequent management decisions in patients with acute on chronic retention. MATERIAL AND METHODS: The medical notes of 187 consecutive patients presenting with urinary retention at two teaching hospitals between 2008 and 2009 were reviewed. All patients were followed up for a minimum of 3 years. All patients were catheterized at presentation. The majority then underwent one or more of trial without catheter (TWOC), transurethral resection of the prostate (TURP) (both considered successful if the patient voided with a subsequent postvoid residual volume of <200 ml on three successive occasions) or long-term catheterization. Patient factors such as age, associated acute kidney injury (AKI), performance status, residual volume, prior lower urinary tract symptoms (LUTS), treatment of LUTS, diagnosis of diabetes and neuropathy were recorded. RESULTS: Increasing age (p = 0.002) and increasing residual volume (p = 0.046) were associated with a significant increase in the failure of TWOC. The rate of AKI increased significantly with residual volume (p < 0.0001). As residual volume increased so did the likelihood that a patient would undergo TURP (p = 0.0009). Age did not appear to influence the outcome of TURP (p = 0.17). Increasing residual volume did not significantly reduce the likelihood of successful TURP (p = 0.068). CONCLUSIONS: High residual volumes should not preclude TURP. There is a clear correlation between AKI and residual volume. Increasing age and residual volume both reduce the likelihood of successful TWOC.