Patients who have received brachytherapy with or without external beam radiation have incontinence rates of 18 to 70 percent after transurethral resection of the prostate (TURP) [ 20-22 ].
What is the rate of incontinence after pelvic radiation therapy?
Purpose: Local therapy for prostate cancer (PCa) includes radical prostatectomy (RP) and radiotherapy (XRT), both of which share a complication of urinary incontinence. Post-treatment incontinence has been reported to occur 6-69%, yet no truly patient-centered report has been compiled. We evaluated patient-reported incontinence rates and bother scores after treatment …
How common is post-treatment incontinence after prostate cancer treatment?
The published rates of late new-onset faecal incontinence after pelvic radiation are between 3% and 53%. Patients treated for prostate rather than gynaecological, bladder, rectal or anal cancer may have a lower rate. Only 8-56% of affected patients state that faecal incontinence reduces their quality of life.
Should urinary diversion be used after irradiated prostate cancer?
Urinary incontinence is the primary urinary side effect for men undergoing a prostatectomy (surgery). About 25 percent of men report frequent leakage or no control at six months. Radiation treatment also causes issues with incontinence. External beam radiation can irritate both the urethra and the bladder causing swelling of the prostate.
What causes urinary incontinence after radical prostatectomy?
Some men may dribble urine, whereas others may experience a total leakage. Loss of urine with a cough, sneeze or laugh is called stress incontinence …
Does radiation treatment for prostate cancer cause incontinence?
How long does incontinence last after radiation treatment?
Radiotherapy can irritate both the bladder and the urethra, causing inflammation or swelling of the prostate. Most symptoms lessen over time with little or no intervention: Nearly 45% of men report irritative voiding symptoms after six months, and the majority resolve by one year.
How long does incontinence last after prostate radiation?
Does radiation therapy cause incontinence?
After radiation therapy, you may need to pass urine more often, particularly at night, or feel as if you need to go in a hurry. You may leak a few drops of urine when you cough, sneeze, laugh or strain.
Does prostate radiation cause frequent urination?
What percent of men are incontinent after prostate removal?
Can radiation cause bladder problems?
Can radiotherapy shrink your bladder?
What is double voiding?
How do you control male urinary incontinence?
- Take Care of Your Prostate.
- Don't Smoke.
- Lose Weight.
- Exercise Your Pelvic Floor.
- Fill Up on Fiber.
- Cut Back on Caffeine and Alcohol.
- Keep Good Bladder Habits.
How do you stop incontinence after prostate removal?
- Pelvic floor exercises. ...
- Supportive care. ...
- Medication. ...
- Neuromuscular electrical stimulation. ...
- Surgery, injections, and devices. ...
- Artificial sphincter. ...
- Bulbourethral sling.
What is the most common type of incontinence?
There are several types of incontinence, the most common of which are stress incontinence and urge incontinence: Stress incontinence is the involuntary leakage of urine when coughing, sneezing, straining, or doing anything that puts stress on the abdomen. This is the most common type about prostate cancer survivors.
What is the loss of bladder control?
Urinary incontinence is the loss of bladder control, ranging from some leaking to complete loss of bladder control. Symptoms may include pain, increased urgency, and urinary frequency. Urinary incontinence and its symptoms can be caused by a number of factors. However, they are typically caused by damage to the nerves and muscles ...
What is the purpose of a med for bladder pain?
Medications may be prescribed to decrease involuntary bladder contractions and improve urinary flow, control urgency, pain, and leakage
What is bladder training?
Bladder training which consists of scheduled bathroom trips at specific times to retrain your bladder
Can you live a long life with bladder cancer?
Most men experience quick improvement over the first several months. However, there are ways to manage long-term incontinence and live a full life.
Can radiation cause urinary incontinence?
About 25 percent of men report frequent leakage or no control at six months. Radiation treatment also causes issues with incontinence. External beam radiation can irritate both the urethra and the bladder causing swelling of the prostate.
How does radiation affect the bladder?
Radiation can decrease the capacity of the bladder and cause spasms that force urine out. Surgery can, at times, damage the nerves that help control bladder function.
What is it called when you have to pee after radiation?
On the other hand, the need to frequently urinate with episodes of leakage, called urge incontinence, is the type seen most often after radiation treatment. Doctors continue to improve treatments for prostate cancer to reduce post-surgery and post-radiation incontinence.
What is the tube that allows urine to flow out of the bladder?
Urine flows out of the bladder, and leaves the body through a tube called the urethra . Urination happens when the muscles in the wall of the bladder contract, forcing urine out of the bladder. At the same time, muscles that surround the urethra relax and allow the flow of urine. The prostate gland surrounds the urethra.
How does the bladder hold urine?
The bladder is a hollow, muscular, balloon-shaped organ. Urine flows out of the bladder, and leaves the body through a tube called the urethra. Urination happens when the muscles in the wall of the bladder contract, forcing urine out of the bladder. At the same time, muscles that surround the urethra relax and allow the flow of urine. The prostate gland surrounds the urethra. Because an enlarged prostate gland can obstruct the urethra, it can cause urination retention or other problems with urination.
What is it called when you lose your urine?
Some men may dribble urine, whereas others may experience a total leakage. Loss of urine with a cough, sneeze or laugh is called stress incontinence and is the most common type of urine leakage men experience after prostate surgery.
What is the best treatment for urinary leakage?
In the near future, newer medications may become available to help stop some other forms of urinary leakage. Neuromuscular electrical stimulation. This treatment is used to retrain and strengthen weak urinary muscles and improve bladder control.
How to improve bladder function?
Surgery, injections, and devices. A number of additional techniques may improve bladder function. I ncontinence products such as pads can also make you feel more comfortable.
How to treat prostate cancer?
The main treatment choices for men with clinically localized prostate cancer are radical prostatectomy, external beam radiotherapy, radioactive seed implants (i.e., brachytherapy), and conservative management . However, because there are few direct comparisons of these treatments, there is continuing disagreement and uncertainty about the relative efficacy of these forms of disease management ( 3 – 5 ) . Results of a large, randomized clinical trial suggested that, compared with “watchful waiting,” radical prostatectomy reduced disease-specific mortality but had statistically significantly greater adverse impacts on sexual and urinary incontinence and no effect on overall survival ( 6 , 7 ) . Presently, there are no completed trials that directly compare the long-term survival of men treated with surgery versus radiotherapy, leaving the question of survival benefit unanswered. In the absence of such survival comparisons, understanding the risks of adverse health-related quality-of-life side effects up to 5 years after treatment may help men better decide between surgery and radiotherapy.
How long does prostate cancer last?
Men who are diagnosed with localized prostate cancer live many years with the sequelae of the treatments they receive ( 1 , 2 ) . Given this reality, it is important that men and their clinicians understand the long-term consequences of various treatments on health-related quality of life.
How is prostate cancer treated?
Treatment for clinically localized prostate cancer has changed since 1994–1995, when our cohort was initially diagnosed and treated. Improvements in surgical and beam radiotherapy techniques and dissemination of newer treatments, such as brachytherapy and androgen deprivation therapy, may produce health outcomes that differ from those we observed. Compared with surgery, brachytherapy may be associated with lower rates of incontinence but greater transient problems with urinary obstruction and irritation while having similar long-term effects on sexual and bowel function ( 28 , 32 ) . Androgen deprivation therapy is also becoming more commonly used as primary therapy for clinically localized disease ( 33 – 35 ) but has substantial adverse effects on sexual function and on general health-related quality-of-life domains ( 35 , 36 ) . In addition, the long-term use of androgen deprivation therapy has been associated with obesity and a decrease in bone density ( 37 ) . Updated prospective studies among patients from community-based settings that compare complications from all of the available treatment options for men with clinically localized disease are needed.
What is PCOS in cancer?
The Prostate Cancer Outcomes Study (PCOS) was designed to address these limitations by prospectively assessing the long-term health-related quality-of-life outcomes for a large, diverse, population-based sample of men who were diagnosed with prostate cancer in 1994 or 1995 and treated in a community-based setting ( 10 ) . The PCOS assembled an extensive dataset of clinical and sociodemographic variables by using patient self-reports as well as reviews of inpatient and ambulatory medical records. Several previous reports have used PCOS data to provide detailed information on the 2-year experiences of men with clinically localized cancer who underwent radical prostatectomy, external beam radiotherapy, or androgen deprivation therapy ( 11 – 14 ) . In this study, we compared treatment-specific and general health outcomes among men who were initially treated with radical prostatectomy or external beam radiotherapy and completed the 5-year survey, adjusting the estimated differences between the two groups for multiple clinical prognostic factors, pretreatment disease-related function and comorbidity, and demographic and socioeconomic variables.
How many measures of bother due to sexual dysfunction are there?
Table 2 lists the six separate measures of bother due to sexual dysfunction that we examined. There were no statistically significant differences between treatment groups for any of these measures. However, overall sexual function was problematic for men in both treatment groups: approximately 41%–62% (based on the adjusted percentages in Table 2 ) of the entire study cohort reported being bothered by various aspects of their sexual function. The highest concerns reported were for achieving or maintaining an erection, satisfying one's spouse or partner, and the lack of sexual enjoyment.
Does bowel function change after a prostatectomy?
Overall , there was very little change in bowel function from year 2 to year 5 after diagnosis. In cross-sectional estimates of bowel dysfunction at 5 years (Table 1 ), men who received external beam radiotherapy had worse outcomes at 5 years than men who received radical prostatectomy. However, only two measures, bowel urgency and painful hemorrhoids, were statistically significantly worse in external beam radiotherapy patients (29% and 20%, respectively) compared with radical prostatectomy patients (19% and 10%, respectively) at 5 years.
How to treat radiation-associated bladder toxicity?
Suggested treatment options comprise simple bladder irrigation, cystoscopic fulguration, intravesical treatment with alum or formalin, hydrodistention, or hyperbaric oxygen therapy (39). Internal iliacal artery embolization can be taken into consideration if hematuria is intractable and contraindication exist regarding a definite surgical solution with cystectomy. However, success rate vary widely and a non-neglectable amount of patients is prone to further interventions (40).
What is the definition of urinary diversion?
Urinary diversion is defined as a surgically applied continent or incontinent mechanism for urine release after functional or disease-specific requirement of surgical intervention and removement of the natural anatomy of the urinary tract system. Foley catheterization and percutaneous nephrostomies are usually included in this definition (9). However, this review will mainly focus on long-lasting, definite types of urinary diversion.
Can a cystoprostatectomy be used as a urinary diversion?
Cystectomy with urinary diversion can be seen as the last resort of end-stage bladderfollowing radiation therapy and reduced quality of life due to persisting patients' suffering. Urinary diversions in form of (ileum)-conduit and ureterocutaneostomies were preferred types of urinary diversion in most studies (41–43). In a retrospective review by Faris et al. (n= 30), analyzing treatment patterns of patients undergoing urinary diversion following radiation therapy for prostate cancer, four out of five end-stage bladderpatients (80%) underwent cystectomy with conduit diversion. Conversely, suprapubic catheter was placed in the remaining 20%. Similar distributions could be observed for patients suffering devastated-bladder outletor a combination of both in this case series (41). In line with these findings, Sack et al. demonstrated in a case series of 15 patients undergoing urinary diversion following radiation therapy of prostate cancer, that cysto(-prostat)ectomy followed by a ileum conduit was the most frequently administered type of urinary diversion in this cohort (88%) (43). Ureteroileal stricture is more often seen in irradiated patients undergoing ileal conduit as a form of urinary diversion. Gontero et al. (44) demonstrated an ureteroileal stricture rate of 9.4%, whereas, non-irradiated control groups presented with significant less rates (45). One should bear in mind, that this was a case series of 643 patients receiving a cystectomy with a radiation therapy due to different oncological tumors (prostate cancer, bladder cancer, colon cancer).
Does radiation cause bladder toxicity?
Radiation therapy of the pelvic structures is in general associated with bladder toxicity as a specific type of iatrogenic damage of the bladder. This holds especially true for prostate cancer treatment, which is usually performed with 74–80 Gy in primary prostate cancer treatment (2, 26). Besides urinary tract infections following radiation therapy, radiation-induced cystitis is a common challenging side effect of radiation therapy. This radiation therapy-induced cystitis is mainly related to DNA-damage associated endarteritis, including bladder hypoperfusion, which leads to mucosal atrophy, hypocellularity, and hypovascularity (27, 28). Patients suffering from hemorrhagic cystitis can present with mild intermittent hematuria. Conversely, also recurrent, progressive, and uncontrollable bleeding can end in life threatening situations.
Is radiation therapy a treatment for prostate cancer?
It is of note that technical developments of radiation therapy took place within the recent years with respect to more precise delivery of the dosage and hypofraction was introduced for the treatment of prostate cancer. These developments may hopefully translate into less occurrence of end-stage bladders in the future and makes it crucial for reassessment of the radiation therapy-related data in the following years.
Can prostate cancer cause pain?
Chronic pubic pain is a common symptom following surgical and non-surgical prostate cancer treatment. However, prolonged episodes of pain should raise suspicion and physicians should consider the above-mentioned diseases as its origin for the patient's suffering. Furthermore, recurrent urinary tract infections and voiding discomfort can also occur as additional symptoms (17).
Can prostate cancer be treated conservatively?
The vast majority of complications following prostate cancer treatments across all stages can be successfully treated conserva tively with a significant increase of patients' quality of life. Unfortunately, a small proportion of patients suffers of ongoing (chronic) complications, leaving patients, and Urologists in a bothersome and frustrating situation. Urinary diversion can be seen as an ultima ratiofor this subgroup of complex cases. The recent literature consists of small case series and expert recommendations (6–8). However, no current clinical trials or guideline recommendation exist to provide an evidence-based approach for those patients with a persisting reduction of quality of life.
What is RT in prostate cancer?
Radiotherapy (RT) is one of the treatment options available for patients affected by prostate cancer (PCa); it is indicated for primary treatment, in an adjuvant regime, or in the setting of salvage treatment after biochemical recurrence postradical prostatectomy [1,2]. However, adverse events may occur acutely or during follow-up due to toxic effects on the gastrointestinal (GI) and/or of the genitourinary (GU) systems.
How long did the median follow up for PCA patients last?
The median follow-up of the patients was 36 months (IQR: 18.75–49.25). Most of the patients harbored intermediate (40%) and high risk (33.75%) PCa according to the National Comprehensive Cancer Network risk stratification [2]. In 97.5% of the cases, a three-dimensional conformal RT was undertaken, with a median fractionation of 1.8 Gy. The demographics of patients are detailed in Table 2.
What is RC in radiation therapy?
Radiation-induced cystitis (RC) includes bladder toxicities of Grade ≥2 according to the Radiation Therapy Oncology Group (RTOG) classification and refers to different degrees of low urinary tract symptoms (LUTS) and haematuria [3].
How many patients have RC?
Incidences of RC reported in literature range between 2% and 59% of patients treated for pelvic cancers: this wide range may be due to the heterogeneity of definitions adopted in literature, which may include acute and/or late toxicities, or even all types of RC (including bladder loss capacity, LUTS, etc.) or just the subgroup of the radiation-induced haemorrhagic cystitis (RHC) [4,5].
What is RT in medical terms?
Patients with radiation therapy (RT) for other diseases
How to treat bowel dysfunction after radiation?
Short of treating individual symptoms as needed, there are few, if any, treatment options for bowel dysfunction following radiation therapy. Laser therapy can stop rectal bleeding caused by radiation. Anti-diarrheal agents can help with loose bowel movements. Increasing fiber intake through whole grains, fruits and vegetables, ...
How rare is rectum damage?
Damage to the rectum is rare (<2 to 3%), and the bowel changes seen in the first few weeks following surgery are more likely the result of the body adjusting to the increased abdominal space with the loss of the prostate.
What are the side effects of external beam radiotherapy?
Diarrhea or frequent stools. Fecal incontinence or the inability to control bowel movements. Rectal bleeding. All of these side effects are far more common following external beam radiotherapy than any other primary therapy, but as techniques and dose planning strategies improve, even these rates have been dropping.
Can radiation damage the rectum?
Radiation therapy can cause significant damage to the rectum, resulting in any and all of the symptoms above. Standard external beam radiotherapy blankets a wide area with radiation, although this area has decreased with modern dosimetry and radiation techniques.
What type of radiation is used for prostate cancer?
The main types of radiation therapy used for prostate cancer are: External beam radiation. Brachytherapy (internal radiation) (Another type of radiation therapy, in which a medicine containing radiation is injected into the body, is described in Treating Prostate Cancer Spread to the Bone .)
What is the best treatment for prostate cancer?
Brachytherapy (internal radiation therapy) 1 Brachytherapy alone is generally used only in men with early-stage prostate cancer that is relatively slow growing (low-grade). 2 Brachytherapy combined with external radiation is sometimes an option for men who have a higher risk of the cancer growing outside the prostate.
How does proton beam therapy work?
Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.
Why do you put a balloon between your prostate and your rectum?
Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum. Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis.
What is EBRT radiation?
In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.
What is IGRT prostate?
Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy (IGRT), lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming.
Can brachytherapy be used for prostate cancer?
Brachytherapy alone is generally used only in men with early-stage prostate cancer that is relatively slow growing (low-grade). Brachytherapy combined with external radiation is sometimes an option for men who have a higher risk of the cancer growing outside the prostate.