Devastating complications after brachytherapy in the treatment of XXXX .

@entity1 @entity295 @entity263 @entity1494 @entity5 @entity1822 @entity292
OBJECTIVE: To report a retrospective chart review of @entity1 who developed @entity292 ( @entity292 ) or several @entity1494 ( @entity1494 ) recurrences after brachytherapy for treating @entity263 . @entity1 AND METHODS: In the past 3 years 18 @entity1 with devastating complications after prostate brachytherapy were referred to our centre ( @entity292 in 11, @entity1494 in seven; mean age 63 years, range 60-81). All @entity1 with @entity292 initially underwent diverting colostomy (six cystoprostatectomy with closure of the @entity292 , omental interposition and urinary diversion; one prostatectomy, @entity1494 closure, @entity292 closure with omentum flap and continent vesicostomy). Three @entity1 had the @entity292 closed with gracilis muscle flap using the York-Mason approach (one had a @entity1494 closure and suprapubic tube; one elected to have no treatment). All @entity1 with @entity1494 had received three or more procedures to resect or incise their contracture. Four had diversion with a catheterizable segment, two used an indwelling Foley catheter and one uses intermittent catheterization. RESULTS: All six @entity1 who had cystoprostatectomy with urinary diversion have had no recurrence of their @entity292 . All three treated with the York-Mason procedure healed well. One developed recurrent @entity263 and two a secondary @entity5 in the prostate or rectum ( @entity1822 and neuroendocrine, respectively). The enterocystoplasty @entity1 developed @entity295 after colostomy reversal and subsequently died. In those @entity1 with @entity1494 , the four who underwent urinary diversion fared well; two tolerate the indwelling catheter poorly, and the seventh uses intermittent catheterization with occasional difficulty. CONCLUSIONS: Brachytherapy with or without external irradiation can be associated with severe complications. @entity292 managed with aggressive anterior pelvic exenteration and urinary diversion can be associated with excellent results. The York-Mason procedure in @entity1 with an adequate urinary continence mechanism and bladder dynamics may provide good functional results. The presence of a secondary malignancy in @entity1 deserves further investigation. Many recurrences of a @entity1494 tend be refractory to transurethral resection/incision; indwelling catheters are then poorly tolerated and @entity1 may require a major reconstructive procedure.
