Prostate Seed Implantation (BrachyTherapy)
Post-Operative Seed Implantation Instructions
Occasionally, you will be discharged with a catheter for the first 24 hours and arrangements will be made for removal of the catheter. You will experience urinary frequency, urgency, weak stream, urine flow that is slow getting started, decreased urinary flow, blood in the urine, and, possibly, a burning sensation. Initially, over the first 24-48 hours, this is related to the seeding procedure itself, but especially with the placement of the catheter in the bladder. The medications that you will be given at discharge to manage these urinary symptoms include:
- *an antibiotic that will prevent infection in the prostate.
- *a pain medication such as Vicodin or Percocet.
- If your pain is mild, you can take Tylenol or Advil. Suggestions for over the counter medications that can assist with urinary burning/discomfort such as Azo Standard, Pyridium, or Pre-lief.
Over the following 6 weeks, the radioactive seeds will deliver half of the radiation dose which is responsible for increased inflammation in the prostate causing increased urinary symptoms. Your medications are prescribed to anticipate this increase in inflammation and must be taken according to the discharge instructions. You may feel that your urinary symptoms are extreme, although this is not uncommon in the first several weeks. If necessary, contact our office for further instructions. After 6 weeks following the seeding procedure, the radioactivity will be dissipating and your urinary symptoms should also start decreasing. We recommend you continue on the medications as prescribed until you are seen in followup. It will take approximately 4 months for all of the radioactivity to be delivered by the seeds, so it is common to have continued mild urinary symptoms for at least this amount of time. Inflammation in the prostate may continue for several months, so everyone is individual as to when all of the urinary symptoms will resolve.
You will also have a moderate amount of bruising in the perineal area (the area between the scrotum and rectum where the seeds have been placed). We recommend taking salt baths (sitting in warm, shallow water for 15-20 minutes), 2-3 times a day as needed to aid in comfort to this area. Avoid extremely hot water temperatures (greater than 100 degrees) since this may actually cause more discomfort in the area.
Activity restrictions include no horse back riding, bicycling or any other related activity that can potentially cause increased inflammation in the perineal area (causing more urinary symptoms). Avoid these activities for 6 weeks. Since the seeds are active for 6 weeks, no holding children or pets in your legs during this period.
Following the implant, dietary restrictions include avoidance of vitamin C or other supplements, since many are antioxidants; no caffeine, carbonated beverages, spicy foods, alcohol, citrus, tomato based foods, or decaffeinated tea or coffee (these have acids in them). These food items may cause increased urinary frequency and burning.
There is no restriction on close adult contact. Sexual activity is permitted, however, it is recommended to use a condom for the first 4 weeks, or first 2-3 times of sexual activity following the seeding procedure.
It is possible for a seed to be lost through the urine, or semen, after the seeding procedure, however, you do not have to strain your urine or retrieve any seed found. The seed(s) is to be flushed down the commode. The radioactivity contained within each seed is no danger to you or your household plumbing. so do not be concerned.
We encourage you to use a disposable urinal after discharge if you are planning on driving home for any extended distance in case it is needed for the frequent urination. We also recommend you purchase an inflatable cushion (donut) to sit on since you may experience mild discomfort sitting for up to one month post operation.
You will probably experience diminished, discolored, delayed and/or dry ejaculate for several months to a year, which may be permanent in nature. This may be an immediate phenomena, or delayed, but is considered to be a common side effect post seeding.
You can resume your pre-operation pain relievers. Please check with your doctor regarding the use of aspirin, plavix, coumadin, fish oil and vitamin E.
Problems you should report to your doctor:
- Fever of 101.5 degrees
- Inability to void
- Heavy bleeding or clots
Your doctor will instruct as to when you should return to the office. You should call his office to schedule the appointment.