What options do you have when a patient has urinary obstruction during radiation treatment?

Here is my general practice on urinary symptom management for a man with prostate cancer undergoing RT.

Urinary symptom management

• RT can decrease urinary symptoms in men with irritable urinary symptoms (Malik et al., PMID 20643513) - not sure of the mechanism, but it takes time to see the IPSS drop ...

Managing severe lower urinary tract voiding symptoms, including obstructive symptoms, can be challenging. It's important to enlist our colleagues in urology early on to optimize management, and sometimes urodynamic studies are needed to better define the nature of the problem. Some patients with sev...

@Dr. First Last covers the territory of this issue very well. Just a few other points: one should be cautious using any form of anticholinergic since complete obstruction may occur. Only use anticholinergics for voiding symptoms once an obstructive condition is ruled out by urodynamics/postvoid resi...

Also, don't forget to check your imaging studies if available or a CT sim film for bladder stones. Patients can form stones that can act as ball valves. These types of stones are usually painless, and small ones can often become lodged in the urethra and be otherwise asymptomatic. This is an uncommo...

Given the very low risk of incontinence in comparison to TURP (also low, but real), I am quick to introduce UroLift either prior to or following radiation treatment for men with bladder outlet obstruction. I have a series of patients whom I treat with both UroLift and rectal spacing together prior t...

In my experience with short-term (1–2-year) follow-up, several patients have achieved successful BPH symptom management after Aquablation without complications. The significantly reduced use of thermal cautery compared to standard TURP seems particularly advantageous in post-radiation cases.