External beam radiotherapy with indwelling catheter

Is there anyone out there who has had a course of radiotherapy while
having a catheter installed.

If so, what has been your experience during the immediate post
radiotherapy period?

Ten days after the radio ended, my prostate gives no pain but the pain
in my urethra, at certain points, particularly the last 2 inches of
penis, has become almost unbearable these past two evenings. I have
taken various mild analgesics but to no effect.

On Mar 11, 6:23 am, John <> wrote:
> Is there anyone out there who has had a course of radiotherapy while
> having a catheter installed.
>
> If so, what has been your experience during the immediate post
> radiotherapy period?
>
> Ten days after the radio ended, my prostate gives no pain but the pain
> in my urethra, at certain points, particularly the last 2 inches of
> penis, has become almost unbearable these past two evenings. I have
> taken various mild analgesics but to no effect.

John, I had a urethral catheter inserted during my INITIAL CT scan and
MRI
that were filled with scan sensitive material. It was used to identify
the
urethra in the prostate with respect to the prostate gold seed markers
so
the beam dose can be programmed to be less around it. During the
actual 5 treatments (this is high does SBRT), I have a rectal balloon
inserted
for each treatment. Towards the last one, I think that the irritation
from it
as possibly the radiation itself caused hourly rectal urgency which
lasted for
2 weeks. It went away after that. My urine flow also burns for about
the first
week after the 5th treatment (an aside: isn't that weird that the
penis and tip,
which is relatively far away from the beam paths feel that effect?).
That is all
the SE I got so far. Oh I forgot, ejaculation also caused burn
feelings.

I think your burning feelings is mostly due to the irritation of
having that tube
inserted as many times in as many days. It will probably be gone in
another
1-2 weeks unless you somehow get an infection, a possibility which you
should check with the Onc if this is suspected!

"cmdrdata" <cmdrdata@mail.com> wrote:
>
>John, I had a urethral catheter inserted during my INITIAL CT scan and
>MRI
>that were filled with scan sensitive material. It was used to identify
>the
>urethra in the prostate with respect to the prostate gold seed markers
>so
>the beam dose can be programmed to be less around it. During the
>actual 5 treatments (this is high does SBRT), I have a rectal balloon
>inserted
>for each treatment. Towards the last one, I think that the irritation
>from it
>as possibly the radiation itself caused hourly rectal urgency which
>lasted for
>2 weeks. It went away after that. My urine flow also burns for about
>the first
>week after the 5th treatment (an aside: isn't that weird that the
>penis and tip,
>which is relatively far away from the beam paths feel that effect?).
>That is all
>the SE I got so far. Oh I forgot, ejaculation also caused burn
>feelings.
>
>I think your burning feelings is mostly due to the irritation of
>having that tube
>inserted as many times in as many days. It will probably be gone in
>another
>1-2 weeks unless you somehow get an infection, a possibility which you
>should check with the Onc if this is suspected!


Many thanks for the feedback - have to go now but will reply properly
in a few hours' time.

<John> wrote in message news:mss7v217adpg5v2hu77ofgs56ifeqnknvd@4ax.com...
> Is there anyone out there who has had a course of radiotherapy while
> having a catheter installed.
>
> If so, what has been your experience during the immediate post
> radiotherapy period?
>
> Ten days after the radio ended, my prostate gives no pain but the pain
> in my urethra, at certain points, particularly the last 2 inches of
> penis, has become almost unbearable these past two evenings. I have
> taken various mild analgesics but to no effect.

There was a catheter installed during my high dose rate
brachytherapies (two of them). The catheter went in
before the treatment and came out about two hours after.
I had no painful sensations in the penis afterwards.

I agree with cmrdata that the radio beams should have
been pretty far from the end of the penis. I think you
should call your rad onc about this and ask for advice.

Alan

John wrote:
> the pain has become almost unbearable these past
> two evenings. I have
> taken various mild analgesics but to no effect.

I can't address your real questions, but I can urge this: hie thee to
your doctor and get some serious pain meds. There's no reason to be in
serious pain these days with little things like radiation burns, kidney
stones, leg transplants, etc.

I.P.

"cmdrdata" <cmdrdata@mail.com> wrote:
>
>John, I had a urethral catheter inserted during my INITIAL CT scan and
>MRI
>that were filled with scan sensitive material. It was used to identify
>the
>urethra in the prostate with respect to the prostate gold seed markers
>so
>the beam dose can be programmed to be less around it. During the
>actual 5 treatments (this is high does SBRT), I have a rectal balloon
>inserted
>for each treatment. Towards the last one, I think that the irritation
>from it
>as possibly the radiation itself caused hourly rectal urgency which
>lasted for
>2 weeks. It went away after that. My urine flow also burns for about
>the first
>week after the 5th treatment (an aside: isn't that weird that the
>penis and tip,
>which is relatively far away from the beam paths feel that effect?).
>That is all
>the SE I got so far. Oh I forgot, ejaculation also caused burn
>feelings.
>
>I think your burning feelings is mostly due to the irritation of
>having that tube
>inserted as many times in as many days. It will probably be gone in
>another
>1-2 weeks unless you somehow get an infection, a possibility which you
>should check with the Onc if this is suspected!


The first point to make is that I am in the UK where we take a more
conservative view of acceptable x-ray fluxes.

This is the first time I have come across these sensible-sounding
refinements to basic, conformal EBRT. (IMRT is being trialled at the
hospital I attended but for breast cancer and not the prostate
version).

My treatment was a series of 35 doses, administered over 7 weeks on
weekdays only (Sat and Sun were recovery days). After only three
treatments, I knew I was about to go into acute retention (my flow,
previously, was pretty poor). When I pointed this out to the team,
they decided to stop the course, put in a catheter, re-do the CT scan
and reference marks, replan the treatment and restart the course after
ten days.

The precautions taken over here are nothing like as sophisticated as
the impressive ones taken in your case, with gold seed references and
a rectal balloon. All I was told was to make sure that, when I got on
the treatment table, I needed to have a comfortably full bladder and
an empty bowel, the former keeping the latter out of harm's way. I
should add that my cancer was on the border between T2 and T3, with
MRI evidence of slight breaching of the capsule.

The new situation with the catheter gave me very little time to
experiment with estimating the amount of urine in my bladder at any
time. I had a tap between the catheter and the graduated leg-bag and
was able to do practice tests to enable me to discern the difference
between the two bladder 'signals' - the urge to pee and the urge to
expel the catheter. As things turned out, I was just about 'spot on'
in ensuring that the amount of urine in my bladder was the same as had
been in it when the CT calibrating scan was done. But it was very
stressful, trying to get it right - and encouraging when, after each
treatment, I found, on checking, that I had got it right.

Sorry about the length of the above.

Now, about the pain in the penis - I was told that this is referred
from the prostate, there being a nerve pathway between the two. That
makes sense in two ways - first, the obvious sexual one and, second,
the fact that, almost instantaneously, the pain can switch from one
part to the other. It also seems to be the case that I get mostly one
or the other on alternate days.

Another odd thing is that the prostate pain responds to analgesics but
the penis pain doesn't.

One source of pain is probably the fact that bladder urgency causes
fairly regular injections of small amounts of urine down the outside
of the catheter.

I find this disorientating because this behaviour, and bladder urgency
(no urgency at the back end, so far) seem so unpredictable and
erratic. I also confess that I've been surprised, and unprepared for
the intensity of pain after having sailed serenely through the 7 weeks
of treatment.

I've gone on at too great a length but I've found it hard to glean
much about people's experiences of EBRT with an indwelling catheter.

--

Thanks, Alan, too, for your response. I'm afraid my oncologist has
almost zero detailed knowledge of such specialised urinary issues.
She specialises in breast cancer but I have had a certain amount of
advice from specialist urology nurses. The plain truth seems to be
that very few people have a catheter in during treatment and very few
of those who do pass on their experiences to others.

Many thanks for your helpful responses.