A comparison of complications between ultrasound-guided prostate brachytherapy and open prostate brachytherapy

Purpose: Prostate brachytherapy has reemerged during the 1990s as a treatme nt for clinically localized prostate cancer. The renewed popularity of pros tate brachytherapy is largely due to the use of transrectal ultrasound of t he prostate, which allows for more accurate isotope placement within the pr ostate when compared to the open approach, The present study investigates w hether this improved cancer control is at the expense of increased morbidit y by comparing the morbidity after transrectal ultrasound-guided prostate b rachytherapy to the morbidity after prostate brachytherapy performed via an open approach. Methods and Materials: All men in the Medicare population who underwent pro state brachytherapy in the year 1991 were identified. These men were furthe r stratified into those men who underwent prostate brachytherapy via an ope n approach and the men who underwent prostate brachytherapy with ultrasound guidance. All subsequent inpatient, outpatient, and physician (Part B) Med icare claims for these men from the years 1991-1993 were then analyzed to d etermine outcomes. Results: In the year 1991, 2124 men in the Medicare population underwent pr ostate brachytherapy, An open approach was used in 715 men (33.7%), and ult rasound guidance was used in 1409 men (66.3%). Mean age for both cohorts wa s 73.7 years with a range of 50.7-92.8 years for the ultrasound group and 6 0.6-92.1 years for the open group, A surgical procedure for the relief of b ladder outlet obstruction was performed in 122 men (8.6%) in the ultrasound group and in 54 men (7.6%) in the open group. An artificial urinary sphinc ter was placed in 2 men (0.14%) in the ultrasound group and in 2 men (0.28% ) in the open group. A penile prosthesis was implanted in 10 men (0.71%) in the ultrasound group and in 4 men (0.56%) in the open group. A diagnosis c ode for urinary incontinence was carried by 95 men (6.7%) in the ultrasound group and by 45 men (6.3%) in the open group. A diagnosis code for erectil e dysfunction was carried by 90 men (6.3%) in the ultrasound group and by 6 4 men (9.0%) in the open group. Conclusion: Prostate brachytherapy performed with ultrasound guidance does not appear to increase significantly complications resulting from the proce dure. Both techniques appear to offer similar rates of procedures performed to correct urinary incontinence, bladder outlet obstruction and erectile d ysfunction. The limitations of claim information in determining patient out comes, however, must be considered when evaluating this data. (C) 2000 Else vier Science Inc.