Urological group practice & Urology Inpatient Department

BEFORE IMPLANTATION

No special preparations or behavioral measures are required before LDR brachytherapy. Please bring all documents from your treating physicians (biopsy results of the prostate, blood values, all PSA values and your medication plan) to the initial consultation.

WE ARE HAPPY TO ADVISE YOU

PREOPERATIVE DIAGNOSIS BY THE UROLOGIST

We take our time, conduct a detailed consultation and give you individual advice on:

We will discuss the treatment options appropriate to the stage (radical surgery, external radiation, permanent seed brachytherapy – possibly in combination with external radiation, anti-hormonal treatment) and explain their advantages and disadvantages to you.
We will then draw up an individual treatment plan.
If your treatment plan has already been drawn up, we will be happy to conduct a detailed second opinion consultation.

In all consultations, we strictly follow the guidelines of the European and German Urological Societies and the Association of Radiotherapy Specialists (ABS).

For a personal consultation, you are welcome to make an appointment at the brachytherapy consultation hours using the telephone number provided.

UROLOGIE EMMENDINGEN
Urological group practice
& Urology Inpatient Department

Dr. med. Stefan Carl
Dr. med. Michael Meilinger
Dr. med. Johannes Andreas

Phone: +49 76 41 / 63 64
E-mail: praxis@urologie-emmendingen.de

Pdf-Download
Info flyer on the subject of brachytherapy

Diagnostics to rule out other concomitant urological diseases

Medical history, physical examination, urine and blood tests (PSA) and ultrasound are carried out. An X-ray examination of the kidneys and urinary tract or cystoscopy is usually not necessary.
If the PSA value is > 10 ng/ml, a bone examination by a nuclear medicine doctor (= skeletal scintigram) and a CT scan of the small pelvis will be arranged.
Alternatively, a PSMA-PET can also be carried out. In these cases, we will promptly refer you to specialized centers.
Once all the findings have been assessed, we will draw up an individual treatment plan with you.

PREOPERATIVE DIAGNOSIS BY THE FAMILY DOCTOR/INTERNIST

Pre-operative diagnostics by your family doctor/internal medicine specialist As part of the pre-operative clarification, please also bring all findings relating to other illnesses with you

Blood sample before surgery (blood count, coagulation values – possibly additional values)
Resting ECG
In the case of serious pre-existing conditions, additional examinations (heart/lung specialist) if necessary
Blood thinners must be discontinued or changed before LDR brachytherapy in consultation with the family doctor.

PERSONAL PREPARATION FOR THE HOSPITAL STAY

One to two weeks before the treatment, you will see the anesthetist with all the documents from your family doctor (laboratory results, ECG, any specialist findings, allergy pass, blood-thinning medication card, current medication list).
To place the seeds in the prostate with millimetre precision, a general or partial anaesthetic is recommended. The anesthetist will discuss the various anesthetic options with you in detail and suggest the best anesthetic procedure for you.
Laxative measures are not necessary, as an enema will be inserted immediately before the treatment to cleanse the bowel.
Medication should be taken as usual. We will provide you with your medication during your stay as an inpatient.

What happens on the day of implantation

ON THE DAY OF IMPLANTATION

The procedure takes place on the day of admission. If you have a long journey, you can of course also be admitted to the hospital the afternoon before.

The perineal and anal region is shaved immediately before treatment.
Surgical procedure: You will be placed on the operating table under general anesthesia. A bladder catheter is inserted through the urethra. In close cooperation between the urologist, radiotherapist and radiation physicist, the prostate is precisely imaged in order to place the seeds with millimeter precision. In Emmendingen, we have developed a special three-dimensional computer-assisted procedure that places the seeds in the tumor and the surrounding prostate tissue with millimetre precision.
After sterile washing and covering of the surgical region, the seeds are inserted sterilely into the prostate from the perineum (position between the base of the penis and rectum) using hollow needles under ultrasound guidance. The seeds, made of titanium, remain in the prostate. This is therefore referred to as permanent brachytherapy. The radiation fades after about a year. After all the seeds have been inserted, the bladder is X-rayed and the correct position of the seeds is checked.

The treatment lasts between 60 and 90 minutes. The treatment is always carried out in a team consisting of specially trained urologists, radiotherapists and radiation physicists. It requires intensive communication between the specialists at every stage of treatment, as the situation is individual for each patient. This enables us to achieve the best possible result for each patient
The implantations are carried out at the Emmendingen District Hospital

Kreiskrankenhaus Emmendingen

What happens after implantation

AFTER IMPLANTATION IN HOSPITAL

Sleep in the recovery room under the care of the anesthesia team
Inpatient stay for two days: monitoring of your state of health, administration of painkillers is usually not necessary, general care by our specialized nursing team
Daily ward rounds by the urologist in charge
You will be able to get up again on the evening of the procedure and eat light, full meals and drinks
Removal of the urinary catheter inserted during the operation the morning after the operation

Sonography check of the residual urine volume and the kidneys before discharge
You will be discharged on the second day after the operation
On the day of discharge, you will receive a prescription for decongestant medication and a substance to facilitate urination as well as an aftercare pass.
The application for rehabilitation measures such as follow-up treatment must be made in hospital. Please let us know on the day of admission if you wish to undergo rehabilitation; our social worker will prepare all the application forms for you.

GENERAL NOTES

Arrival and departure are possible without an accompanying person, our hospital has a large parking garage.
We will issue a sick note during your inpatient stay.
When eating, please pay attention to fiber-rich products with as little meat as possible to prevent constipation. Please ensure that you drink enough fluids, 1.5 liters a day.
You can shower as usual and also take full baths.
There are no restrictions on your physical capacity.
You can continue to take your medication as before the operation. Blood thinners can be taken as usual on the third post-operative day.

AFTER IMPLANTATION

After implantation of the seeds, life continues without major restrictions.

You will receive a permanent seed implantation certificate (accompanying document after application of enclosed radioactive substances in the form of iodine 125 seeds), which you can show at the airport or during examinations in the first year after treatment if required.
In the first few weeks after treatment, you may experience temporary discomfort when urinating, i.e. burning urine, urinary urgency and frequent urination. In these cases, we are available to you personally at any time and can prescribe medication to alleviate the symptoms.
Horse riding and cycling should be restricted for three months. All other sporting activities such as walking, jogging, skiing, cross-country skiing, golf and swimming can be resumed immediately.

There are no concerns about sexual activity. Reddish or brownish discolored seminal fluid is a consequence of the treatment, a temporary phenomenon and completely harmless.
It is recommended not to hold babies or small children on the lap for longer periods of time for the duration of one year (radiation), hugging and carrying around are possible without restriction.
Contact with pregnant women in close quarters (physical contact) should be restricted for at least the first six months.

CARE BY PRACTICING PHYSICIANS

CARE BY PSYCHO-ONCOLOGISTS / PSYCHOLOGISTS

Postoperative therapy is carried out according to our standardized aftercare plan.

Outpatient appointment with the referring urologist in the first week after discharge from hospital, then regular follow-up appointments every three months
Consultation, examination, urine/ultrasound checks, possible initiation of additional drug therapy, possible initiation of rehabilitation measures, possible contact with a psycho-oncologist / psychologist / social worker
Carrying out a follow-up CT scan six weeks after treatment: each seed used is reassessed and assigned a corresponding radiation dose. This is compared with the radiation dose determined intraoperatively. This procedure is used for internal quality control. Examination results carried out externally should be sent to our center as a CD.
Presentation to the radiotherapist:
As a rule after six months and after one year following therapy

At the request of the patient and/or partner, contact can be arranged with a psycho-oncologist/psychologist. This can provide support in coming to terms with the illness and help with mental stabilization after being confronted with the diagnosis of cancer.

INITIATION OF REHABILITATION MEASURES

Rehabilitation treatment can be initiated at the patient’s request. Follow-up treatment must be initiated during the inpatient stay. Please inform us on the day of admission if you wish to undergo rehabilitation.

Urological group practice & Urology Inpatient Department