Your Guide to Brachytherapy: The University Hospital, Newark, NJ

Your urologist's office will schedule your procedure with the University Prostate Brachytherapy coordinator. All pre-registration and insurance information is provided at that time. However, you may receive a call from University Hospital's financial counselors to verify the information is correct.

The Coordinator will contact you to introduce herself and her role in your care at the Brachytherapy Center. She will provide you with a brief overview of the surgical treatment plan as well as the process from Pre- Admission to discharge. You will be given a contact number for the University Brachytherapy Program including a 24-hour pager, and directions to the facility.

An appointment for pre-admission testing is also made at this time. Your physician orders preoperative tests to ensure your safety during the procedure and your pre-admission testing must be completed one week prior to your day of surgery. These tests include blood work, an EKG, and CXR. A note from your primary medical doctor may be required depending on your medical history.

Pre-admission testing is offered at University Hospital; please allow approximately 1/1/2 hours for this process. In order to process your information, you must bring any insurance cards and forms you have. You are responsible for meeting the requirements of your particular insurance plan, including any necessary preauthorizations and/or referrals prior to your procedure.

The Pre-Admission Testing Center is located on the Lower Level (LL) of the Doctors Office Center (DOC) in Room 0400. The telephone number is (973) 972-2929 and the fax number is (973) 972-2942. Parking is available in the DOC parking deck, directly adjacent to the Doctors Office Center.

When you come for Pre-Admission Testing, the Nursing Coordinator will also meet with you to discuss the procedure and answer any questions or concerns you may have. Based upon your specific needs and health history, an individualized plan of care will be designed for you. Your discharge instructions will be explained to you at this time (and will be reviewed again at your actual discharge).

It is important for you to keep your physician informed of your physical condition prior to and including the day of your procedure. Remember to let your physician know if you are taking any medications; if you have any allergies: or if you now have or have had a history of:

If your physical condition changes, (for example, you develop a cold, cough, fever, or flu), or if you need to cancel your procedure, please contact your Urologist and the Prostate Brachytherapy Coordinator immediately.

For your comfort and safety, follow these instructions the day before your procedure:

Be sure to follow these important instructions on the day of your procedure:

The University Prostate Brachytherapy Program is located in the Same Day Surgery Unit at the Doctors Office Center, lower level. When you arrive, a nurse will take your vital signs, discuss any questions or concerns you may have, and review your medical history. The anesthesiologist will also meet with you in the pre-op area and discuss your anesthesia plan. An intravenous line will be started for the delivery of anesthetic medications.

Your escort will be able to stay with you in the pre-operative holding area until you are taken into the operating room. This person will then be asked to wait in the family waiting room until your return.

During the hour-long procedure you will be placed on the operating room table in a comfortable position. Your urologist will be present as well as the Prostate Brachytherapy Team which includes the Radiation Oncologist, Physicist, Anesthesiologist and Nursing Staff. The Anesthesiologist will apply electrodes for cardiac monitoring, a blood pressure cuff, and a pulse oximeter to measure oxygen saturation. You will be monitored throughout the entire procedure. General anesthesia will be used, and you may also receive medication to help you relax prior to the general anesthesia.

Once you are asleep, your urethra and perineum will be covered with a drape and washed with antiseptic soap. An ultrasound probe is placed in the rectum so that a picture of your prostate appears on a video screen. A number of seeds--the quantity is determined by the size of your prostate gland--are inserted through special needles that deliver the seeds to the prostate. The ultrasound probe insures the needles are guided accurately. Once the seeds are implanted the needles are withdrawn.

After the seeds are implanted, your urologist may opt to do a cystoscopy. By inserting a cystoscope into your urethra, the urologist is able to directly examine the bladder. Also, at this time a foley catheter will be placed in your bladder; this will allow the nursing staff to monitor your urine for any seeds that may be passed.

Ordinarily, the procedure takes about one hour. After the procedure is complete, the Brachytherapy team will transport you to the recovery room.

You will rest in the recovery room for approximately 45 minutes and will be monitored throughout your stay. You will receive light nourishments and any medication prescribed by your physicians.

You will then be transported one floor up from the Same Day Surgery Center to our convenient Imaging Center, where a post-implant CT scan will be taken to verify the seed placement.

Once the CT scan has been read, your catheter will be removed. Typically, you will be required to urinate prior to your discharge. Your urologist may prescribe an antibiotic, but usually no prescription pain medication is required. Your total stay at the University Prostate Brachytherapy Center is approximately four hours.

It is possible to pass a seed with your urine. You will be given a strainer to take home so that you may strain your urine for one week and look for seeds (silver in color and the size of a grain of rice). If you find a seed, pick it up with a tweezer and place it in the lead container given to you at the time of discharge. Only return the lead container if you find one or more seeds.

The procedure causes minimal trauma to the region beneath the scrotum, but there can be some tenderness, bruising or swelling. Some patients may want over-the-counter pain medication for a few days after the implant. Patients may be tired and want to rest, but some feel up to normal activities quickly. Of course, as in all medical procedures, patient response is varied.

The soreness and swelling usually go away in a few days. Some men may experience blood in their urine and semen, and a small percentage may experience rectal irritation or bleeding. Some men may experience discomfort while urinating or the need to urinate more frequently. These symptoms usually begin one to two weeks after implantation and gradually decrease over time as the seeds lose their strength. If the burning sensation persists, contact your doctor and your doctor may prescribe medication. For some men, nighttime urination will be more difficult than daytime because there may be a slightly greater swelling of the prostate at night. Often, this symptom can be diminished by simply walking for a brief period of time.

If there is any sexual intercourse during the first two weeks following the implant, you must use a condom. It is normal for semen to be discolored (dark brown to black) due to bleeding that occurred during the procedure. After two months, condom use should return to normal public health recommendations.

The seeds that have been implanted in your prostate emit low level radiation for a very short period of time. The radiation effect is mostly confined to the prostate itself and should not affect your other organs or people near you. Objects you touch do not become radioactive nor are your stool or urine radioactive.

Although the radiation poses no risk to people around you, we advise you to be more cautious around pregnant women and children. Children and pregnant women should avoid prolonged close contact with you for one month with palladium seeds, and two months with iodine seeds: six feet is a safe distance. Children should not sit on your lap for one-two months after the procedure.