Radiation-induced complex anterior urinary fistulation for prostate cancer: a retrospective multicenter study from the Trauma and Urologic Reconstruction Network of Surgeons: Beyond the Abstract

Radiation induced urinary fistula following treatment for prostate cancer represents a complex and challenging condition for urologists. Much is known on the management and diagnosis of posterior urinary fistula i.e. rectourethral fistula; however little is known on anterior urinary fistula. 

In this study, we present the largest, multi-institutional retrospective series on anterior urinary fistula from the prostate / urethra to the pubic symphysis and/or thigh following radiation therapy for prostate cancer.  Over a 10-year period, 31 men were evaluated and treated for an anterior urinary fistula secondary to primary radiation or salvage radiation. 

Patients commonly reported debilitating pain and difficulty with walking secondary to the anterior fistula. Consistent with prior data, more than half of men had recent endoscopic treatment for a bladder neck contracture or a membranous urethral stricture prior to fistula development. We found that MRI appropriately identified fistulae. We found no statistically significant differences in the number of men who underwent a simple cystectomy and urinary diversion versus bladder sparing procedures by radiation subtypes, previous number of endoscopic procedures, types of endoscopic procedures, flap usage, pubectomy usage, length of stay, blood loss, or total operative time.

When choosing which type of procedure to offer (cystectomy versus urethroplasty) urologists should take into account a patent distal urethra, preoperative continence, bladder capacity, and patient comorbidities. Taken together, regardless of the type of surgical intervention, success is high with the majority of patients reporting resolution of pain. 

Written by: Thomas W. Gaither and Mohannad A. Awad

Read the abstract