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

To characterize anterior urinary fistulae following radiotherapy for prostate cancer.

Over 10 years, 31 men were identified to have an anterior urinary fistula. A retrospective database was created to evaluate patient demographics, presentation, diagnostic procedures, operative interventions, outcomes, and complications.

Comparisons between men who underwent cystectomy versus bladder-sparing surgeries were performed.

At a median age of 73 (interquartile range (IQR) 68.5, 79) years, presenting symptoms included as follows: pubic pain (19/31, 61%), urine drainage via fistula (10/31, 32%), or a superficial wound infection (6/31, 19%). Recent instrumentation prior to diagnosis of anterior urinary fistula was reported by 18/31 (58%) at a median of 14.9 months (IQR 7.9, 103.8) after manipulation. Anterior fistula formation was either isolated to the pubic symphysis (19/31, 61%) or the thigh (12/31, 38%). Nineteen men underwent a cystectomy, whereas 12 men underwent a fistula repair. Excluding grades 1 and 2, 30- and 90-day postoperative complications were limited to four and two men, respectively, all of whom had a grade 3 complication. At 6-month follow-up, 26/31 (84%) men reported their pain had resolved. There was one fistula recurrence managed with subsequent cystectomy.

Complex anterior urinary fistulae to the pubic symphysis and thigh are devastating yet treatable conditions. Universally, these men have a history of radiotherapy and repeated endoscopic interventions. Surgical intervention with either cystectomy or primary repair was highly successful.

World journal of urology. 2016 Jan 07 [Epub ahead of print]

E Charles Osterberg, Alex J Vanni, Thomas W Gaither, Mohannad A Awad, Joshua A Broghammer, Scott C Pate, Hadley Wyre, Jeremy B Myers, Sean P Elliott, Suprita Krishna, Lee C Zhao, Christopher McClung, Bradley A Erickson, Benjamin N Breyer

Department of Surgery (Urology), Clinical Education Center, Dell Medical School, University of Texas, 1400 North I35, Suite 300, Austin, TX, 78701, USA. ., Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA., Department of Surgery (Urology), Clinical Education Center, Dell Medical School, University of Texas, 1400 North I35, Suite 300, Austin, TX, 78701, USA., Department of Urology, University of Kansas, Kansas City, KS, USA., Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA., Department of Urology, University of Minnesota, Minneapolis, MN, USA., Department of Urology, New York University, New York, NY, USA., Central Ohio Urology Group, Columbus, OH, USA., Department of Urology, University of Iowa, Iowa City, IA, USA.

Go Beyond the Abstract with a commentary written by the authors

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