Comparison of Urinary Diversion in Patients With Prostatic Fistula to Those with Localized Radiation Injury After Radiotherapy for the Treatment of Prostate Cancer

Abstract

ObjectivesTo compare characteristics and outcomes in patients who had radiotherapy (RT) for prostate cancer (PCa) and underwent urinary diversion (UD) due to prostatic fistula (Fistula) vs. localized radiation injury (Localized). MethodsThis study was a retrospective single-institution study. Exclusion criteria included: follow-up < 3 months, large pelvic tumor, and surgery for cancer control. The Fistula group included fistulization outside of the urinary tract (rectal, soft tissue, thigh, pubic symphysis, and extensive necrosis surrounding the prostate). The group Localized had a multitude of problems; however, all were confined to the urinary tract. Patient characteristics, perioperative variables, and outcomes were compared between groups. Results69 patients were included and had UD from 2009-2022. Median age and time from RT to UD were 73 (IQR-67.9,78.1) and 7.3 (IQR-3.2,12.5) years. There were 29 (42%) and 40 (58%) patients in the Fistula and Localized groups. The Fistula group had a higher rate of abdominal/perineal approach (62.1% vs. 12.5%,p<0.001), a lower rate of right colon pouch (17.2% vs. 40%,p=0.043), and a longer operative time (515.7 vs 414.2 mins,p=0.017). Clavien-Dindo complications ≥ 3 were higher in the Fistula group (44.8% vs. 20%,p=0.027), including a higher rate of re-operation for recurrent pelvic abscess (37.9% vs. 5%,p<0.001). Survival for the cohort was 85.5% and did not differ between groups. ConclusionsPatients with prostate fistula after RT for PCa undergoing UD had longer, more complex operations, and higher rates of complications, notably post-operative pelvic abscesses, compared to men with localized RT injury. Long-term survival was comparable in both groups.