Evaluation and Management of Rectourethral Fistulas After Prostate Cancer Treatment

Abstract

Most men newly diagnosed with prostate cancer will undergo local treatment with prostatectomy, radiation, or tissue ablation. A small percentage of these men will develop a rectourethral fistula, a complicated disease that requires a multidisciplinary approach to management. Diagnosis is typically made with a careful history and physical exam with endoscopy and select imaging recommended in all patients. Fistulas resulting from prostatectomy, radiation, or tissue ablative technology are approached differently due to local tissue changes following therapy. Post-radiation and thermal ablation fistulas have a lower fistula closure rate due to the deleterious effect of the primary treatment on local tissue. It is imperative that the patient understands the complexity of treatment and sets reasonable goals for treatment.