MP41-19 URINARY TRACT FISTULAE AFTER PROSTATE CANCER RADIATION: A LONG-TERM EXPERIENCE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-19 URINARY TRACT FISTULAE AFTER PROSTATE CANCER RADIATION: A LONG-TERM EXPERIENCE Emily J. Ji*, Alexandra J. Berger, Valary T. Raup, Jairam R. Eswara, and Martin N. Kathrins Emily J. Ji*Emily J. Ji* More articles by this author , Alexandra J. BergerAlexandra J. Berger More articles by this author , Valary T. RaupValary T. Raup More articles by this author , Jairam R. EswaraJairam R. Eswara More articles by this author , and Martin N. KathrinsMartin N. Kathrins More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fistulae of the urinary tract (UF) are a rare but highly morbid complication of prostate cancer radiation. While the surgical management, long-term outcomes, and complications vary widely, there remains a paucity of data regarding long-term outcomes, particularly in patients who are nonsurgical candidates. Here, we describe fistula presentation, surgical and medical management, and long-term outcomes of patients who developed UF after prostate cancer radiation at our institution. METHODS: We utilized the Research Patient Data Registry to identify all patients who underwent radiation from 1992-2013 for prostate cancer and subsequently developed UF. Exclusion criteria included patients whose UF resulted from rectal injury during radical prostatectomy. RESULTS: We identified 23 patients of which 16(69.6%) developed rectourethral (RUF), and 7 (30.4%) developed pubosymphyseal fistulae(PSF). Mean follow up was 9.9 years, median age at fistula diagnosis was 68.1 years. Radiation type was 43.5% brachytherapy, 34.78% external beam radiation therapy, and 17.4% combination. 85% of men with PSF had a urethral stricture prior to fistula development while only 37.5% of men with RUF had a prior diagnosis of urethral stricture. Graciloplasty repair was attempted in 6 (37.5%) RUF cases and led to successful colostomy take down and normal voiding in only two men, both of whom later developed problems with urethral stricture. 4 (57.1%) of the PSF cases underwent surgery while the remaining 3 (42.9%) were managed conservatively. Suppressive antibiotics and a long term indwelling urethral catheter were successful in healing the fistulous tract in one PSF case. 5 (71.4%) of the PSF cases had radiographic evidence of pubic bone osteomyelitis but only one case underwent pubectomy. Altogether, six patients underwent cystectomy and urinary diversion, 10 urinary diversion alone, and all RUF cases underwent fecal diversion. At last follow-up, 43.5% of all patients had a urostomy, 30.4% a suprapubic tube, and 26.1% were voiding. Notably, four RUF cases developed new enterocutaneous fistulae and required additional reconstructive procedures. At last follow-up, only two RUF and one PSF patient were fistula free and voiding on their own. CONCLUSIONS: Here, we present a long-term, descriptive analysis of the disease course for patients who develop UF after prostate radiation. Surgical management and long-term outcomes varied widely. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e602-e602 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emily J. Ji* More articles by this author Alexandra J. Berger More articles by this author Valary T. Raup More articles by this author Jairam R. Eswara More articles by this author Martin N. Kathrins More articles by this author Expand All Advertisement PDF downloadLoading ...