Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer

Kristin L. Chrouser, Bradley C. Leibovich, Susan D. Sweat, David W. Larson, Brian J. Davis, Nho V. Tran, Horst Zincke, Michael L. Blute

Research output: Contribution to journalArticle

91 Scopus citations

Abstract

Purpose: Prostate cancer (PCa) radiotherapy (RT), including brachytherapy, may lead to significant morbidity, including urinary fistulas. If conservative measures fail, urinary and/or fecal diversion is often required. In this study we examined a series of patients with fistulas that developed after pelvic radiation therapy and explored potential predisposing factors and treatment recommendations for refractory fistulas. Materials and Methods: Patients were identified who received radiation therapy for PCa between 1977 and 2002, and subsequently had a fistula to the urinary tract. Patients were excluded who had diverticulitis, inflammatory bowel disease, a history of recent radical retropubic prostatectomy (possible iatrogenic etiology) or cancer in the excised fistula. Data were extracted from patient charts, mailed questionnaires and outside records. Results: A total of 51 patients were identified with a history of radiation for PCa who subsequently had a urinary fistula. Of 20 patients meeting inclusion criteria 30% received external beam RT alone, 30% received brachytherapy and 40% received combined external beam RT/brachytherapy. Most fistulas (80%) were from the rectum to the urinary tract with an average diameter of 3.2 cm. Of patients with rectal fistulas 81% had a history of rectal stricture, urethral stricture, rectal biopsy, rectal argon beam therapy or transurethral prostate resection after radiation. All patients with rectourethral fistulas who achieved symptomatic resolution required urinary and fecal diversion. Conclusions: Conservative treatment is generally ineffective in the management of large urinary fistulas. Surgical intervention offers symptomatic relief and improved quality of life in most patients.

Original languageEnglish (US)
Pages (from-to)1953-1957
Number of pages5
JournalJournal of Urology
Volume173
Issue number6
DOIs
StatePublished - Jun 2005

Keywords

  • Iatrogenic disease
  • Prostatic neoplasms
  • Radiation injuries
  • Rectal fistula
  • Urinary fistula

ASJC Scopus subject areas

  • Urology

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    Chrouser, K. L., Leibovich, B. C., Sweat, S. D., Larson, D. W., Davis, B. J., Tran, N. V., Zincke, H., & Blute, M. L. (2005). Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer. Journal of Urology, 173(6), 1953-1957. https://doi.org/10.1097/01.ju.0000158041.77063.ff