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Rectal complications after prostate brachytherapy.

Shimul A Shah1, Robert R Cima, Eric Benoit

  • 1Section of Colon and Rectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Diseases of the Colon and Rectum
|October 16, 2004
PubMed
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Rectal-urethral fistula is a rare complication of prostate brachytherapy, occurring in 1% of patients. Early symptoms include pain and discharge, with definitive treatment involving ostomy and resection.

Area of Science:

  • Urology
  • Oncology
  • Surgical Gastroenterology

Background:

  • Prostate brachytherapy is increasingly used for localized prostate cancer.
  • Rectal-urethral fistula is a rare but severe complication of this treatment.
  • Limited data exists on its incidence, presentation, risk factors, and management.

Purpose of the Study:

  • To describe the incidence, clinical presentation, risk factors, and management of rectal-urethral fistulas following prostate brachytherapy.
  • To analyze outcomes of surgical interventions for this complication.

Main Methods:

  • Retrospective review of seven patients with rectal-urethral fistulas treated at two institutions between January 1997 and October 2002.
  • Analysis of clinical presentation, risk factors, prostate cancer staging, and treatment strategies.

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Main Results:

  • Seven fistulas occurred in approximately 700 patients (1% incidence).
  • Symptoms manifested 27.3 months post-brachytherapy, including anorectal pain, mucous discharge, diarrhea, and rectal ulceration.
  • Coronary artery disease was a common comorbidity (71%). Previous transurethral resection or pelvic radiation did not increase fistula risk.
  • All patients underwent diverting ostomy; four proceeded to definitive resection. Patients achieved symptom relief nine months post-surgery.

Conclusions:

  • Rectal-urethral fistula is a rare but serious complication of prostate brachytherapy, with potential for late symptom onset.
  • Long-term follow-up (at least three years) is recommended.
  • Initial management involves diverting ostomy to alleviate symptoms, followed by consideration of definitive resection and ostomy closure.