Rectourethral fistula following LDR brachytherapy

Area of Science:

• Urology
• Radiation Oncology
• Medical Complications

Background:

• Modern low-dose-rate (LDR) brachytherapy significantly minimizes rectal toxicity and rectourethral fistulas (<0.5%).
• Late-onset sequelae symptoms are frequently overlooked due to the perceived low risk.
• Rectourethral fistulas cause substantial patient morbidity and necessitate multidisciplinary management.

Observation:

• A rare case of rectourethral fistula is presented.
• The fistula manifested 4 years post-iodine-125 ((125)I) seed implantation for brachytherapy.
• This delayed presentation challenges initial assumptions about treatment-related risks.

Findings:

• Late-onset rectourethral fistula occurred 4 years after (125)I brachytherapy.
• The fistula presented with significant morbidity, requiring specialized intervention.
• This case underscores that even rare complications can have a late onset.

Implications:

• Clinicians should maintain awareness of potential late-onset complications, including rectourethral fistulas, years after brachytherapy.
• Interdisciplinary collaboration is crucial for managing complex sequelae like rectourethral fistulas.
• Further research may be warranted to understand the mechanisms and risk factors for delayed fistula formation.