Rectourethral fistulas in the cancer survivor

Iatrogenic rectourethral fistulas (RUFs) are a rare but challenging complication that can follow the treatment of prostate cancer. We review the literature regarding the surgical management of RUFs and subsequent outcomes, focusing on a cause-specific approach.

Iatrogenic RUFs are reported to occur in approximately 1% of patients treated with external-beam radiation therapy, in 1-6% of patients after radical prostatectomy, and in 5-9% following brachytherapy or cryotherapy after prostate cancer. Most of these patients will require surgical treatment at some point. Though there have been multiple surgical procedures described with varying degrees of success, there is no consensus as to the procedure of choice, though authors now agree on the importance of the interposition of healthy tissue in radiation-induced fistulas.

The current literature regarding surgical approaches to the iatrogenic RUF in the prostate cancer patient highlights the importance of a cause-specific and often multidisciplinary approach, as well as the one that is most familiar to the individual surgeon, because there is often little difference in the approaches in terms of recurrence. However, given the high success rate and low complication rate, muscle transposition flap repairs remain an attractive surgical option for fistulas with unfavorable local conditions such as those present after radiation.