Imaging of Complications after Prostate Interventions

Prostate interventions are increasingly employed in management of benign prostatic hyperplasia (BPH) and prostate cancer. Routinely performed procedures include a widening array of surgical therapies for BPH, prostate needle biopsy, focal therapies, radical prostatectomy, and radiation therapy. While generally safe, these interventions are associated with various complications, broadly categorized as vascular, infectious, urinary, radiation related, and miscellaneous. CT is the first-line modality for detection of early complications, such as active hemorrhage and postoperative fluid collections. Fluoroscopic studies such as voiding cystourethrography and conventional cystography assist in evaluation of urinary leaks, fistulas, and strictures. MRI is particularly useful for characterization of late complications, such as complex urinary fistulas and pubic osteomyelitis, as well as detection of local recurrence alongside prostate-specific membrane antigen (PSMA) PET/CT or PET/MRI. Familiarity with expected and unexpected postinterventional imaging findings is essential to avoid delayed diagnosis and guide appropriate management. The authors highlight key complications through illustrative cases across multiple imaging modalities. ^©RSNA, 2026 Supplemental material is available for this article.