Unique presentation of urosymphyseal fistula and conservative management

A urosymphyseal fistula is an abnormal connection between the lower urinary tract (typically bladder or proximal urethra) and pubic symphysis. This is an uncommon late complication of prostate cancer treatment, often occurring after pelvic radiation and urethral instrumentation. We report a 79-year-old man who, after external radiotherapy, salvage brachytherapy, and transurethral bladder neck incision, developed a urosymphyseal fistula with urinary tracking into the anterior thigh compartment. Given comorbidities, he was managed conservatively with urinary diversion, percutaneous drainage, and antibiotic therapy. Serial imaging demonstrated nonoperative resolution. This case highlights an unusual clinical presentation and suggests selected patients may avoid extirpative surgery.