Abstract
Purpose
To characterize anterior urinary fistulae following radiotherapy for prostate cancer.
Methods
Over 10 years, 31 men were identified to have an anterior urinary fistula. A retrospective database was created to evaluate patient demographics, presentation, diagnostic procedures, operative interventions, outcomes, and complications. Comparisons between men who underwent cystectomy versus bladder-sparing surgeries were performed.
Results
At a median age of 73 (interquartile range (IQR) 68.5, 79) years, presenting symptoms included as follows: pubic pain (19/31, 61%), urine drainage via fistula (10/31, 32%), or a superficial wound infection (6/31, 19%). Recent instrumentation prior to diagnosis of anterior urinary fistula was reported by 18/31 (58%) at a median of 14.9 months (IQR 7.9, 103.8) after manipulation. Anterior fistula formation was either isolated to the pubic symphysis (19/31, 61%) or the thigh (12/31, 38%). Nineteen men underwent a cystectomy, whereas 12 men underwent a fistula repair. Excluding grades 1 and 2, 30- and 90-day postoperative complications were limited to four and two men, respectively, all of whom had a grade 3 complication. At 6-month follow-up, 26/31 (84%) men reported their pain had resolved. There was one fistula recurrence managed with subsequent cystectomy.
Conclusions
Complex anterior urinary fistulae to the pubic symphysis and thigh are devastating yet treatable conditions. Universally, these men have a history of radiotherapy and repeated endoscopic interventions. Surgical intervention with either cystectomy or primary repair was highly successful.
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Abbreviations
- EBRT:
-
External beam radiotherapy
- BT:
-
Brachytherapy
- RP:
-
Radical prostatectomy
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Acknowledgements
The study was partially funded by the Alafi Foundation and Hellman Foundation.
Author contributions
EC Osterberg and BN Breyer involved in protocol/project development, data collection, data analysis, and manuscript writing/editing; AJ Vanni involved in data collection and data analysis; T Gaither involved in data collection, data analysis, and manuscript writing/editing; MA Awad involved in data collection, data analysis, and manuscript writing/editing; J Broghammer, SC Pate, HW Wyre, JB Myers, SP Elliott, S Krishna, LC Zhao, C McClung, and BA Erickson involved in data collection and manuscript writing/editing.
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All of the authors declare they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
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Informed consent was obtained from all individual participants included in the study.
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Osterberg, E.C., Vanni, A.J., Gaither, T.W. et al. Radiation-induced complex anterior urinary fistulation for prostate cancer: a retrospective multicenter study from the Trauma and Urologic Reconstruction Network of Surgeons (TURNS). World J Urol 35, 1037–1043 (2017). https://doi.org/10.1007/s00345-016-1983-3
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DOI: https://doi.org/10.1007/s00345-016-1983-3