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- Title
Radiation-induced complex anterior urinary fistulation for prostate cancer: a retrospective multicenter study from the Trauma and Urologic Reconstruction Network of Surgeons (TURNS).
- Authors
Osterberg, E.; Vanni, Alex; Gaither, Thomas; Awad, Mohannad; Broghammer, Joshua; Pate, Scott; Wyre, Hadley; Myers, Jeremy; Elliott, Sean; Krishna, Suprita; Zhao, Lee; McClung, Christopher; Erickson, Bradley; Breyer, Benjamin
- 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.
- Subjects
PROSTATE cancer treatment; CANCER radiotherapy; URINARY fistula; CYSTECTOMY; RETROSPECTIVE studies; SURGICAL complications
- Publication
World Journal of Urology, 2017, Vol 35, Issue 7, p1037
- ISSN
0724-4983
- Publication type
Article
- DOI
10.1007/s00345-016-1983-3