title: Conservative management of urorectal fistulae.
abstract: OBJECTIVE
  To characterize conservative management of urorectal fistulae (URF).
  
  
  METHODS
  URF are a recognized but rare complication of treatments for prostate and rectal cancers. URF can lead to incontinence, fecaluria, pain, urinary infection, and sepsis, and thus are usually treated surgically. We present a series of 3 patients whose complex URF were managed conservatively. Between 2004 and 2010, 43 patients were diagnosed with URF resulting from treatment for prostate or rectal cancer. All patients were evaluated and offered surgical treatment; 40 patients elected surgical therapy, and 3 patients chose conservative, nonoperative management of the URF. The primary outcome was the patient choosing or needing formal surgical URF closure. Because this was not a comparative study, no formal statistical analysis was undertaken.
  
  
  RESULTS
  The 3 patients have been regularly monitored and have required symptomatic and episodic care. None, however, has opted for formal surgical fistula repair, and to date, all continue in conservative management of their URF.
  
  
  CONCLUSIONS
  Spontaneous URF closure is uncommon and is unknown to occur in complex URF. Surgery is the mainstay of treatment. Patients should consider treatment options, potential outcomes, and their quality of life when choosing or not choosing treatment. The applicability and durability of conservative management of URF remains unclear.
authors.affiliation: University College London Hospital, Department of Urology, Institute of Urology, London, United Kingdom. krishnan38@gmail.com
authors.forename: Krishnan
authors.initials: K
authors.lastname: Venkatesan
authors.forename: Evangelos
authors.initials: E
authors.lastname: Zacharakis
authors.forename: Daniela E
authors.initials: DE
authors.lastname: Andrich
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Mundy
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D002408:Catheters, Indwelling; D003125:Colostomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000628:therapy*; D012003:Rectal Fistula / Q000209:etiology / Q000628:therapy*; D012004:Rectal Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects; D014522:Urethral Diseases / Q000209:etiology / Q000628:therapy*; D014548:Urinary Fistula / Q000209:etiology / Q000628:therapy*