title: Radiation-induced complex anterior urinary fistulation for prostate cancer: a retrospective multicenter study from the Trauma and Urologic Reconstruction Network of Surgeons (TURNS).
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery (Urology), Clinical Education Center, Dell Medical School, University of Texas, 1400 North I35, Suite 300, Austin, TX, 78701, USA. charlesosterberg@gmail.com.
authors.forename: E Charles
authors.initials: EC
authors.lastname: Osterberg
authors.affiliation: Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Vanni
authors.affiliation: Department of Surgery (Urology), Clinical Education Center, Dell Medical School, University of Texas, 1400 North I35, Suite 300, Austin, TX, 78701, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Gaither
authors.affiliation: Department of Surgery (Urology), Clinical Education Center, Dell Medical School, University of Texas, 1400 North I35, Suite 300, Austin, TX, 78701, USA.
authors.forename: Mohannad A
authors.initials: MA
authors.lastname: Awad
authors.affiliation: Department of Urology, University of Kansas, Kansas City, KS, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Broghammer
authors.affiliation: Department of Urology, University of Kansas, Kansas City, KS, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Pate
authors.affiliation: Department of Urology, University of Kansas, Kansas City, KS, USA.
authors.forename: Hadley
authors.initials: H
authors.lastname: Wyre
authors.affiliation: Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Myers
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Suprita
authors.initials: S
authors.lastname: Krishna
authors.affiliation: Department of Urology, New York University, New York, NY, USA.
authors.forename: Lee C
authors.initials: LC
authors.lastname: Zhao
authors.affiliation: Central Ohio Urology Group, Columbus, OH, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: McClung
authors.affiliation: Department of Urology, University of Iowa, Iowa City, IA, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Erickson
authors.affiliation: Department of Surgery (Urology), Clinical Education Center, Dell Medical School, University of Texas, 1400 North I35, Suite 300, Austin, TX, 78701, USA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D059351:Organ Sparing Treatments / Q000379:methods / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy; D011832:Radiation Injuries / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D001743:Urinary Bladder / Q000528:radiation effects / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods / Q000706:statistics & numerical data; D014548:Urinary Fistula / Q000453:epidemiology / Q000209:etiology / Q000628:therapy
keywords: Bladder neck contracture; Complication; Radiation; Radiotherapy; Urinary fistula