A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management

Abstract

Colovesical fistula (CVF) is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF) is a possible but extremely rare complication of treatment of prostate cancer with “transrectal High-Intensity Focused Ultrasound (HIFU) treatment.” We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan—with MPR, MIP, and VR reconstruction—before emptying the bladder. Since the CT scan confirmed that the fistula involved solely the urethra and excluded even a minimal involvement of the bladder, it was possible to employ a conservative treatment by positioning a Foley catheter of monthly duration, in order to allow the urethra to rest. Still today, after 6 months, the patient is in a good clinical condition and has not shown yet signs of a recurrence of the fistula.

Urethrorectal Fistula - Complication of Tuberculosis of Prostate

“…11 It is very important not only to diagnose the fistula, but also to localize it correctly in the event of surgery. 12,13 In every case especially in the case of a suspected neoplastic pathology, it is necessary to establish the cause of the fistula to plan the best therapeutic and/or surgical approach of the treatment. 14 It is therefore necessary to use the available diagnostic technologies to confirm the diagnosis.…”