Radiation therapy is commonly utilised in the management of prostate cancer, however it can present with significant complications, especially in younger patient populations. We describe the investigation and successful management of significant urethrocutaneous fistula disease in the regional setting. Pelvic fistulas are associated with significant morbidity and notoriously difficult to treat.

Prostate cancer is ranked fifth in male cancer cause of death, in 2020, worldwide there were estimated to be 1.4 million diagnoses (Sung). Fistula formation post pelvic radiotherapy is a rare but debilitating complication with significant associated morbidity (Yu) . This is the case of a 66 year old male with a complex medical history from a rural area who presented post external beam radiotherapy (EBRT) for prostate cancer with a UCF. His fistula disease was successfully conservatively managed with temporary bilateral percutaneous nephrostomy and IDC urinary diversion from a regional centre.

Urethrocutaneous fistulas are a rare but devastating adverse effect from RT for prostate cancer amongst other pelvic malignancies (Takekawa). A recent systematic review showed that medical management with antibiotics alone was unsuccessful in 96% of cases who had undergone radiation treatment for prostate cancer, 86% underwent a cystectomy with urinary diversion (Patel). A multidisciplinary approach is required in these cases. In this case there was urological, general surgical, endocrinology, physiotherapy, occupational therapy and dietician involvement. There was also a great deal of learning and support from the aged care facility staff where this patient resided as well as his family and support system. Can get good outcome from temporary diversion with patience, especially if patient is tolerating nephrostomies well

This case adds a successful account of conservative management of a notoriously difficult to manage, rare and severely debilitating complication of EBRT for prostate cancer treatment. Consideration of temporary diversion of UCF with bilateral nephrostomies and IDC should be considered in select patient populations.