Figure 35.6. Voiding cystourethrogram in a patient with history of brachytherapy for prostate cancer. Arrow identifies the rectourethral fistula.

Conservative management with catheter drainage, bowel rest, hyperalimentation, and occasionally fecal diversion can result in spontaneous fistula healing after prostatectomy.102 In most cases, however, surgical therapy is necessary.103 Surgical repairs can be performed in single or multiple stages and accessed via transrectal, perineal, or trans-abdominal approaches.

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