Background: Radiotherapy in the treatment of prostate cancer is well established. Intestinal complications following radiotherapy are divided into acute and chronic toxicity. Chronic complications like perforation and fistula formation to the rectum are rare and difficult to treat.
Materials and methods: In case of chronic radiotherapy complications and particularly chronic fistula formation to the rectum, evidence is low. Therefore, an overview of the available literature of surgical therapy strategies is given.
Results: Options for the treatment of acute intestinal toxicity are established and therapy algorithms exist. Therapy of acute rectal perforation covers primary suture repair with or without diversion stoma as well as primary rectal resection with or without primary restoring bowel continuity. In chronic rectal lesions and particularly in fistula formation to the rectum, abdominal treatment strategies are preferred with additional interposition of an omental flap or vascularized muscle flap.
Conclusion: Although evidence for surgical therapy strategies of the rare chronic rectourethral and rectovesical fistula is low, treatment is a real interdisciplinary challenge and should be provided in a specialized center.
Keywords: Fistula, rectourethral; Fistula, rectovesical; Prostate cancer; Prostatectomy; Salvage therapy.