How do you treat a rectoprostatic fistula after prostate SBRT?

This is a difficult problem to manage, regardless of whether it occurs after SBRT or any other type of prostate radiation. It will require close cooperation between multiple specialists. Early involvement of a gastroenterologist and a colorectal surgeon is imperative as this is likely to require a diverting colostomy, at least temporarily. Clearing the resulting infection from the prostate will require close cooperation with the urologist, and possibly other internal medicine subspecialties. If the infection can be cleared, consultation with a wound healing specialist offering hyperbaric oxygen may be warranted to try to speed the healing of the rectal ulcer. If the fistula and rectal mucosa heal, hopefully, colostomy may be taken down and ...

As @Dr. First Last emphasized, managing a rectoprostatic fistula requires multi-disciplinary care. Unfortunately, that can be a double-edged sword without the radiation oncologist stepping up to safeguard the patient's passage from specialist to specialist. A best practice is to stay on top of care coordination and schedule frequent follow-up visits with the patient during their journey. Next, call the specialists to confirm what they're recommending and make sure they are communicating with each other. If you can find an oncoplastic surgeon, they may have better results trying to repair ischemic tissue. For example, they may have experience with a rotational gracilis flap to repair the defect, whereas others may have never been trained in ...