Spontaneous Rectovesical Fistula Secondary to Castration-resistant Prostate Cancer

Abstract

Introduction: Rectovesical fistula (RVF) is an abnormal communication between the rectum and the urinary bladder. This condition has a negative impact on the patient’s quality of life due to the associated morbidity. The patient may present with complaints of passage of urine per rectum, pneumaturia, fecaluria, recurrent cystitis, pyelonephritis, or urosepsis. Method and Material: We present a case of a 61-year-old man with histologically diagnosed prostate cancer who developed passage of urine per rectum about two years after bilateral total orchidectomy. He defaulted on follow-up and presented with castration-resistant prostate cancer. Results: On performing a micturiting cystourethrogram/retrograde urethrogram under fluoroscopic guidance, the contrast media were seen passing from the bladder into the large bowel hence establishing a diagnosis of RVF. Conclusion: The patient was counseled for a diverting colostomy but he declined. He has an intact anal sphincter and therefore is presently continent of both stool and urine per rectum. Unfortunately, he is financially unable to afford any of the treatment options for castration-resistant prostate cancer.

Keywords

• castration-resistant prostate cancer
• colostomy
• rectovesical fistula