Vesicocutaneous Fistula Following Radiation and Surgery for the Treatment of Rectal Cancer

Vesicocutaneous fistulas (VCF) are abnormal tracts formed between the bladder and the cutaneous surfaces of the body. Although rare, it has been reported following radiotherapy to the pelvic region, surgery and trauma. We present a case of a 70-year-old male who underwent neoadjuvant chemoradiotherapy for the treatment of rectal cancer metastatic to the perineum prior to definitive abdominoperineal resection (APR). Six months later, he developed urinary retention secondary to bladder obstructive outlet disease. This was managed with urinary catheterisation and a month later with transurethral resection of the prostate (TURP). At outpatient follow-up, he complained of urinary leakage in the perineal region approximately 10 months post-chemoradiotherapy. He underwent a computer tomography (CT) cystogram which confirmed the findings of a VCF extending to his perineum scar. He was managed conservatively with successful outcomes using a multidisciplinary team approach. This is the first case of delayed VCF reported arising after chemoradiotherapy for locally advanced rectal colorectal cancer.