Abstract: PD56-03
Sources of Funding: none

Introduction

While recto-urethral fistula is a rare complication following salvage cryoablation for radiorecurrent prostate cancer, less is known about the development of recto-urethral fistula after primary whole gland cryoablation. We define the incidence and risk factors for recto-urethral fistula in a multicenter, centralized registry.

Methods

The Cryo-On-Line Data (COLD) Registry was queried for men undergoing primary whole gland cryotherapy between 1990 and 2014 who developed a recto-urethral fistula. Patient factors and disease parameters were correlated with the recto-urethral fistula using chi-squared tests for categorical variables and t-test for continuous variables. Variables with p<0.25 were entered into a binary logistic regression with stepwise backward elimination to determine the factors associated with formation of urethral fistula.

Results

We identified 4,102 men who underwent primary whole gland cryotherapy between 1990 and 2014. Median age was 71 years (IQR:66-76). Median PSA was 6.5 (IQR: 4.8-9.8). Available Gleason Score included 8-10:500 pts, 7:1,194 pts and 6:1,601 while pretreatment clinical stage included T1:1539, T2:1,503 T3:328 and T4:20. 1,508 pts received neoadjuvant androgen deprivation. 805 cases were performed at academic centers and 3297 were performed in the private setting. Post-operative recto-urethral fistula was identified in 50 (1.2%) men. On univariate analysis, pre-operative Gleason score, pre-operative incontinence and post-operative urinary retention were statistically significant predictors for development of recto-urethral fistula. On multivariate analysis, post-operative urinary retention (OR 7.26, 95%CI 4.06-13.03, p<0.001) pre-operative Gleason score of 7 (OR 1.92, 95%CI 1.08-3.43, p=0.027) and pre-operative incontinence (OR 2.95, 95% CI 1.12-7.76, p=0.028) predicted urethral fistula.

Conclusions

In a large, mixed cohort of patients undergoing primary whole gland cryoablation for prostate cancer, the incidence of urethral fistula was very low at 1.2%. The strongest association was present in men with post-procedural urinary retention. Further study regarding instrumentation of the lower tract for retention following cryotherapy in the early post-operative setting is warranted.

Funding

none