three distinct urethral fistulae 35 years after pelvic radiation

introduction: while the development of fistulae is a well-known complication of radiotherapy, such fistulae can often be challenging to manage. case presentation: we describe the case of a 37 year old male who developed in succession a urethrocutaneous fistula to the thigh, a rectourethral fistula and a peritoneo-urethral fistula 35 years after radiotherapy for pediatric pelvic rhabdomyosarcoma. these complications were managed successfully after multiple surgical procedures. discussion: we subsequently discuss the different approaches currently employed for the management of radiation induced urinary fistulas and describe the rationale behind our approach towards their surgical management.