10 doctors weighed in:
Can radioactive seed implants for prostate cancer cause complications like a vesiculorectal fistula?
10 doctors weighed in

Dr. Joshua Katz
Surgery - Colorectal
5 doctors agree
In brief: RECTOURETHRAL
This is one of the most feared, and thankfully rare complications of radiation therapy, external or with seeds.
It can occur also in response to treatments for radiation proctitis, when attempts are made to cautering bleeding vessels in the rectum near the prostate. This condition is to be distinguished from a fistula from colon to urinary bladder which is much easier to fix., .

In brief: RECTOURETHRAL
This is one of the most feared, and thankfully rare complications of radiation therapy, external or with seeds.
It can occur also in response to treatments for radiation proctitis, when attempts are made to cautering bleeding vessels in the rectum near the prostate. This condition is to be distinguished from a fistula from colon to urinary bladder which is much easier to fix., .
Dr. Joshua Katz
Dr. Joshua Katz
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Dr. Bahman Daneshfar
Radiation Oncology
4 doctors agree
In brief: Yes
Having done 1300 seed cases I have never seen this complication.
The skill of the doctor is therefore critical. If the seeds end up in the wrong place between the bladder and rectum a hole can develop and the above complication can happen. I am so good at knowing where the needles, seeds and rectum is i will never expect this in my patient. But it is listed in the consent form.

In brief: Yes
Having done 1300 seed cases I have never seen this complication.
The skill of the doctor is therefore critical. If the seeds end up in the wrong place between the bladder and rectum a hole can develop and the above complication can happen. I am so good at knowing where the needles, seeds and rectum is i will never expect this in my patient. But it is listed in the consent form.
Dr. Bahman Daneshfar
Dr. Bahman Daneshfar
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Dr. Andrew Turrisi
Radiation Oncology
1 doctor agrees
In brief: Not if done well
The beauty of a good implant is tht the seeds are "in and around" the prostae capsule, so the dose to the rectum is generally within tolerance.
The problem comes when the seeds are maldistributed leading to excess dose to the rectal wall. I've never had this happen in 20 years of implants. (occurred once after cryo and external beam salvage attempt). No idess for gift basket (ur other ?).

In brief: Not if done well
The beauty of a good implant is tht the seeds are "in and around" the prostae capsule, so the dose to the rectum is generally within tolerance.
The problem comes when the seeds are maldistributed leading to excess dose to the rectal wall. I've never had this happen in 20 years of implants. (occurred once after cryo and external beam salvage attempt). No idess for gift basket (ur other ?).
Dr. Andrew Turrisi
Dr. Andrew Turrisi
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Dr. Reza Shirazi
Radiation Oncology
1 doctor agrees
In brief: Yes
It is possible, but fortunately it is extremely uncommon.

In brief: Yes
It is possible, but fortunately it is extremely uncommon.
Dr. Reza Shirazi
Dr. Reza Shirazi
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Dr. Lawrence Hochman
Radiation Oncology
In brief: Fortunately Rare
20 years doing seed implants, I have seen urethro-rectal fisutulas twice, fortunately not in my patients.
In experienced hands this should not happen, and careful technique can help avoid this. Today most brachytherapists use axial and sagital ultrasound to ensure proper placement of needles and seeds so these rare complications can be avoided.

In brief: Fortunately Rare
20 years doing seed implants, I have seen urethro-rectal fisutulas twice, fortunately not in my patients.
In experienced hands this should not happen, and careful technique can help avoid this. Today most brachytherapists use axial and sagital ultrasound to ensure proper placement of needles and seeds so these rare complications can be avoided.
Dr. Lawrence Hochman
Dr. Lawrence Hochman
Thank
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