Bladder neck necrosis resulting in fistulae to rectum and bilateral thighs post radical prostatectomy and salvage radiotherapy

Salvage radiotherapy (SRT) is a widely used treatment option for patients demonstrating biochemical recurrence post radical prostatectomy. Urologists are familiar with common adverse effects of SRT, such as voiding and erectile dysfunction. In rare instances, more devastating complications can occur. We report a case of bladder neck necrosis following SRT resulting in urethrorectal fistula, fistulae extending into bilateral thighs, and infectious osteomyelitis (OM) of the pubis symphysis. Although rare, this case highlights the severity of complications that can occur following SRT, as well as the surgical management of such complications.