Vesico-cutaneous fistula presenting as medial thigh sepsis following salvage prostate cancer radiotherapy

Vesico-cutaneous fistula is a rare complication following prostate cancer treatment, often involving a complex interplay between prior radiation and subsequent instrumentation. We present a case of a 71-year-old male presenting with acute medial thigh sepsis. Imaging revealed a vesico-cutaneous fistula tracking from a posterior-inferior bladder defect, through the pubic symphysis (causing osteomyelitis), and into the adductor compartment. Though a salvage cystectomy was not feasible, urinary diversion alone was successful in ameliorating the patient's symptoms and achieving clinical control. This case emphasizes maintaining a high index of clinical suspicion for urinary fistulation in irradiated patients with atypical soft tissue presentations.