65-year-old patient diagnosed with adenocarcinoma of the prostate Gleason 6/10 in both prostatic lobes (TNM Stage 2003 T1c). PSA at the time of diagnosis was 9.43 ng/ml. In January 2006 the patient underwent a radical retorpubic prostatectomy (Anatomical pathology report: Gleason 6/10 pT2c prostate adenocarcinoma with tumour-free margins). During dissection of the posterior aspect of the prostate 2 cm opening in the anterior aspect of the rectum. Direct closure of the rectal wall with loose stitches. No other intraoperative complications. On the fifth postoperative day, the patient presented fever (37.6ºC), abdominal pain, urinary fistula, faecaluria and signs of peritonitis on physical examination. An abdominal CT scan was performed showing free retrohepatic fluid and an urgent laparotomy was performed, showing faecaloid peritonitis secondary to perforation of the sigma and abundant urine and faeces in the pelvis. A new vesico-urethral suture, resection of the perforated segment of the sigma and discharge colostomy were performed.
After emergency surgery, the patient developed septic symptoms and was admitted to the ICU for respiratory support. During the septic condition, the patient presented urinary fistula with abundant urine leakage through the drainage and infection of the surgical wound.
After respiratory and haemodynamic stabilisation, the patient was discharged from the ICU with a permeable colostomy. Clear urine. Subsequently, disappearance of urinary fistula and fat necrosis in the distal third of the surgical wound, observing abdominal musculature as a background of the ulcer.
In March 2006, cystography was performed, showing passage of contrast from the urethrovesical junction to the rectal ampulla. With a diagnosis of vesico-rectal fistula, conservative treatment was indicated with bladder catheterisation until resolution of the surgical wound infection and closure by secondary intention.

In October 2006, given the persistence of the fistulous orifice, closure of the urethro-rectal fistula and transanal mucosal advancement plasty was performed. One month after surgery, cystography was performed and no contrast leakage was observed outside the urinary tract, so the bladder catheter was removed.

In March 2007 colostomy closure and eventroplasty of the abdominal wall with mesh was performed.
In June 2007 the patient had comfortable spontaneous urination and normal bowel movements. Absence of urinary incontinence. Erectile dysfunction treated with phosphodiesterase inhibitors and PSA less than 0.15 ng/ml.