A 72-year-old man presented with a history of recurrent urinary tract infections, pneumaturia, hematuria, irritative voiding symptoms, and ultimately urinary incontinence. He had had a radical perineal prostatectomy in 1993 for prostate cancer (pT3aNxM0, Gleason sum 3+4=7). Seven years later he underwent local radiotherapy and hormone therapy for a rising psa without evidence of distant disease. The patient had no history of diverticulitis or inflammatory bowel disease. Cystoscopy on workup showed radiation changes in the bladder mucosa without a definite site of colovesical fistula. Flexible sigmoidoscopy showed diverticula and a stricture at 20cm that the scope could not be passed beyond.