We report a rare complication of rectourethral fistula formation 6 weeks after a 70-year-old man underwent an uneventful HoLEP procedure. Cystourethrogram confirmed the diagnosis and the patient was managed conservatively with chronic indwelling catheter placement for 6 weeks. After this, his symptoms resolved completely and a repeat cystourethrogram showed marked resolution of the fistulous tract. The cause of the fistula formation is believed to be due to a delayed thermal or infectious reaction. Post-procedure follow up is necessary in all patients to monitor for complications that do not arise immediately after surgery.