Pubectomy and urinary reconstruction provides definitive treatment of urosymphyseal fistula following prostate cancer treatment

Andrews, Jack R.; Hebert, Kevin; Boswell, Timothy; Avant, R.; Boonipatt, Thanapoom; Kreutz‐Rodrigues, Lucas; Bakri, Karim; Houdek, Matthew T.; Karnes, R.J.; Viers, Boyd R.

doi:10.1111/bju.15333

Cited by 20 publications

(19 citation statements)

References 24 publications

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“…The remaining patients required resection of the fistulous tract and affected bone and omentoplasty followed by further reconstructive or diversionary surgery 11. In another study, the most frequent procedure undertaken was bone resection with cystectomy and urinary diversion with an ileal conduit due to outflow devastation 12…”

Section: Discussionmentioning

confidence: 99%

Groin pain in the postradiotherapy pelvis: have you considered osteomyelitis?

2022

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A man in his 80s presented to the emergency department with a 5-week history of lower abdominal and groin pain which had substantially affected his mobility. He practised intermittent self-catheterisation following radiotherapy for prostate cancer. Multiple suggestive features led to initial treatment for a urinary tract infection (UTI). However, CT imaging revealed pubic symphysis osteomyelitis with associated abdominal wall abscesses and fistulation to the prostate. This case illustrates the need to consider osteomyelitis as a differential for pain in previously irradiated body areas and to beware of diagnosing UTI where pain affects mobility.

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Section: Discussionmentioning

confidence: 99%

Groin pain in the postradiotherapy pelvis: have you considered osteomyelitis?

2022

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“…USF is an uncommon condition typically observed in men in the context of prior prostate cancer radiotherapy and often following EBOP [ 1 ]. This condition is progressively destructive, leading to pubic osteomyelitis and periodically local abscess formation [ 1 , 5 ]. Thus, patients may present with pubic pain and experience delayed diagnosis due to lapses in timely recognition.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, patients may present with pubic pain and experience delayed diagnosis due to lapses in timely recognition. Definitive management in most cases warrants cystectomy with urinary diversion and pubic bone debridement/resection [ 5 ]. Although increasingly recognized in men, this phenomenon is rare in women and thus has not been previously described.…”

Section: Discussionmentioning

confidence: 99%

Urosymphyseal fistulas in women: identification and characterization of a previously undescribed phenomenon

Anele¹,

Wood

Angermeier

2021

Journal of Surgical Case Reports

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Urosymphyseal fistula (USF) is a very uncommon but catastrophic condition which typically occurs in the setting of previous radiation treatment for prostate cancer. As a result, USF has only been described in male populations. For the first time, we characterize this phenomenon in a series consisting of four women managed at our quaternary institution. We found that most patients presented with pubic pain and all were diagnosed with USF on CT or MRI. Imaging commonly demonstrated features suggesting osteomyelitis which was confirmed on histology. Patients experienced significant decreases in peri-operative pain scores following extirpative surgery with urinary diversion, bone debridement/resection and tissue interposition. This case series highlights the rarity of USF in women in order to help promote increased recognition and timely management.

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“…USF in an irradiated tissue usually fails conservative treatment. Nonetheless, heterogenous treatment options from conservative management [1] to extensive surgery with pubectomy and urinary reconstruction as a treatment standard [2] have been proposed. Nonetheless, there is a knowledge gap in the current literature on the optimal management of USF.…”

Section: Introductionmentioning

confidence: 99%

Urosymphyseal fistula after pelvic radiotherapy in a tertial referral centre – a rare entity with significant comorbidity requiring multidisciplinary management

Brändstedt

Abrahamsson

Baseckas

et al. 2023

SJU

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Objective: To report population-based clinical presentation and outcomes in patients with urosymphyseal fistula (USF) after pelvic radiotherapy (RT).Patients and methods: A retrospective chart review was performed in 33 consecutive patients diagnosed with suspicion of USF in a tertial referral center from 2014–2022 to ascertain information about diagnostic delay, clinical presentation, precipitating causes, treatments received and outcomes during the median 22 months follow-up. Out of 33 consecutive patients with suspicion of USF, one female with vesicovaginal fistula, one patient developing RT-associated bladder angiosarcoma, four patients with short follow-up (<3 months), and three patients that during chart review not were considered to have a USF were excluded. Results: In all, 24 males with a median age of 77 years were diagnosed with USF. Local pain was the predominating symptom in 17/24 (71%) patients. Endourologic manipulations preceded the diagnosis of USF in 16 patients. Five patients had a diagnostic delay of more than 3 months. At diagnosis, 20/24 patients had radiological signs of osteomyelitis, and five had a concomitant rectourethral fistula. Due to comorbidity, five patients were not amenable to any other interventions than urinary catheter or suprapubic tube in conjunction with long-term antibiotics, of which three died from infections related to the USF. Out of the remaining 19 patients receiving some form of urinary diversion, five had recurrent osteomyelitis, of which four did not undergo cystectomy in conjunction with surgery for the USF.Conclusions: Urethral endourologic interventions in patients previously subjected to pelvic RT should be performed cautiously.

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Pubectomy and urinary reconstruction provides definitive treatment of urosymphyseal fistula following prostate cancer treatment

Cited by 20 publications

References 24 publications

Groin pain in the postradiotherapy pelvis: have you considered osteomyelitis?

Groin pain in the postradiotherapy pelvis: have you considered osteomyelitis?

Urosymphyseal fistulas in women: identification and characterization of a previously undescribed phenomenon

Urosymphyseal fistula after pelvic radiotherapy in a tertial referral centre – a rare entity with significant comorbidity requiring multidisciplinary management

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