Osteitis Pubis After TURP: A Rare Complication Difficult to Recognize

Abstract

TURP is a widespread urologic procedure that is performed by many urologists. This report describes a rare complication that causes serious morbidity because it is not recognized in time. This is also the first report of a prostatosymphyseal fistula treated without major surgery. Eventually diagnosis is made by a MRI 5 months after surgery. Decompressive surgery was necessary to treat pubic osteïtis with invalidating pain. Culture results revealed Escherichia coli but eventually the diagnosis was made by fistulography. Treatment consisted of bladder drainage and long-term antibiotic treatment and these could eventually heal the fistula.

Osteitis pubis following holmium laser enucleation of the prostate

“…Osteitis pubis is a rare, inflammatory condition involving the pubic symphysis 17. This condition often presents insidiously in athletes, in the antepartum and postpartum period, after herniorrhaphy, and after a myriad of urological procedures (most often the Marshall-Marchetti-Krantz) urethropexy 18–21. Several theories with conflicting evidence have been posed explaining the aetiology of the condition, including trauma, low-grade infection and venous congestion; however, the cause is likely multifactorial.…”

Management of prostatosymphyseal fistula following photoselective vaporization of the prostate: Case series and systematic review of the literature

“…An extensive literature search identified a total of 14 case reports describing 9 cases of PSF following TURP [4][5][6][7][8][9][10][11][12] and 7 cases of PSF following PVP [13][14][15][16][17] (Fig. 3).…”

“…In this series, many patients presented in the early postoperative period with acute symptoms but were not correctly diagnosed for several months. While severe pubic pain is nearly always present, [4,5,[14][15][16][17][6][7][8][9][10][11][12][13] this is likely non-specific. Leg/thigh swelling [6,14,15] and difficulty ambulating, [4,5,[7][8][9][11][12][13]15,17] on the other hand, should prompt further workup as these are likely quite specific.…”

“…While severe pubic pain is nearly always present, [4,5,[14][15][16][17][6][7][8][9][10][11][12][13] this is likely non-specific. Leg/thigh swelling [6,14,15] and difficulty ambulating, [4,5,[7][8][9][11][12][13]15,17] on the other hand, should prompt further workup as these are likely quite specific. Following initial presentation, a number of imaging studies can be of use.…”

“…Typically occurring as a result of a capsular perforation at the anterior prostate, PSF results in the development of osteitis pubis and pubic osteomyelitis with or without anterior thigh urinoma, lower urinary tract symptoms, and/or infection. To date 9 cases of PSF following TURP have been reported in the literature [4][5][6][7][8][9][10][11][12] with management strategies ranging from conservative management via antibiotics and bladder drainage to open surgical repair or extirpative surgery.…”