Uro-symphyseal Fistula: A Systematic Review to Inform a Contemporary, Evidence-based Management Framework

Patel, Nirmal; Mehawed, Georges; Dunglison, Nigel; Esler, Rachel; Navaratnam, Anojan; Yaxley, John; Chung, Eric; Tse, Vincent; Roberts, Matthew J.

doi:10.1016/j.urology.2023.05.002

Cited by 2 publications

(11 citation statements)

References 33 publications

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“…RT is a standard treatment for localized PC and a salvage treatment for local recurrence after prostatectomy, but it carries a 2–5% risk of urethral stenosis, with increasing risk over time 5,6 . A recent systematic review found that transurethral treatment for urethral stenosis triggered USF in 83% of patients with irradiated PC 1 . Our report further revealed that USF can result from not only transurethral treatment but also SPT placement and urethroplasty, indicating that any urinary tract opening poses a risk for USF in irradiated PC patients.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis delay due to the atypical nature of USF may necessitate prolonged opioid use 7 . MRI is crucial, confirming USF in 95% of cases 1 . MRI can depict minor fistulas, concurrent PBO, and surrounding fluid collection 1 .…”

Section: Discussionmentioning

confidence: 99%

“…USF, a rare and devastating complication of RT for PC, is a fistula extending from the urinary tract to the pubic symphysis 1 . Extravasation of urine from a damaged urinary tract can trigger fistula formation 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Extravasation of urine from a damaged urinary tract can trigger fistula formation 2 . Therefore, treatment of radiation‐induced urethral stenosis, such as through DVIU and urethral dilation, often leads to USF development 1–3 . USF causes local tissue inflammation and destruction, resulting in PBO and recurrent abscess formation.…”

Section: Introductionmentioning

confidence: 99%

“…USF causes local tissue inflammation and destruction, resulting in PBO and recurrent abscess formation. Patients with USF present with pelvic and suprapubic pain, chronic infections, and gait disturbance 1 . Conservative management, such as antibiotic administration, is generally ineffective; surgical interventions, including debridement of the necrotic pubic symphysis and cystectomy with urinary diversion, are often required 1 .…”

Section: Introductionmentioning

confidence: 99%

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Urosymphyseal fistula development following treatment for radiation‐induced urethral stenosis in three patients with prostate cancer

Takekawa,

Horiguchi,

Ojima

et al. 2023

IJU Case Reports

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IntroductionUrosymphyseal fistula is a rare and devastating complication that develops after radiation therapy for prostate cancer and is often triggered by the treatment of radiation‐induced urethral stenosis. Here, we report our experience with urosymphyseal fistulas in three patients with prostate cancer.Case presentationThree patients with prostate cancer developed urethral stenosis after radiotherapy. The management of urethral stenosis was suprapubic tube placement in case 1, direct vision internal urethrotomy in case 2, and excision with primary anastomosis in case 3. All patients presented with severe suprapubic or thigh pain or both. Urosymphyseal fistulas were detected on magnetic resonance imaging. Conservative treatment was unsuccessful, and all patients required debridement of the necrotic pubic symphysis and simple cystectomy. In cases 1 and 2, ileal conduit urinary diversion was performed.ConclusionUrologists need to be aware that urosymphyseal fistulas can occur in irradiated patients with prostate cancer, especially after urethral stenosis treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Urosymphyseal fistula development following treatment for radiation‐induced urethral stenosis in three patients with prostate cancer

Takekawa,

Horiguchi,

Ojima

et al. 2023

IJU Case Reports

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Pelvic Extirpative Surgery for the “End-Stage Irradiated Bladder”

Moring,

Barrett,

Peterson

et al. 2023

Cancers

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Men with prostate cancer have the daunting task of selecting from multiple modalities of treatment. The long-term effects of radiation therapy are only now being recognized. For both patients and surgeons, the end-stage irradiated bladder poses numerous problems and challenges. Specifically, irradiated bladders with urosymphyseal fistula, radiation cystitis, and rectourethral fistula are challenging to manage and treat. This review outlines the presentation, workup, and management including cystectomy for these three devastating late complications of radiation therapy. There are special considerations when performing benign cystectomy that are not typically considered during oncologic cystectomy. We discuss an overview of the current literature regarding the “end-stage bladder” resulting from radiation therapy and the important considerations that must be acknowledged when managing these patients. It is shown that many of the less invasive and conservative options ultimately lead to cystectomy. Indeed, our review concludes that cystectomy with urinary diversion is a safe and viable option in select irradiated patients with the goal to improve quality of life.

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Uro-symphyseal Fistula: A Systematic Review to Inform a Contemporary, Evidence-based Management Framework

Cited by 2 publications

References 33 publications

Urosymphyseal fistula development following treatment for radiation‐induced urethral stenosis in three patients with prostate cancer

Urosymphyseal fistula development following treatment for radiation‐induced urethral stenosis in three patients with prostate cancer

Pelvic Extirpative Surgery for the “End-Stage Irradiated Bladder”

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