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

Abstract

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.

Pubosymphyseal Urinary Fistula Following Radiation Therapy of Bladder Sarcomatoid Tumor

“…Later, it was identified as a complication of radiation therapy for prostate cancer and as a sequela of endoscopic procedures for radiation-induced posterior urethral strictures [ 2 , 4 - 6 ]. Recently, a case series published cases of women who developed PUF after radiation therapy for anal and endometrial cancer, along with chronic indwelling Foley usage [ 7 ]. Our case report highlights the growing recognition of this condition in patients receiving pelvic radiation for malignancies other than the prostate gland.…”