Pd21-12 Urosymphyseal Fistula and Pubic Osteomyelitis in Prostate Cancer Survivors—tertiary Care Experience With a Complex Challenge

You have accessJournal of UrologyReconstruction: Augmentation, Substitution, Diversion (PD21)1 May 2024PD21-12 UROSYMPHYSEAL FISTULA AND PUBIC OSTEOMYELITIS IN PROSTATE CANCER SURVIVORS—TERTIARY CARE EXPERIENCE WITH A COMPLEX CHALLENGE Laurien Smeyers, Jens Borremans, Frank Van der Aa, Michiel Herteleer, and Steven Joniau Laurien SmeyersLaurien Smeyers , Jens BorremansJens Borremans , Frank Van der AaFrank Van der Aa , Michiel HerteleerMichiel Herteleer , and Steven JoniauSteven Joniau View All Author Informationhttps://doi.org/10.1097/01.JU.0001008888.07102.14.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe urosymphyseal fistula (UF) and pubic osteomyelitis (PO) in prostate cancer survivors. METHODS: Ethical approval granted, retrospective chart review was conducted on 26 patients treated for UF/PO after localized prostate cancer treatment at the University Hospital of Leuven (1996-2021). We reviewed demographics, prostate cancer history, urethral manipulations (UMs), diagnosis, treatment, microbiology and outcomes. RESULTS: 81% had a history of radical prostatectomy, 88% radiotherapy (RT) (69% adjuvant/salvage) and 85% had ≥1 UM. All experienced pubic pain and possibly groin pain, gait difficulties or infectious complications. The median time from RT, last UM and first symptoms to diagnosis was 102 months, 4 months and 43 days respectively. Diagnosis was based on Computed Tomography (85%), Magnetic Resonance Imaging (69%), cystography (54%), cystoscopy (54%) and nuclear imaging (77%), cumulatively confirming PO in 95% and UF in 65% of cases. Treatment included cystectomy in 19, bladder-sparing surgery in 4, abscess drainage in 1 and full conservative treatment in 2 patients. 21 patients needed pubic debridement. All cystectomy patients had previous RT. UF on imaging, led to cystectomy in all but one case. Only non-irradiated patients succeeded full conservative treatment. Bone cultures were positive in 95% and discordant with urine cultures in 82%. All patients received antibiotics for a median of 46 days. Reinterventions and severe complications affected 57% and 53% patients respectively, whereafter 92% were pain-free. Figure 1 shows our treatment algorithm. CONCLUSIONS: UF/PO occurs years after local prostate cancer treatment. Risk factors include RT and UMs. Conservative treatment rarely succeeds, with prior RT and persistent UF being negative predictive factors for bladder sparing. Most patients need cystectomy and pubic debridement. Collecting perioperative bone cultures is crucial due to discordance with urine cultures. Antibiotics are preferably stopped ≥2 weeks preoperatively, perioperatively restarted and adjusted based on bone cultures. Complications are common, often requiring reinterventions. Early diagnosis and multidisciplinary treatment are vital in this uncommon disease. We recommend cautious use of UMs in irradiated patients. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e459 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Laurien Smeyers More articles by this author Jens Borremans More articles by this author Frank Van der Aa More articles by this author Michiel Herteleer More articles by this author Steven Joniau More articles by this author Expand All Advertisement PDF downloadLoading ...