The Complex Challenge of Urosymphyseal Fistula and Pubic Osteomyelitis in Prostate Cancer Survivors
Background and objective: Urosymphyseal fistula (UF) and pubic osteomyelitis (PO) are rare and often poorly recognized long-term complications of treatment for localized prostate cancer. Our aim was to describe UF/PO in prostate cancer survivors. Methods: We performed a retrospective review of 26 pa...
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Elsevier
2024-12-01
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| Series: | European Urology Open Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666168324009236 |
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| author | Laurien Smeyers Jens Borremans Frank Van der Aa Michiel Herteleer Steven Joniau |
| author_facet | Laurien Smeyers Jens Borremans Frank Van der Aa Michiel Herteleer Steven Joniau |
| author_sort | Laurien Smeyers |
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| description | Background and objective: Urosymphyseal fistula (UF) and pubic osteomyelitis (PO) are rare and often poorly recognized long-term complications of treatment for localized prostate cancer. Our aim was to describe UF/PO in prostate cancer survivors. Methods: We performed a retrospective review of 26 patients treated for UF/PO after localized prostate cancer treatment at University Hospitals Leuven (1996–2021). We analyzed data for demographic characteristics, history, urethral manipulations (UMs), diagnostic and therapeutic approaches, microbiology, and treatment success. Key findings and limitations: Before diagnosis, 80.8% of the patients had undergone RP, 88.5% received radiotherapy, and 84.6% had at least one UM. The median time from radiotherapy (RT), the last UM, and the first symptoms to diagnosis were 102 mo, 4 mo, and 43 d, respectively. Treatment included cystectomy (n = 19), bladder-sparing interventions (n = 5), and conservative treatment (n = 2). Pubic debridement was required in 21 patients. All cystectomy patients had a history of RT. Imaging-detected UF led to cystectomy in 94.1% of cases. Full conservative treatment succeeded only in non-irradiated patients. Bone cultures were positive in 95% of cases and discordant with urine cultures in 82.4%. Reinterventions and severe complications affected 56.5% of patients; all were UF/PO-free after up to four treatment attempts. Our study is limited by the small sample size, retrospective nature, and possible information and referral bias. Conclusions and clinical implications: UF/PO can occur years after local prostate cancer treatment. Risk factors include RT and UMs. Conservative treatment rarely succeeds, particularly in irradiated patients with persistent UF. Most patients require multidisciplinary treatment involving cystectomy and pubic debridement. A perioperative bone culture to guide postoperative antibiotic treatment is crucial because of discordance with urine cultures. Postoperative complications are common, often requiring reintervention. Caution with UMs is advised after pelvic RT. Patient summary: We looked at data for patients with a rare complication that can occur after treatment for localized prostate cancer that involves a small tunnel between the lower urinary tract and the pubic bone, and infection in the pubic bone. Diagnosis occurred years after pelvic radiotherapy and shortly after a procedure performed through the urethra, typically surgery for narrowing of the urethra. Most patients needed removal of their bladder and surgical cleaning of the pubic bone, followed by long-term antibiotics. The bacteria found in bone were often different from those found in the patient’s urine, which is important in guiding antibiotic treatment after surgery. |
| format | Article |
| id | doaj-art-c14d369816ad488c9eb1a11c3e75ad68 |
| institution | Kabale University |
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| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
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| series | European Urology Open Science |
| spelling | doaj-art-c14d369816ad488c9eb1a11c3e75ad682024-12-01T05:08:06ZengElsevierEuropean Urology Open Science2666-16832024-12-01704351The Complex Challenge of Urosymphyseal Fistula and Pubic Osteomyelitis in Prostate Cancer SurvivorsLaurien Smeyers0Jens Borremans1Frank Van der Aa2Michiel Herteleer3Steven Joniau4Department of Urology, University Hospitals Leuven, Leuven, BelgiumDepartment of Urology, University Hospitals Leuven, Leuven, BelgiumDepartment of Urology, University Hospitals Leuven, Leuven, BelgiumDepartment of Traumatology, University Hospitals Leuven, Leuven, BelgiumDepartment of Urology, University Hospitals Leuven, Leuven, Belgium; Corresponding author. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel. +32 48 609 8583Background and objective: Urosymphyseal fistula (UF) and pubic osteomyelitis (PO) are rare and often poorly recognized long-term complications of treatment for localized prostate cancer. Our aim was to describe UF/PO in prostate cancer survivors. Methods: We performed a retrospective review of 26 patients treated for UF/PO after localized prostate cancer treatment at University Hospitals Leuven (1996–2021). We analyzed data for demographic characteristics, history, urethral manipulations (UMs), diagnostic and therapeutic approaches, microbiology, and treatment success. Key findings and limitations: Before diagnosis, 80.8% of the patients had undergone RP, 88.5% received radiotherapy, and 84.6% had at least one UM. The median time from radiotherapy (RT), the last UM, and the first symptoms to diagnosis were 102 mo, 4 mo, and 43 d, respectively. Treatment included cystectomy (n = 19), bladder-sparing interventions (n = 5), and conservative treatment (n = 2). Pubic debridement was required in 21 patients. All cystectomy patients had a history of RT. Imaging-detected UF led to cystectomy in 94.1% of cases. Full conservative treatment succeeded only in non-irradiated patients. Bone cultures were positive in 95% of cases and discordant with urine cultures in 82.4%. Reinterventions and severe complications affected 56.5% of patients; all were UF/PO-free after up to four treatment attempts. Our study is limited by the small sample size, retrospective nature, and possible information and referral bias. Conclusions and clinical implications: UF/PO can occur years after local prostate cancer treatment. Risk factors include RT and UMs. Conservative treatment rarely succeeds, particularly in irradiated patients with persistent UF. Most patients require multidisciplinary treatment involving cystectomy and pubic debridement. A perioperative bone culture to guide postoperative antibiotic treatment is crucial because of discordance with urine cultures. Postoperative complications are common, often requiring reintervention. Caution with UMs is advised after pelvic RT. Patient summary: We looked at data for patients with a rare complication that can occur after treatment for localized prostate cancer that involves a small tunnel between the lower urinary tract and the pubic bone, and infection in the pubic bone. Diagnosis occurred years after pelvic radiotherapy and shortly after a procedure performed through the urethra, typically surgery for narrowing of the urethra. Most patients needed removal of their bladder and surgical cleaning of the pubic bone, followed by long-term antibiotics. The bacteria found in bone were often different from those found in the patient’s urine, which is important in guiding antibiotic treatment after surgery.http://www.sciencedirect.com/science/article/pii/S2666168324009236Pubic osteomyelitisPubic symphysisProstate cancerPelvic radiotherapyUrosymphyseal fistula |
| spellingShingle | Laurien Smeyers Jens Borremans Frank Van der Aa Michiel Herteleer Steven Joniau The Complex Challenge of Urosymphyseal Fistula and Pubic Osteomyelitis in Prostate Cancer Survivors European Urology Open Science Pubic osteomyelitis Pubic symphysis Prostate cancer Pelvic radiotherapy Urosymphyseal fistula |
| title | The Complex Challenge of Urosymphyseal Fistula and Pubic Osteomyelitis in Prostate Cancer Survivors |
| title_full | The Complex Challenge of Urosymphyseal Fistula and Pubic Osteomyelitis in Prostate Cancer Survivors |
| title_fullStr | The Complex Challenge of Urosymphyseal Fistula and Pubic Osteomyelitis in Prostate Cancer Survivors |
| title_full_unstemmed | The Complex Challenge of Urosymphyseal Fistula and Pubic Osteomyelitis in Prostate Cancer Survivors |
| title_short | The Complex Challenge of Urosymphyseal Fistula and Pubic Osteomyelitis in Prostate Cancer Survivors |
| title_sort | complex challenge of urosymphyseal fistula and pubic osteomyelitis in prostate cancer survivors |
| topic | Pubic osteomyelitis Pubic symphysis Prostate cancer Pelvic radiotherapy Urosymphyseal fistula |
| url | http://www.sciencedirect.com/science/article/pii/S2666168324009236 |
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