A Rare Complication After Endoscopic Resection of the Prostate: Osteitis Pubis Due to a Prostate-Symphysis Fistula

Kats, E.; Venema, Pieter L.; Kropman, R. F.

doi:10.1016/s0022-5347(01)65223-6

Cited by 14 publications

(10 citation statements)

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“…It was first described by Beer in 1924 [ 1] and the aetiology is poorly understood. Osteitis pubis after open prostatectomy has been noted previously but only Laroche et al and recently our clinic have reported osteitis pubis after TURP [ 2, 3]. In both cases, the TURP was complicated by a prostate‐symphysis fistula.…”

Section: Commentmentioning

confidence: 81%

Diagnosis and treatment of osteitis pubis caused by a prostate‐symphysis fistula: a rare complication after transurethral resection of the prostate

Kats¹,

Venema²,

Kropman³

et al. 1998

British Journal of Urology

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an omental interposition. The exostosis of the symphysis Case report was not removed. Post-operatively the patient recovered with no further complications. Cystography after 2 weeks An 83-year-old man underwent TURP for BPH; 2 weeks later the patient was unable to void and complained of showed no leakage and when the suprapubic catheter was removed, the patient voided normally and was pain in the lower abdomen, fever and that walking was painful. Physical examination showed tenderness over continent. the symphysis pubis that radiated to the perineum and legs. A pelvic X-ray showed an exostosis of the symphysis Comment ( Fig. 1), with reactive sclerosis and superficial bone destruction typical of osteitis pubis. Conservative treat-Osteitis pubis is a painful, non-infectious inflammatory condition that involves the pubic bone and surrounding ment was started, including placement of a transurethral catheter, bedrest and antibiotics. However, the patient structures. It was first described by Beer in 1924 [1] and the aetiology is poorly understood. Osteitis pubis after developed fever, and CT showed an abscess in both adductor muscles (Fig. 2). Cystography revealed a fistula open prostatectomy has been noted previously but only Laroche et al. and recently our clinic have reported between the prostate and the adductor muscles on both sides. The abscess was drained and a transurethral osteitis pubis after TURP [2,3]. In both cases, the TURP was complicated by a prostate-symphysis fistula. In the catheter and ureteric catheters placed. Because of the large exostosis of the symphysis and the impression of case reported by Laroche et al. it was successfully treated conservatively. In the latter case, an operation was this exostosis into the roof of the prostate, conservative treatment was thought unlikely to be successful. necessary and the fistula closed using omental interposition. Osteitis pubis not caused by a prostate-Therefore, 8 weeks after TURP the patient underwent further surgery; at median laparotomy the large defect symphysis fistula has been associated with various urological and gynaecological procedures. The aetiology into the roof of the prostatic urethra was closed using in these cases is still unclear and the treatment is controversial, although mostly conservative. In the two cases we have reported, the patients did not respond to Fig. 1. Pelvic X-ray showing an exostosis of the symphysis (arrow). Fig. 2. CT showing the abscess in both adductor muscles (arrows).

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Section: Commentmentioning

confidence: 81%

Diagnosis and treatment of osteitis pubis caused by a prostate‐symphysis fistula: a rare complication after transurethral resection of the prostate

Kats¹,

Venema²,

Kropman³

et al. 1998

British Journal of Urology

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“…This difficult to manage complication is not limited to PVP and has also been documented to occur following TURP (51,52). PSF is rare and as such was not reported in any of the reviewed literature.…”

Section: Post-operativementioning

confidence: 99%

Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review

Pascoe

Perera

et al. 2017

Transl. Androl. Urol.

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Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI’s does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.

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“…[3] Starting in the mid-90 s, several case reports began to describe an uncommon complication from TURP first presenting with pelvic pain and difficulty walking. [4,5] Further workup revealed the presence of a prostatosymphyseal fistula (PSF), also known as a puboprostatic fistula, from the prostatic fossa to the pubic symphysis. 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.…”

Section: Introductionmentioning

confidence: 99%

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

Lundy¹,

Hauser²,

Wood³

et al. 2022

Current Urology

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Background: This study is aimed to describe our institutional experience and review the literature to date on prostatosymphyseal fistula (PSF), or puboprostatic fistula, following bladder outlet procedures such as transurethral resection of the prostate (TURP) or laser photoselective vaporization of the prostate (PVP). Materials and methods: We retrospectively queried our institutional experience for management of PSF following PVP performed for symptomatic benign prostatic hyperplasia. We also performed a systematic literature review for PSF following PVP or TURP. Finally, we describe our surgical approach to the management of this challenging condition. Results: We identified 7 cases of PSF following PVP from our institution, as well as an additional 7 cases following PVP and 9 cases following TURP from literature review. The diagnosis of PSF was made between 0.5 and 24 months following PVP, and the most specific symptoms were pubic pain and difficulty ambulating. Most patients requiring several evaluations before the diagnosis was made using appropriate imaging studies. Seventy percent of patients required surgical intervention including fistula repair or prostatectomy. Our surgical approach has evolved, and we now routinely perform robotic fistula repair with Y-V plasty and interposition flap with excellent results. Conclusions: Puboprostatic fistula is a rare and poorly described complication of PVP or TURP. To the best of our knowledge, this case series of PSF following PVP represents the largest series to date and doubles the number of reported cases in the literature. Robotic fistula repair with interposition of either peritoneal or perivesical fat flaps appears to be a viable management strategy.

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A Rare Complication After Endoscopic Resection of the Prostate: Osteitis Pubis Due to a Prostate-Symphysis Fistula

Cited by 14 publications

References 1 publication

Diagnosis and treatment of osteitis pubis caused by a prostate‐symphysis fistula: a rare complication after transurethral resection of the prostate

Diagnosis and treatment of osteitis pubis caused by a prostate‐symphysis fistula: a rare complication after transurethral resection of the prostate

Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review

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

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