Prostato-symphyseal Fistula After Photoselective Vaporization of the Prostate: Case Series and Literature Review of a Rare Complication

Sánchez, Alejandro Sánchez; Rodríguez, Dayron; Cheng, Jed-Sian; McGovern, Francis J.; Tabatabaei, Shahin

doi:10.1016/j.urology.2014.09.028

Cited by 26 publications

(25 citation statements)

References 13 publications

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“…This patient concurrently had significant urinary symptoms, mainly manifested by recurrent episodes of macroscopic haematuria, and, in spite of initial full investigation, there was a failure to determine the diagnosis of prostate-symphyseal fistula. The symptoms and delay in diagnosis are not inconsistent with cases previously reported [ 2 ]. Of these patients, all eight presented with difficulty and pain when walking with vague groin and lower abdominal pain.…”

Section: Discussionsupporting

confidence: 82%

“…A meta-analysis of randomised controlled trials has demonstrated equivalent functional outcomes to transurethral resection of the prostate but a complication profile in favour of PVP [ 1 ]. Prostatosymphyseal fistula formation is a rare complication of any form of transurethral prostate surgery for BPH and a literature search finds only eight reported such cases [ 2 – 5 ]. Whilst treatment has predominantly required surgery, we believe this to be the first reported case of treatment with robotic assisted radical prostatectomy.…”

Section: Introductionmentioning

confidence: 99%

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Prostatosymphyseal Fistula Treated by Robotic Assisted Radical Prostatectomy

Whelan

Mullarkey

Woo

2015

Case Reports in Urology

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This case report documents a rare complication of prostate resection following a Greenlight laser procedure. The 75-year-old gentleman involved underwent photoselective vaporisation of the prostate (PVP) for clinically benign prostatic obstruction. Subsequent to PVP, the patient experienced recurrent macroscopic haematuria and pubic pain. Investigations confirmed the presence of a prostate-symphyseal fistula, a rare complication of PVP. We believe this to be the first reported case of successful treatment with robotic assisted radical prostatectomy.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Prostatosymphyseal Fistula Treated by Robotic Assisted Radical Prostatectomy

Whelan

Mullarkey

Woo

2015

Case Reports in Urology

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“…It is postulated that osteitis pubis and associated sinus tract after PVP surgery can develop after an intraoperative capsular perforation and/or periprostatic tissue ischaemia 2. With PVP, a coagulated hypovascular zone that is up to 11 mm in depth develops beyond the visualised field 7.…”

Section: Discussionmentioning

confidence: 99%

Osteitis pubis after standard bipolar TURP surgery: insight into aetiology, diagnosis, management and prevention of this rarity

Davis

Torregiani

Thornhill³

2016

BMJ Case Reports

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Transurethral resection of the prostate (TURP) surgery is standard treatment for symptomatic benign prostatic hyperplasia when medical therapy has failed. We describe a rare case of osteitis pubis secondary to a prostato-symphocoele sinus after standard bipolar TURP surgery. We also discuss diagnostic techniques and management strategies, and provide an insight into the aetiology of this rare phenomenon. Conservative management with intravenous antibiotics and an indwelling catheter was successful in our case. Treatment in more severe cases may include laparotomy with peritoneal or omental interposition or open retropubic radical prostatectomy to remove the entire sinus tract.

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“…Complications documented following PVP include capsular perforation, damage to the bladder or ureteral orifices and even more rare but serious is the development of a prostatosymphyseal fistula (PSF) leading to urinoma and osteitis pubis (50). This difficult to manage complication is not limited to PVP and has also been documented to occur following TURP (51,52).…”

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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Prostato-symphyseal Fistula After Photoselective Vaporization of the Prostate: Case Series and Literature Review of a Rare Complication

Cited by 26 publications

References 13 publications

Prostatosymphyseal Fistula Treated by Robotic Assisted Radical Prostatectomy

Prostatosymphyseal Fistula Treated by Robotic Assisted Radical Prostatectomy

Osteitis pubis after standard bipolar TURP surgery: insight into aetiology, diagnosis, management and prevention of this rarity

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

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