Prostatosymphyseal Fistula After Photoselective Vaporization of the Prostate: A Very Rare Complication of a Transurethral Surgery

Abstract

Prostatosymphyseal fistula (PSF) is a very rare complication described after transurethral surgery of the prostate including photoselective vaporization of the prostate (PVP) with GreenLight ΤΜ laser (Boston Scientific, Marlborough, MA). Sporadic cases have also been reported in the literature as side effects of pelvic radiation therapy. We present a 65-year-old male patient who underwent PVP as an elective procedure for the treatment of severe lower urinary tract symptoms. The primary management after the diagnosis of the fistula was conservative but as this did not result in an expected improvement, the patient underwent radical prostatectomy as a last resort. PSF formation is the result of the communication between the anterior capsule of the prostate and the bladder neck via pubic symphysis and the surrounding tissues. This condition often leads to either urinoma formation or osteitis pubis. In the majority of cases, treatment options are complex surgical reconstruction using flaps or grafts, radical prostatectomy or urinary diversion as an ultimate solution. The rarity of the complication and the accompanied atypical signs and symptoms warrant a low threshold for suspicion so as to diagnose the event early and provide the appropriate treatment.

Conservative Management of a Prostate-Symphyseal Fistula With Osteomyelitis: A Case Report and Management of a Rare Complication

“…Fistula formation following TURP is rare and there have been very few reported cases [1][2][3][4][5][6]. To our knowledge, this is the first paper describing this rare fistula formation between the prostate and pubic symphysis that was successfully conservatively managed, treating the infection and pain caused by this phenomenon.…”

“…There is one documented case of successful conservative management of a prostate-lymphocele sinus tract; however, this differs anatomically from this case of prostate-pubic symphysis fistula formation [6]. All other reported cases have either been managed with first-line surgical correction or have trialed conservative management that subsequently failed, leading to future surgical intervention [1][2][3][4][5]. In these cases, surgical management involved surgical excision and closure and was associated with high risks of morbidity and mortality [1,2,4,5].…”

“…All other reported cases have either been managed with first-line surgical correction or have trialed conservative management that subsequently failed, leading to future surgical intervention [1][2][3][4][5]. In these cases, surgical management involved surgical excision and closure and was associated with high risks of morbidity and mortality [1,2,4,5].…”

“…A prostate-symphyseal fistula is a rare late complication of pelvic radiation and transurethral resections of the prostate (TURPs). There have been very few reported cases of this type of fistula in the literature [1][2][3][4][5], all of which were surgically managed. Our case describes a multidisciplinary approach to conservative management with the involvement of the infectious diseases, orthopedics, urology, physiotherapy, occupational therapy, and community nursing teams.…”

Management of Medium and Long Term Complications Following Prostate Cancer Treatment Resulting in Urinary Diversion – A Narrative Review

“…It is also of note that few cases of urosymphyseal fistula and concomitant osteomyelitis were observed in patients undergoing salvage focal therapy for prostate cancer treatment, such as HIFU, and palliative transurethral resection of the prostate following initial radiation therapy of prostate cancer treatment ( 19 , 22 , 23 ).…”