Objective To describe the inciting events leading to urosymphyseal fistulas (UF) and pubic osteomyelitis (PO) in patients who had radiation induced urethral strictures. Materials and Methods We retrospectively reviewed patients who underwent simultaneous pubic debridement, simple cystectomy and urinary diversion for refractory UF and PO from 2014-2016. We investigated inciting events leading to UF as well as patient presenting symptoms, diagnosis, management, and outcomes. Results Five patients were identified over a two-year period. All patients had previous history of radiation for prostate cancer. The median age was 67 years. All patients developed UF and PO after endoscopic intervention for urethral stricture. The number of endoscopic interventions per patient for stricture ranged from 1-7 including serial dilation, balloon dilation and urethrotomy. Sterile urine cultures were obtained prior to all endoscopic interventions. All patients had pelvic pain with ambulation and recurrent UTIs at presentation. Patients were diagnosed using a combination of retrograde urethrography and magnetic resonance imaging. Simultaneous pubic debridement with simple cystectomy and diversion was used for management in all cases. One patient died post-operatively with the remainder recovering well without PO or fistula recurrence, with a median follow-up of 16 months. Conclusions UF can occur as a complication of endoscopic treatment of posterior urethral stricture in patients with a history of radiation therapy for prostate cancer. This study demonstrates that UF and PO may develop even with minimally traumatic procedures and sterile urine. All patients treated for posterior stricture must be considered at risk for development of fistula and osteomyelitis.
Urology. 2018 Jan 03 [Epub ahead of print]
Daniel D Shapiro, David C Goodspeed, Wade Bushman
Department of Urology, University of Wisconsin School of Medicine and Public Health. Electronic address: ., Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health., Department of Urology, University of Wisconsin School of Medicine and Public Health.