To assess the success of robot assisted holmium laser debridement (RALD) of the pubic symphysis for osteomyelitis of the pubic symphysis with associated urosymphyseal fistula (USF). Traditionally, excision of the fistulous tract and concomitant cystectomy with urinary diversion and pubic symphyseal debridement has been done using an open approach. This paper presents patients who were successfully managed with this approach.
Between January 2007 and January 2018, all patients who underwent pubic symphyseal debridement with or without cystectomy were identified. We reviewed patients who underwent planned robot assisted cystectomy with holmium laser debridement for osteomyelitis of the pubic symphysis as a result of urinary fistula. Data on clinical presentation, perioperative outcomes and recurrence of urinary tract fistula and symptoms were collected.
Twelve patients underwent holmium laser debridement of the pubic symphysis during robot assisted cystectomy for urinary fistula. Eleven patients had prior radiation treatments for prostate cancer with all having failed prior conservative management. Median operative time was 270 minutes with median length of stay of 5 days. At last follow up, 11 (91.7%) of patients had complete resolution of their urinary fistula at median follow up of 29 months. No patients developed osteonecrosis of the bone or complications from their urinary diversion at last follow up.
Definitive surgical treatment with holmium laser debridement of the pubic symphysis with concomitant robot assisted cystectomy and urinary diversion is a safe and durable approach to the complex problem of urinary fistula with pubic symphysis osteomyelitis.
Urology. 2019 Sep 19 [Epub ahead of print]
Anojan Navaratnam, Kassem Faraj, Kyle Rose, Haidar Abdul-Muhsin, Vijay Singh, Adam Schwartz, Christopher Beauchamp, Erik P Castle
Mayo Clinic in Arizona, Department of Urology, 5777 E Mayo Blvd, Phoenix, AZ 85054; Royal Brisbane and Women's Hospital, Department of Urology, Butterfield St, Herston, QLD, 4029, Australia; Brisbane Urology Clinic, 11/135 Wickham Terrace, Brisbane, QLD, 4000, Australia. Electronic address: ., Mayo Clinic in Arizona, Department of Urology, 5777 E Mayo Blvd, Phoenix, AZ 85054., Mayo Clinic in Arizona, Department of Orthopedic Surgery, 5777 E Mayo Blvd, Phoenix, AZ 85054.