Lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement are common in the aging male population. In patients where surgical management is warranted, GreenLight photoselective photovaporization (GreenLight-PVP) of the prostate is an option. Prostatic capsule perforation and urethral-pubic symphysis leak is a rare but highly morbid complication of this procedure.
In this case study compilation, cases of urethral-pubic symphysis leak following Greenlight-PVP were reported on and described. Following this, a literature search across several different platforms was performed.
Four cases of urethral-pubic symphysis leak following GreenLight-PVP are reported on, and an additional seven cases from literature are tabulated.
From these cases, it is seen that patients with this complication often present with difficulty ambulating, urinary retention, pubic symphysis tenderness, and groin pain. Investigations included urine culture, pubic bone culture, imaging (computed tomography cystogram or magnetic resonance imaging of the pelvis), and cystoscopy. Non-surgical management includes urinary diversion and antibiotics and is the first-line treatment. Second-line surgical management includes open prostatectomy, robotic prostatectomy, or sequestration sequestrectomy of pubic symphysis and repair of the prostate. Additionally, early recognition of this complication can lead to significant improvement in patient quality of life.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2026 Mar 16 [Epub ahead of print]
Michael Kim, Aiden Kooyman, Sharon E Fishberg, Jenn A Locke, Sarah Neu, Sender Herschorn
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada., University of British Columbia, Vancouver, BC, Canada., Kelowna General Hospital, University of British Columbia, Kelowna, BC, Canada.