Login to Access Video or Poster Abstract: MP24-15
Sources of Funding: None

Introduction

Pubic osteomyelitis (PO) is an uncommon but challenging complication of pelvic radiation for urologic and gynecologic malignancies. Some cases of PO result from urethral strictures requiring endoscopic management. Others occur spontaneously. We describe here our experience with urinary fistula complicated by PO.

Methods

We retrospectively reviewed patients with fistula and PO who underwent pubic debridement and simple cystectomy with urinary diversion from 2014-2016. PO was diagnosed by history, physical exam, C-reactive protein (CRP) and imaging (CT or MRI). We analyzed patient demographics, treatment history, management, and outcomes.

Results

Eight patients met study criteria (7 males, 1 female). All had a history of radiation for pelvic malignancy (7 prostate cancer, 1 cervical cancer). All but one patient had history of tobacco use. The median time between radiation and PO diagnosis was 9.5 years (range 1-15 years). Six had undergone interventions for urethral stricture disease, ranging between 1 to 3 procedures. All had a history of pelvic pain, urinary tract infection, and elevated CRP prior to the diagnosis of PO. Most underwent MRI for diagnosis of PO (5 MRI, 3 CT). Average CRP was 14.1 (range 4-24). All had pubic symphysis resection and bone cultures obtained during surgery. The most common organism was Staphylococcus aureus. Seven patients underwent ileal conduit urinary diversion and 1 patient had a transverse colon conduit. The average length of stay was 11.5 days. Two patients were admitted within 30 days of discharge. Complications consisted of one post-operative death due to pulmonary embolism, and 2 patients required drain placement for pelvic abscesses. No patient had recurrent PO. Average follow-up was 8 months (range 3-21 months).

Conclusions

Patients with fistula and PO can be definitively managed by combined pubic debridement, simple cystectomy and urinary diversion.

Funding

None