Login to Access Video or Poster Abstract: MP24-16
Sources of Funding: none

Introduction

Urosymphyseal fistulation is a recently described condition which is also referred to in the literature as osteitis pubis or pubic osteomyelitis. The morbidity of this is considerable particularly the pain it generates, which is often uncontrollable and unbearable. The name of the condition reflects our understanding of the nature and cause of the problem and in view of the discrepancy in terminology we have assessed the clinical, biochemical, microbiological and histological evidence in our own group of patients to determine the nature of the condition.

Methods

There were 37 patients treated in our centre in the last five years (2012 - 2016 inclusive). We have complete data in 27 of these. Blood studies, imaging and microbiological investigations were performed preoperatively; microbiology and histology specimens were taken at the time of surgery; and there was further imaging and blood studies postoperatively.

Results

The only imaging investigation that was 100% reliable was MRI scanning. The white blood cell count was normal in 6 patients and the average elevation was to 12.3 x103/μL. The CRP was elevated in every patient up to a level of a mean of 26.5mg/L. There appeared to be no specific correlation between the CRP and the symptoms. Urine culture was positive in only 12 patients (44.4%) with an even spread between coliforms, pseudomonas spp. and candida spp.. The tissue culture was positive in 11 (40.7%) of the patients and did not necessarily match the urine culture. Histological assessment showed chronic inflammation in both the symphysis and the adjacent bone in 9 patients. There were external beam radiotherapy-related changes in all of these. There were chronic inflammatory changes in the symphysis alone in 18 patients. There was no evidence of osteomyelitis in any patient.

Conclusions

Essentially the characteristic intraoperative finding was of a thick-walled fluid containing cavity within the pubic symphysis which was sometimes related to inflammatory changes in the surrounding bone and sometimes to post-irradiation changes in the bone but never to any acute inflammatory change. Correlating the symptoms, the clinical findings, the surgical findings and the haematological and microbiological findings suggest that the fundamental problem is the urine leak and direct fistulation into (and sometimes through) the pubic symphysis. The more extensive the leak the worse the pain. The urinary and tissue microbiology did not correlate with each other or with the symptoms. _x000D_ _x000D_ The correct terminology for this condition, we believe, is Urosymphyseal Fistulae. _x000D_

Funding

none