Glickman Urological & Kidney Institute Outcomes

Urosymphyseal fistulas are an emerging problem in urology resulting in life-altering impact on patient quality of life. The condition typically occurs in patients who have undergone pelvic radiation therapy as part of their treatment for prostate cancer, usually complicated by posterior urethral stenosis requiring subsequent endoscopic outlet procedures. The reason for the increase in occurrence is unclear but may be related to increasing doses of pelvic radiation, or possibly an anterior shift in treatment to avoid rectal complications. Patients present with severe pelvic pain leading to difficulty in walking and use of a walker or wheelchair in many cases. Associated pubic osteomyelitis is often present.

Clinicians in the Center for Genitourinary Reconstruction treated and recently reported on 33 patients who underwent surgery for this condition, and over 90% underwent cystectomy, pubic bone debridement or resection, urinary diversion, and omental pedicle flap to the deep pelvis. Clavien-Dindo grade ++>++ 3 complications occurred in 15.6% of patients, which is typical based on the complex nature of the surgery. Postoperative pain was significantly reduced with the median pain score decreasing from 4 to 0, and this was associated with a significant reduction in opioid use.¹