Kapogiannis Filipos, Fasoulakis Konstantinos, Tsiampa Eleni, Triantafyllou Spyridon, Fasoulakis Charalampos
Urology, Hippokration General Hospital, Athens, GRC.
Obstetrics and Gynecology, Elena Venizelou General Hospital, Athens, GRC.
Cureus. 2020 Apr 16;12(4):e7703. doi: 10.7759/cureus.7703.
Prostatosymphyseal fistula (PSF) is a very rare complication described after transurethral surgery of the prostate including photoselective vaporization of the prostate (PVP) with GreenLight laser (Boston Scientific, Marlborough, MA). Sporadic cases have also been reported in the literature as side effects of pelvic radiation therapy. We present a 65-year-old male patient who underwent PVP as an elective procedure for the treatment of severe lower urinary tract symptoms. The primary management after the diagnosis of the fistula was conservative but as this did not result in an expected improvement, the patient underwent radical prostatectomy as a last resort. PSF formation is the result of the communication between the anterior capsule of the prostate and the bladder neck via pubic symphysis and the surrounding tissues. This condition often leads to either urinoma formation or osteitis pubis. In the majority of cases, treatment options are complex surgical reconstruction using flaps or grafts, radical prostatectomy or urinary diversion as an ultimate solution. The rarity of the complication and the accompanied atypical signs and symptoms warrant a low threshold for suspicion so as to diagnose the event early and provide the appropriate treatment.
前列腺耻骨联合瘘（PSF）是一种非常罕见的并发症，在前列腺经尿道手术后出现，包括使用绿激光（美国波士顿科学公司，马尔伯勒，马萨诸塞州）进行前列腺光选择性汽化术（PVP）。文献中也有零星病例报道为盆腔放疗的副作用。我们报告一名65岁男性患者，他接受了PVP作为治疗严重下尿路症状的择期手术。瘘管诊断后的初始处理是保守治疗，但由于未取得预期改善，患者最终接受了根治性前列腺切除术。PSF的形成是前列腺前包膜与膀胱颈通过耻骨联合及周围组织相通的结果。这种情况常导致尿瘤形成或耻骨炎。在大多数情况下，治疗选择包括使用皮瓣或移植物进行复杂的手术重建、根治性前列腺切除术或尿流改道作为最终解决方案。该并发症的罕见性以及伴随的非典型体征和症状使得怀疑门槛较低，以便早期诊断并提供适当治疗。
