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腹腔镜单纯前列腺切除术后耻骨骨髓炎:耻骨切除伴部分膀胱切除术

Pubic Osteomyelitis After Laparoscopic Simple Prostatectomy: Pubic Bone Resection With Partial Cystectomy.

作者信息

Aragão Vital João, Marques Monteiro Miguel, Silva Soares José, Teves Frederico, Fraga Avelino

机构信息

Urology, Hospital Central do Funchal, Funchal, PRT.

Urology, Centro Hospitalar Universitário de Santo António, Porto, PRT.

出版信息

Cureus. 2024 Feb 1;16(2):e53390. doi: 10.7759/cureus.53390. eCollection 2024 Feb.

Abstract

Osteomyelitis of the pubic symphysis presents a diagnostic challenge, characterized by symptoms of pubic pain and discomfort radiating to the groin, thigh, or hip. Post-prostate surgery occurrences are rare, with a propensity for cancer-related procedures. Conservative antibiotic therapy may prove insufficient, necessitating surgical intervention. This article details a unique case involving infection, the second most prevalent pathogen. Despite the rarity of the diagnosis, particularly after a benign surgical procedure, timely intervention was hindered, leading to a delayed management course. The case involves a 69-year-old male with a history of benign prostatic hyperplasia who underwent laparoscopic simple prostatectomy. Post surgery, he developed recurrent urinary infection-related symptoms, leading to hospitalization. Diagnostic tools such as CT scans, MRI, and F-18-FDG-PET/CT scan played crucial roles in identifying the inflammatory process. Subsequent surgical debridement, pubic bone resection, and partial cystectomy, followed by an eight-week antibiotic course, led to a favorable recovery. Discussion emphasizes the rarity of pubic symphysis osteomyelitis, particularly after benign surgery, underscoring the importance of imaging and timely intervention. The presented case adds to the limited literature on post-prostatectomy osteomyelitis, emphasizing the need for heightened clinical awareness and consideration of rare complications even in routine surgical scenarios.

摘要

耻骨联合骨髓炎是一项诊断难题,其特征为耻骨疼痛及不适症状放射至腹股沟、大腿或髋部。前列腺手术后发生耻骨联合骨髓炎的情况罕见,且多见于与癌症相关的手术。保守的抗生素治疗可能并不充分,因此需要进行手术干预。本文详细介绍了一个涉及感染(第二常见病原体)的独特病例。尽管该诊断罕见,尤其是在良性手术后,但及时干预受到阻碍,导致治疗过程延迟。该病例涉及一名69岁男性,有良性前列腺增生病史,接受了腹腔镜单纯前列腺切除术。术后,他出现了与复发性尿路感染相关的症状,随后住院治疗。CT扫描、MRI和F-18-FDG-PET/CT扫描等诊断工具在识别炎症过程中发挥了关键作用。随后进行的手术清创、耻骨切除和部分膀胱切除术,以及为期八周的抗生素疗程,最终实现了良好的康复。讨论强调了耻骨联合骨髓炎的罕见性,尤其是在良性手术后,突出了影像学检查和及时干预的重要性。该病例补充了关于前列腺切除术后骨髓炎的有限文献,强调即使在常规手术情况下,也需要提高临床意识并考虑罕见并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/10908421/19e0b861549c/cureus-0016-00000053390-i01.jpg

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