Smeyers Laurien, Borremans Jens, Van der Aa Frank, Herteleer Michiel, Joniau Steven
Department of Urology, University Hospitals Leuven, Leuven, Belgium.
Department of Traumatology, University Hospitals Leuven, Leuven, Belgium.
Eur Urol Open Sci. 2024 Oct 14;70:43-51. doi: 10.1016/j.euros.2024.09.008. eCollection 2024 Dec.
Urosymphyseal fistula (UF) and pubic osteomyelitis (PO) are rare and often poorly recognized long-term complications of treatment for localized prostate cancer. Our aim was to describe UF/PO in prostate cancer survivors.
We performed a retrospective review of 26 patients treated for UF/PO after localized prostate cancer treatment at University Hospitals Leuven (1996-2021). We analyzed data for demographic characteristics, history, urethral manipulations (UMs), diagnostic and therapeutic approaches, microbiology, and treatment success.
Before diagnosis, 80.8% of the patients had undergone RP, 88.5% received radiotherapy, and 84.6% had at least one UM. The median time from radiotherapy (RT), the last UM, and the first symptoms to diagnosis were 102 mo, 4 mo, and 43 d, respectively. Treatment included cystectomy ( = 19), bladder-sparing interventions ( = 5), and conservative treatment ( = 2). Pubic debridement was required in 21 patients. All cystectomy patients had a history of RT. Imaging-detected UF led to cystectomy in 94.1% of cases. Full conservative treatment succeeded only in non-irradiated patients. Bone cultures were positive in 95% of cases and discordant with urine cultures in 82.4%. Reinterventions and severe complications affected 56.5% of patients; all were UF/PO-free after up to four treatment attempts. Our study is limited by the small sample size, retrospective nature, and possible information and referral bias.
UF/PO can occur years after local prostate cancer treatment. Risk factors include RT and UMs. Conservative treatment rarely succeeds, particularly in irradiated patients with persistent UF. Most patients require multidisciplinary treatment involving cystectomy and pubic debridement. A perioperative bone culture to guide postoperative antibiotic treatment is crucial because of discordance with urine cultures. Postoperative complications are common, often requiring reintervention. Caution with UMs is advised after pelvic RT.
We looked at data for patients with a rare complication that can occur after treatment for localized prostate cancer that involves a small tunnel between the lower urinary tract and the pubic bone, and infection in the pubic bone. Diagnosis occurred years after pelvic radiotherapy and shortly after a procedure performed through the urethra, typically surgery for narrowing of the urethra. Most patients needed removal of their bladder and surgical cleaning of the pubic bone, followed by long-term antibiotics. The bacteria found in bone were often different from those found in the patient's urine, which is important in guiding antibiotic treatment after surgery.
尿道耻骨联合瘘（UF）和耻骨骨髓炎（PO）是局限性前列腺癌治疗罕见且常未被充分认识的远期并发症。我们的目的是描述前列腺癌幸存者中的UF/PO情况。
我们对鲁汶大学医院（1996 - 2021年）26例局限性前列腺癌治疗后发生UF/PO的患者进行了回顾性研究。我们分析了人口统计学特征、病史、尿道操作（UMs）、诊断和治疗方法、微生物学及治疗效果等数据。
诊断前，80.8%的患者接受了根治性前列腺切除术（RP），88.5%接受了放疗，84.6%至少进行过一次UM。从放疗、最后一次UM及首次出现症状到诊断的中位时间分别为102个月、4个月和43天。治疗包括膀胱切除术（n = 19）、保膀胱干预（n = 5）和保守治疗（n = 2）。21例患者需要进行耻骨清创。所有膀胱切除患者均有放疗史。影像学检测到的UF在94.1%的病例中导致了膀胱切除术。完全保守治疗仅在未接受放疗的患者中成功。95%的病例骨培养呈阳性，82.4%与尿培养结果不一致。再次干预和严重并发症影响了56.5%的患者；经过多达四次治疗尝试后，所有患者均无UF/PO。我们的研究受样本量小、回顾性性质以及可能存在的信息和转诊偏倚的限制。
UF/PO可在局部前列腺癌治疗数年后发生。危险因素包括放疗和UMs。保守治疗很少成功，尤其是在患有持续性UF的放疗患者中。大多数患者需要多学科治疗，包括膀胱切除术和耻骨清创。由于与尿培养结果不一致，围手术期骨培养以指导术后抗生素治疗至关重要。术后并发症很常见，常需要再次干预。盆腔放疗后建议谨慎进行UMs。
我们研究了局限性前列腺癌治疗后可能发生的一种罕见并发症患者的数据，该并发症涉及下尿路与耻骨之间的小通道以及耻骨感染。诊断发生在盆腔放疗数年之后，且在经尿道进行的操作（通常是尿道狭窄手术）后不久。大多数患者需要切除膀胱并对耻骨进行手术清理，随后进行长期抗生素治疗。在骨中发现的细菌通常与患者尿液中发现的细菌不同，这对指导术后抗生素治疗很重要。
