MP24-15 MANAGEMENT OF PUBIC OSTEOMYELITIS FOLLOWING PELVIC RADIATION WITH SIMULTANEOUS PUBIC DEBRIDEMENT AND URINARY DIVERSION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2017MP24-15 MANAGEMENT OF PUBIC OSTEOMYELITIS FOLLOWING PELVIC RADIATION WITH SIMULTANEOUS PUBIC DEBRIDEMENT AND URINARY DIVERSION Daniel Shapiro, David Goodspeed, and Wade Bushman Daniel ShapiroDaniel Shapiro More articles by this author , David GoodspeedDavid Goodspeed More articles by this author , and Wade BushmanWade Bushman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3309AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pubic osteomyelitis (PO) is an uncommon but challenging complication of pelvic radiation for urologic and gynecologic malignancies. Some cases of PO result from urethral strictures requiring endoscopic management. Others occur spontaneously. We describe here our experience with urinary fistula complicated by PO. METHODS We retrospectively reviewed patients with fistula and PO who underwent pubic debridement and simple cystectomy with urinary diversion from 2014-2016. PO was diagnosed by history, physical exam, C-reactive protein (CRP) and imaging (CT or MRI). We analyzed patient demographics, treatment history, management, and outcomes. RESULTS Eight patients met study criteria (7 males, 1 female). All had a history of radiation for pelvic malignancy (7 prostate cancer, 1 cervical cancer). All but one patient had history of tobacco use. The median time between radiation and PO diagnosis was 9.5 years (range 1-15 years). Six had undergone interventions for urethral stricture disease, ranging between 1 to 3 procedures. All had a history of pelvic pain, urinary tract infection, and elevated CRP prior to the diagnosis of PO. Most underwent MRI for diagnosis of PO (5 MRI, 3 CT). Average CRP was 14.1 (range 4-24). All had pubic symphysis resection and bone cultures obtained during surgery. The most common organism was Staphylococcus aureus. Seven patients underwent ileal conduit urinary diversion and 1 patient had a transverse colon conduit. The average length of stay was 11.5 days. Two patients were admitted within 30 days of discharge. Complications consisted of one post-operative death due to pulmonary embolism, and 2 patients required drain placement for pelvic abscesses. No patient had recurrent PO. Average follow-up was 8 months (range 3-21 months). CONCLUSIONS Patients with fistula and PO can be definitively managed by combined pubic debridement, simple cystectomy and urinary diversion. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e307 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Daniel Shapiro More articles by this author David Goodspeed More articles by this author Wade Bushman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...