MP29-14 MANAGEMENT OF PUBIC OSTEOMYELITIS FOLLOWING RADIATION THERAPY FOR PROSTATE CANCER

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma II1 Apr 2015MP29-14 MANAGEMENT OF PUBIC OSTEOMYELITIS FOLLOWING RADIATION THERAPY FOR PROSTATE CANCER McCabe C. Kenny, Andrew P. Windsperger, Brian J. Flynn, and Ty T. Higuchi McCabe C. KennyMcCabe C. Kenny More articles by this author , Andrew P. WindspergerAndrew P. Windsperger More articles by this author , Brian J. FlynnBrian J. Flynn More articles by this author , and Ty T. HiguchiTy T. Higuchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.617AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pubic osteomyelitis (PO) is a rare condition and has been reported following surgery, radiation, and cryotherapy for prostate cancer. PO can cause significant morbidity and few studies have described the optimal treatment of this devastating condition. We describe our experience with management of pubic osteomyelitis following radiation therapy for prostate cancer. METHODS We retrospectively reviewed patients presenting with PO and a history of radiation therapy for prostate cancer from 2012-2014. PO was diagnosed with physical examination, elevated C-reactive protein (CRP), and CT or MRI. We recorded patient demographics, prostate cancer treatment history, urinary history, labs, imaging results, management, and outcomes. RESULTS Eight patients met study criteria and all patients had biopsy confirmed prostate cancer. Prostate cancer treatment included; prostatectomy with adjuvant external beam radiation (XRT) (n=4), XRT alone (2), XRT with adjuvant brachytherapy (1) and brachytherapy alone (1). Median time from last radiation dose to PO was 12 years (range 6-23). All patients had radiographic evidence of PO, pubic pain, waddling gait, and elevated CRP (range 1.3-132.1). Six patients had a history of posterior urethral stricture and underwent transurethral treatment (range 1-3 procedures) and 7 patients required chronic oral pain medications for pubic pain. Pubocutaneous fistula was present in 6 patients. Primary surgical management included cystectomy and diversion with concomitant orthopedic pubectomy and omental flap in four patients. Three patients had previously undergone urinary diversion and presented with persistent symptoms that were managed by pubectomy with gracilis flap (n=2) and hemipelvectomy (n=1). One patient was not a surgical candidate and was managed with bilateral nephrostomy tubes and suppressive antibiotics. Six of the seven surgical patients were continued on 6 weeks of IV antibiotics. Median follow up in the surgical patients is 7 months (range 1-30) and all surgical patients have had improvement in their pubic pain. One patient developed a recurrent fistula (rectal to urethral stump) while one patient died from an unrelated cause. CONCLUSIONS PO is a devastating condition that presents with pubic pain, waddling gait, and elevated CRP. A majority of patients had transurethral treatment of posterior urethral stricture that may seed the pubic bone with urine inciting the inflammatory process. Surgical removal of the urinary system in combination with pubic debridement and long term antibiotic appears to be a treatment option. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e344 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information McCabe C. Kenny More articles by this author Andrew P. Windsperger More articles by this author Brian J. Flynn More articles by this author Ty T. Higuchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...