MP53-17 IS PREOPERATIVE BIOPSY AND BONE CULTURE NECESSARY BEFORE SURGERY FOR PUBIC OSTEOMYELITIS CAUSED BY THE URINARY SYSTEM?

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-17 IS PREOPERATIVE BIOPSY AND BONE CULTURE NECESSARY BEFORE SURGERY FOR PUBIC OSTEOMYELITIS CAUSED BY THE URINARY SYSTEM? Anessa Sax-Bolder, Eseosa Enabulele, Jason Stoneback, and Ty Higuchi Anessa Sax-BolderAnessa Sax-Bolder More articles by this author , Eseosa EnabuleleEseosa Enabulele More articles by this author , Jason StonebackJason Stoneback More articles by this author , and Ty HiguchiTy Higuchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pubic osteomyelitis (PO) is a rare and devastating diagnosis. Historically, first line treatment for PO has been antibiotic treatment. More recently, a multidisciplinary surgical approach has been used, including radical cystectomy with ileal conduit and omental flap with simultaneous anterior pelvic resection with intraoperative biopsies. Preoperative CT-guided bone biopsies for pathology and culture data can be helpful in guiding therapy. Herein we report the concordance of pre and intraoperative biopsies in pubic osteomyelitis caused by urinary tract erosion. METHODS: Retrospective chart reviews were completed at a single tertiary academic medical center. Patients that received surgery for PO from 2013-2020 were included. Demographic data, management and outcomes were collected. RESULTS: A total of 17 patients were identified. 10 patients (59%) underwent a preoperative CT-guided biopsy with 50% (5/10) yielding negative bone culture (BC) results. Of the negative BC results, 4 had positive intraoperative BC. The remaining patient had a negative intraoperative BC but did have a positive intraoperative tissue culture. Of the 5 positive preoperative BC, 4 had intraoperative BC that grew organisms not found in the preoperative biopsy. The final patient with a positive preoperative BC had a negative intraoperative BC. Overall, of the 10 patients who underwent preoperative BC, 90% (9/10) had discordance between their preoperative CT-guided BC and their intraoperative BC. No patients had preoperative biopsy showing cancer, yet 24% (4/17) had intraoperative frozen sections showing cancer (prostatic adenocarcinoma, colorectal adenocarcinoma, urothelial cell carcinoma and squamous cell carcinoma). All 4 had a history of radiation for prostate cancer. One recent patient not included in the study had a bone biopsy showing urothelial carcinoma, thus the success rate of bone biopsy in our series is 18% (2/11). CONCLUSIONS: In this review, preoperative BC was not concordant with intraoperative BC. Potential explanations include the limited sample obtained in preoperative BC or subsequent antimicrobial treatment after preoperative BC. This study suggests caution should be used when basing clinical decisions off preoperative BC due to risk of misguiding antimicrobial treatment. Preoperative biopsy for pathology should be performed to rule out malignancy, however in our series this yielded low success rate and intraoperative frozen sections are vital. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e945-e945 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anessa Sax-Bolder More articles by this author Eseosa Enabulele More articles by this author Jason Stoneback More articles by this author Ty Higuchi More articles by this author Expand All Advertisement Loading ...