PD44-04 DIAGNOSIS AND MANAGEMENT OF PUBIC OSTEOMYELITIS ASSOCIATED WITH GENITOURINARY FISTULA

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2016PD44-04 DIAGNOSIS AND MANAGEMENT OF PUBIC OSTEOMYELITIS ASSOCIATED WITH GENITOURINARY FISTULA John Lacy, Hakan Ilaslan, Kenneth Angermeier, and Hadley Wood John LacyJohn Lacy More articles by this author , Hakan IlaslanHakan Ilaslan More articles by this author , Kenneth AngermeierKenneth Angermeier More articles by this author , and Hadley WoodHadley Wood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1796AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We sought to evaluate the clinical diagnosis and management of patients with pubic osteomyelitis and genitourinary (GU) fistula at a single institution. Although associated with significant patient morbidity, there is a dearth of literature on this rare disease process. METHODS Patients with a diagnosis of pubic osteomyelitis and GU fistula were identified by retrospectively reviewing surgical logs and clinic visits of 2 surgeons at a single institution between 2009 and 2015. All imaging studies were evaluated blindly by a single radiology staff member. RESULTS 13 patients met inclusion criteria during the study period with a mean follow up of 17.5 months after definitive intervention. Diagnostic criteria evolved over the time period and are summarized in the table below. The majority of patients (9/13) required ileal conduit urinary diversion with local debridement, excision of fistula and flap coverage. The remaining patients underwent more conservative management or fistula excision and GU reconstruction. 10/12 patients reported improvement or complete resolution of their initial symptoms after intervention and 1 patient is being followed expectantly with suppressive antibiotics. 7/13 patients experienced Clavien grade 3 or 4 complications. CONCLUSIONS Pubic osteomyelitis associated with genitourinary fistula is challenging to diagnose and to treat. There are a variety of etiologies and contributing factors that may often overlap and are frequently related to prostate cancer therapy. Sensitivity of imaging and lab studies vary, but magnetic resonance imaging (MRI) and C-reactive protein (CRP) are the diagnostic tests of choice. Treatment options are typically limited and invasive, and excellent success rates are paired with relatively high complication rates. Goals of therapy and patient expectations should be defined prior to surgical intervention. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e999 Advertisement Copyright & Permissions© 2016MetricsAuthor Information John Lacy More articles by this author Hakan Ilaslan More articles by this author Kenneth Angermeier More articles by this author Hadley Wood More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...