PD62-11 PUBOPROSTATIC FISTULAE FOLLOWING PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia II1 Apr 2018PD62-11 PUBOPROSTATIC FISTULAE FOLLOWING PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE Nicholas Hauser, Kenneth Angermeier, Amr Fergany, and Hadley Wood Nicholas HauserNicholas Hauser More articles by this author , Kenneth AngermeierKenneth Angermeier More articles by this author , Amr FerganyAmr Fergany More articles by this author , and Hadley WoodHadley Wood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2847AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Photoselective vaporization of the prostate (PVP) has become a common alternative to transurethral resection of the prostate (TURP) since the introduction of the 80-W GreenLight laser in 2000 (American Medical Systems, Minnetonka MN) and the subsequent higher energy 120-W HPS and 180-W XPS lasers in 2006 and 2009, respectively. While complications including injury to ureteral orifices, bleeding, and development of a bladder neck contracture are similar to those following TURP, a less commonly reported complication after PVP is the development of a puboprostatic or pubosymphyseal fistula. METHODS This was a descriptive retrospective study of patients who presented to a single tertiary referral center for puboprostatic fistula following PVP. All patients underwent cross sectional imaging to confirm the diagnosis of fistula, and all required operative management. The Cleveland Clinic Institutional Review Board approved all research. RESULTS Five patients presented to the Cleveland Clinic with puboprostatic fistula after PVP. The table presents a summary of their clinical characteristics, presentation, and management. No patient had a history of prostate cancer or pelvic radiotherapy. Presenting symptoms included abdominal, pelvic, and thigh pain as well as difficulty ambulating. Though symptoms developed in some cases only days after the PVP, diagnosis of fistula took between 2 and 11 months. Four patients underwent successful repair of the fistula, including two robotic repairs with bladder advancement and interposition of perivesical fat or peritoneum, one open repair, and one robotic prostatectomy. The final patient had a distal prostatic and membranous urethral fistula and underwent attempted robotic repair but developed a recurrent fistula and subsequently underwent an ileal conduit urinary diversion. In follow up ranging from 2 to 57 months, all patients experienced resolution of their presenting symptoms. CONCLUSIONS Puboprostatic fistula is an uncommon complication following PVP. Patient symptoms can include severe abdominal or pelvic pain, pubic pain, and difficulty ambulating, and these symptoms may be misdiagnosed leading to significant treatment delay. Though rare, surgeon awareness of this significant complication is important to improve timely referral and management. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1160-e1161 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nicholas Hauser More articles by this author Kenneth Angermeier More articles by this author Amr Fergany More articles by this author Hadley Wood More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...