Objective: To characterize and identify factors associated with long-term morbidity of definitive urosymphyseal fistula (USF) treatment.
Methods: Retrospective chart review of a single institution database identified 57 patients who underwent operative treatment of USF between 2009 and 2022 with at least 90 days of follow-up. Delayed complications were considered those occurring ≥90 days following surgery. Morbidity related to surgery was assessed up to 10 years post-operatively. Statistical analysis was performed using Chi-Square, Fisher's exact, and Mann Whitney-U tests.
Results: A total of 57 patients, median age of 71 years old, presented with USF. Delayed (>90 days) post-operative complications requiring major intervention occurred in 26 (46%) patients at a median time of 11 months. Twelve (21%) patients required image-guided drain placement, 5 (9%) required nephrostomy tubes, and 14 (25%) patients required additional major surgery. The use of omentum, rectus, or no flap made no difference in hernia occurrence or the type of hernia formed (P >.05). Patients with recurrent osteomyelitis had smaller width of pubic bone resection (48 vs 73 mm, P = .049). Delayed pelvic abscess formation was more common in patients who did not have flap interposition (40% vs 9%) (P = .03). De novo or worsening sacral insufficiency fractures occurred in 14 (25%) patients. The width of pubic bone resection was not associated with developing new or worsening sacral insufficiency fracture (P = .78). Durable resolution of pelvic pain was achieved in 40 (70%) patients and 49 (86%) patients were able to discontinue antibiotic therapy.
Conclusion: While definitive USF repair is associated with delayed morbidity, most male are rendered free of infection and have resolution of pain following surgical treatment.
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http://dx.doi.org/10.1016/j.urology.2024.11.062 | DOI Listing |
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