Abscess originating from osteomyelitis as a cause of lower urinary tract symptoms (LUTS) and acute urinary retention

Lower urinary tract symptoms in an elderly women caused by degeneration of the pubic symphysis

Background

Lower urinary tract symptoms are very common in elderly women, and transvaginal delivery and multiple deliveries have been confirmed to be risk factors. Transvaginal delivery and multiple deliveries may lead to an increase in pubic symphysis degeneration.

Case presentation

A 79-year-old woman consulted a urologist because of worsening lower urinary tract symptoms such as frequent urination and urodynia. Color ultrasound and cystoscopy suggested the possibility of a bladder mass. A lump on the anterior wall of the bladder was observed although the surface mucosa was normal. Physical examination showed obvious tenderness in the posterior area of the pubic symphysis. Further urological computed tomography (CT) and pelvic magnetic resonance imaging (MRI) showed a nodular bony protuberance in the posterior part of the pubic symphysis, which was more obvious than before, with compression changes near the anterior wall of bladder. Open pelvic surgery showed that nodular bone tissue originating from the pubic symphysis significantly oppressed the anterior wall of the bladder behind the pubic symphysis. After resection of the nodule, the lower urinary tract symptoms were relieved significantly.

Conclusions

Pubic symphysis degeneration caused by transvaginal delivery may be an important cause of lower urinary tract symptoms in women. Pelvic CT or MRI is necessary to diagnosis this condition.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12894-022-01052-1.

Family Physician's Educational Interview with Patients Helps in Early Recognition of Lower Urinary Tract Symptoms

Purpose

Lower urinary tract symptoms (LUTS) can have an etiology outside the lower urinary tract (LUT) and are therefore an important diagnostic indicator for assessing the overall health of a person. However, LUTS is still mainly neglected by primary health care providers as well as by patients. In this study, we assessed the importance of an educational interview (EI) conducted by a GP on the patients’ ability to recognize LUTS. We also investigated other factors that affect the recognition of LUTS: subjects’ personal educational level, number of LUT symptoms and their bothersome level on a scale 0–10.

Patients and Methods

This cross-sectional study was conducted in Croatia (2018–2020) by interviewing 499 subjects. We compared recognized LUT symptoms before and after the EI and determined whether their number, their bothersome level, or the subjects’ personal educational level were associated with LUTS recognition.

Results

EI significantly improved the ability to recognize LUTS (p=0.001). The number of LUT symptoms and bothersome level in subjects before EI was much greater than the number in subjects after EI (p<0.0001, mean>4 and p<0.0001, median>8, respectively). Subjects with higher educational level recognized LUTS with fewer symptoms after the EI (p<0.01), but no difference was observed among subjects who recognized LUTS before the EI.

Conclusion

For subjects to recognize LUTS, their condition had to be severe – more than 4 symptoms and bothersome level >8/10. Personal educational level had little impact on LUTS recognition. However, an EI proved to be an excellent tool for raising awareness about LUTS and its early recognition.