Symphysis Pubis Osteomyelitis: An Uncommon Complication after Robotic Assisted Radical Prostatectomy-Case Description with Literature Review

Pubic Osteomyelitis After Laparoscopic Simple Prostatectomy: Pubic Bone Resection With Partial Cystectomy

Osteomyelitis of the pubic symphysis presents a diagnostic challenge, characterized by symptoms of pubic pain and discomfort radiating to the groin, thigh, or hip. Post-prostate surgery occurrences are rare, with a propensity for cancer-related procedures. Conservative antibiotic therapy may prove insufficient, necessitating surgical intervention. This article details a unique case involving Pseudomonas aeruginosa infection, the second most prevalent pathogen. Despite the rarity of the diagnosis, particularly after a benign surgical procedure, timely intervention was hindered, leading to a delayed management course. The case involves a 69-year-old male with a history of benign prostatic hyperplasia who underwent laparoscopic simple prostatectomy. Post surgery, he developed recurrent urinary infection-related symptoms, leading to hospitalization. Diagnostic tools such as CT scans, MRI, and F-18-FDG-PET/CT scan played crucial roles in identifying the inflammatory process. Subsequent surgical debridement, pubic bone resection, and partial cystectomy, followed by an eight-week antibiotic course, led to a favorable recovery. Discussion emphasizes the rarity of pubic symphysis osteomyelitis, particularly after benign surgery, underscoring the importance of imaging and timely intervention. The presented case adds to the limited literature on post-prostatectomy osteomyelitis, emphasizing the need for heightened clinical awareness and consideration of rare complications even in routine surgical scenarios.

Hip Adductor Muscle Abscess Descending From Septic Symphysitis

Hip adductor muscle abscesses that descend from an infected symphysis pubis are rare but cause serious morbidity. We present a case of a 73-year-old male patient with unilateral hip adductor muscle abscess that descended from septic symphysitis caused by Staphylococcus aureus. Surgical debridement of the adductor compartment could not clear the infection and secondary debridement of the symphysis was necessary to eradicate S. aureus. Additionally, we review another four cases with similarities to our case comparing their investigation, treatment, and outcome.

Management of Medium and Long Term Complications Following Prostate Cancer Treatment Resulting in Urinary Diversion - A Narrative Review

The purpose of this narrative review is to discuss and highlight recently published studies regarding the surgical management of patients suffering from prostate cancer treatment complications. Focus will be put on the recalcitrant and more complex cases which might lead to urinary diversion as a definite, last resort treatment. It is in the nature of every treatment, that complications will occur and be bothersome for both patients and physicians. A small percentage of patients following prostate cancer treatment (radical prostatectomy, radiation therapy, or other focal therapies) will suffer side effects and thus, will experience a loss of quality of life. These side effects can persist for months and even years. Often, conservative management strategies fail resulting in recalcitrant recurrences. Prostate cancer patients with "end-stage bladder," "devastated outlet," or a history of multiple failed interventions, are fortunately rare, but can be highly challenging for both patients and Urologists. In a state of multiple previous surgical procedures and an immense psychological strain for the patient, urinary diversion can offer a definite, last resort surgical solution for this small group of patients. Ideally, they should be transferred to centers with experience in this field and a careful patient selection is needed. As these cases are highly complex, a multidisciplinary approach is often necessary in order to guarantee an improvement of quality of life.

Surgical debridement of infected pubic symphysitis supports optimal outcome

INTRODUCTION

Infected pubic symphysitis (IPS) is a rare bacterial infection of the pubic symphysis that causes subpubic pain, disability and ultimately permanent immobility. Due to difficult diagnosis, patients present with long-standing complaints and consult several doctors. To date, no validated treatment protocol exists and most patients are treated conservatively with antibiotics. This study was aimed to assess the results after careful surgical debridement and pathogen-specific antibiotic treatment in IPS.

MATERIALS AND METHODS

A chart review of eight patients with proven IPS was performed. Five of eight patients filled in a specific own-developed questionnaire and could be examined clinically and radiologically at a mean of 13 months (range: 6-30 months) postoperatively.

RESULTS

There were six males and two females with an average age of 69 years (range: 55-80 years). The mean duration of symptoms before surgical treatment was 10.5 months (range: 1-30 months). There were no complications due to the surgical debridement. There was no recurrence of infection at the pubic symphysis during the follow-up period. The most common pathogen was Pseudomonas aeruginosa in three patients. Mean preoperative pain, measured on the visual analogue scale (VAS, range: 0-10) for the four analysed categories in the five follow-up patients was 7.2, 30 days postoperatively 2.7 and 13 months postoperatively 0.4. There was a steady increase in the quality of life (QoL) 30 days postoperatively and at the 13 months follow-up when compared to preoperative values.

CONCLUSIONS

Surgical debridement is the keystone for treatment of IPS and should be combined with local and systemic antibiotic therapy.