Claire Haas, Amir Feinberg, George E Koch, Hiren V Patel
{"title":"耻骨骨髓炎合并尿联合瘘的诊断与治疗。","authors":"Claire Haas, Amir Feinberg, George E Koch, Hiren V Patel","doi":"10.1007/s11934-025-01293-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of review: </strong>Urosymphyseal Fistula (USF) is a rare, often debilitating condition in which the urinary tract fistulizes with the pubic bone, resulting in recurrent pubic osteomyelitis (POM) from urinary tract seeding. These injuries commonly arise in the setting of pelvic radiation and are generally preceded by instrumentation of the lower urinary tract for obstruction. USFs tend to be recognized only after patients fail to recover from multiple lower urinary tract infections, resulting in repeat hospital readmissions. While fistula closures with urinary tract reconstruction have been described, treatment of USF is often complex and is best treated via urinary diversion with pubic bone debridement in the setting of preoperative optimization and long-term postoperative antibiotic regimens. The general understanding of USF presentation, work-up, and management is largely based on retrospective reviews with small sample sizes and case reports. Here we review the etiology, diagnosis, and considerations when providing care for this complex condition and propose a management algorithm to guide care.</p><p><strong>Recent findings: </strong>Recent data on USF remain limited, with the literature dominated by small, retrospective case series and single-institution reviews. Most published studies report on cohorts of fewer than 30 patients, often focusing on men with a history of pelvic radiotherapy and subsequent urethral manipulation for prostate cancer. There is a notable absence of formal guidance from professional societies regarding standardized preoperative evaluation, diagnostic criteria, antimicrobial regimens, surgical techniques, or follow-up protocols for this condition. The literature published in the past 18 months continues to be sparse, with fewer than 10 new publications identified, underscoring the rarity of the condition and the ongoing need for multicenter studies and consensus guidelines. The presentation of USF can be quite subtle initially, and thus its diagnosis is nuanced and requires providers maintain a low threshold for further evaluation in high-risk patients with pelvic pain and refractory urinary tract infections. Here, we propose a comprehensive management pathway, informed by the current data, data from relevant related disease processes and institutional experience, that begins with contrast-enhanced imaging, preoperative medical optimization, and early involvement of infectious disease and surgical subspecialists to support perioperative and intraoperative planning and management. Ultimately, long durations of culture-directed antibiotics as well as surgical debridement with cystectomy, pubectomy, and urinary diversion is the most definitive method for cure of this condition. Long-term, high-volume studies on management and outcomes in these patients have yet to be performed.</p>","PeriodicalId":11112,"journal":{"name":"Current Urology Reports","volume":"26 1","pages":"62"},"PeriodicalIF":2.9000,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484387/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Diagnosis and Management of Urosymphyseal Fistula with Pubic Osteomyelitis.\",\"authors\":\"Claire Haas, Amir Feinberg, George E Koch, Hiren V Patel\",\"doi\":\"10.1007/s11934-025-01293-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose of review: </strong>Urosymphyseal Fistula (USF) is a rare, often debilitating condition in which the urinary tract fistulizes with the pubic bone, resulting in recurrent pubic osteomyelitis (POM) from urinary tract seeding. These injuries commonly arise in the setting of pelvic radiation and are generally preceded by instrumentation of the lower urinary tract for obstruction. USFs tend to be recognized only after patients fail to recover from multiple lower urinary tract infections, resulting in repeat hospital readmissions. While fistula closures with urinary tract reconstruction have been described, treatment of USF is often complex and is best treated via urinary diversion with pubic bone debridement in the setting of preoperative optimization and long-term postoperative antibiotic regimens. The general understanding of USF presentation, work-up, and management is largely based on retrospective reviews with small sample sizes and case reports. Here we review the etiology, diagnosis, and considerations when providing care for this complex condition and propose a management algorithm to guide care.</p><p><strong>Recent findings: </strong>Recent data on USF remain limited, with the literature dominated by small, retrospective case series and single-institution reviews. Most published studies report on cohorts of fewer than 30 patients, often focusing on men with a history of pelvic radiotherapy and subsequent urethral manipulation for prostate cancer. There is a notable absence of formal guidance from professional societies regarding standardized preoperative evaluation, diagnostic criteria, antimicrobial regimens, surgical techniques, or follow-up protocols for this condition. The literature published in the past 18 months continues to be sparse, with fewer than 10 new publications identified, underscoring the rarity of the condition and the ongoing need for multicenter studies and consensus guidelines. The presentation of USF can be quite subtle initially, and thus its diagnosis is nuanced and requires providers maintain a low threshold for further evaluation in high-risk patients with pelvic pain and refractory urinary tract infections. Here, we propose a comprehensive management pathway, informed by the current data, data from relevant related disease processes and institutional experience, that begins with contrast-enhanced imaging, preoperative medical optimization, and early involvement of infectious disease and surgical subspecialists to support perioperative and intraoperative planning and management. Ultimately, long durations of culture-directed antibiotics as well as surgical debridement with cystectomy, pubectomy, and urinary diversion is the most definitive method for cure of this condition. 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The Diagnosis and Management of Urosymphyseal Fistula with Pubic Osteomyelitis.
Purpose of review: Urosymphyseal Fistula (USF) is a rare, often debilitating condition in which the urinary tract fistulizes with the pubic bone, resulting in recurrent pubic osteomyelitis (POM) from urinary tract seeding. These injuries commonly arise in the setting of pelvic radiation and are generally preceded by instrumentation of the lower urinary tract for obstruction. USFs tend to be recognized only after patients fail to recover from multiple lower urinary tract infections, resulting in repeat hospital readmissions. While fistula closures with urinary tract reconstruction have been described, treatment of USF is often complex and is best treated via urinary diversion with pubic bone debridement in the setting of preoperative optimization and long-term postoperative antibiotic regimens. The general understanding of USF presentation, work-up, and management is largely based on retrospective reviews with small sample sizes and case reports. Here we review the etiology, diagnosis, and considerations when providing care for this complex condition and propose a management algorithm to guide care.
Recent findings: Recent data on USF remain limited, with the literature dominated by small, retrospective case series and single-institution reviews. Most published studies report on cohorts of fewer than 30 patients, often focusing on men with a history of pelvic radiotherapy and subsequent urethral manipulation for prostate cancer. There is a notable absence of formal guidance from professional societies regarding standardized preoperative evaluation, diagnostic criteria, antimicrobial regimens, surgical techniques, or follow-up protocols for this condition. The literature published in the past 18 months continues to be sparse, with fewer than 10 new publications identified, underscoring the rarity of the condition and the ongoing need for multicenter studies and consensus guidelines. The presentation of USF can be quite subtle initially, and thus its diagnosis is nuanced and requires providers maintain a low threshold for further evaluation in high-risk patients with pelvic pain and refractory urinary tract infections. Here, we propose a comprehensive management pathway, informed by the current data, data from relevant related disease processes and institutional experience, that begins with contrast-enhanced imaging, preoperative medical optimization, and early involvement of infectious disease and surgical subspecialists to support perioperative and intraoperative planning and management. Ultimately, long durations of culture-directed antibiotics as well as surgical debridement with cystectomy, pubectomy, and urinary diversion is the most definitive method for cure of this condition. Long-term, high-volume studies on management and outcomes in these patients have yet to be performed.
期刊介绍:
This journal intends to review the most important, recently published findings in the field of urology. By providing clear, insightful, balanced contributions by international experts, the journal elucidates current and emerging approaches to the care and prevention of urologic diseases and conditions.
We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as benign prostatic hyperplasia, erectile dysfunction, female urology, and kidney disease. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.