耻骨骨髓炎合并尿联合瘘的诊断与治疗。

IF 2.9 2区 医学 Q2 UROLOGY & NEPHROLOGY
Claire Haas, Amir Feinberg, George E Koch, Hiren V Patel
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引用次数: 0

摘要

回顾目的:尿联合瘘管(USF)是一种罕见的,经常使人衰弱的疾病,其中尿路与耻骨发生瘘管,导致尿路播散引起的复发性耻骨骨髓炎(POM)。这些损伤通常发生在盆腔放射治疗的背景下,通常在进行下尿路阻塞检查之前。usf往往是在患者多次下尿路感染无法恢复后才被发现,导致反复住院。虽然已经报道过用尿路重建闭合瘘管,但USF的治疗通常是复杂的,在术前优化和术后长期抗生素治疗的情况下,通过耻骨清创的尿分流治疗是最好的。对USF表现、检查和管理的一般理解很大程度上是基于小样本和病例报告的回顾性审查。在这里,我们回顾病因,诊断和注意事项时,提供护理这种复杂的条件,并提出一个管理算法来指导护理。最近的发现:最近关于USF的数据仍然有限,文献主要是小型回顾性病例系列和单一机构的综述。大多数已发表的研究报告的队列少于30例患者,通常集中于有盆腔放疗史和随后尿道操作前列腺癌的男性。值得注意的是,专业协会缺乏关于标准化的术前评估、诊断标准、抗菌方案、手术技术或该病症的随访方案的正式指导。在过去的18个月里发表的文献仍然很少,只有不到10篇新的出版物被确定,这强调了这种疾病的罕见性,以及对多中心研究和共识指南的持续需求。USF的表现最初可能非常微妙,因此其诊断也很微妙,要求医生在骨盆疼痛和难治性尿路感染的高危患者中保持较低的阈值以进一步评估。在这里,我们提出了一个综合的管理途径,根据当前的数据,相关疾病过程的数据和机构经验,从对比增强成像开始,术前医疗优化,早期参与传染病和外科专科医生,以支持围手术期和术中计划和管理。最终,长时间的培养导向抗生素以及手术清创,膀胱切除术,耻骨切除术和尿转移是治疗这种疾病的最确定方法。对这些患者的治疗和结果的长期、大量研究尚未进行。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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来源期刊
Current Urology Reports
Current Urology Reports UROLOGY & NEPHROLOGY-
CiteScore
4.60
自引率
3.80%
发文量
39
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.
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