Urosymphyseal fistula after pelvic radiotherapy in a tertial referral centre – a rare entity with significant comorbidity requiring multidisciplinary management

Authors

  • Johan Brändstedt Department of Translational Medicine, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
  • Johan Abrahamsson Department of Translational Medicine, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
  • Gediminas Baseckas Department of Translational Medicine, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
  • Johannes Bobjer Department of Translational Medicine, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
  • Axel Gerdtsson Department of Translational Medicine, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
  • Adalstein Gunnlaugsson Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
  • Petter Kollberg Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
  • Marie-Louise Lydrup Department of Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
  • Martin Nyberg Department of Translational Medicine, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
  • Daniel Wenger Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
  • Anne Sörenby Department of Translational Medicine, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
  • Johan Tham Department of Translational Medicine, Lund University, Lund, Sweden; Department of Clinical Infection Medicine, Skåne University Hospital, Malmö, Sweden
  • Åsa Warnolf Department of Translational Medicine, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
  • Fredrik Liedberg Department of Translational Medicine, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden

DOI:

https://doi.org/10.2340/sju.v58.5765

Keywords:

Urosymphyseal fistula, osteomyelitis, radiotherapy, urinary diversion

Abstract

Objective: To report population-based clinical presentation and outcomes in patients with urosymphyseal fistula (USF) after pelvic radiotherapy (RT).
Patients and methods: A retrospective chart review was performed in 33 consecutive patients diagnosed with suspicion of USF in a tertial referral center from 2014–2022 to ascertain information about diagnostic delay, clinical presentation, precipitating causes, treatments received and outcomes during the median 22 months follow-up. Out of 33 consecutive patients with suspicion of USF, one female with vesicovaginal fistula, one patient developing RT-associated bladder angiosarcoma, four patients with short follow-up (<3 months), and three patients that during chart review not were considered to have a USF were excluded.
Results: In all, 24 males with a median age of 77 years were diagnosed with USF. Local pain was the predominating symptom in 17/24 (71%) patients. Endourologic manipulations preceded the diagnosis of USF in 16 patients. Five patients had a diagnostic delay of more than 3 months. At diagnosis, 20/24 patients had radiological signs of osteomyelitis, and five had a concomitant rectourethral fistula. Due to comorbidity, five patients were not amenable to any other interventions than urinary catheter or suprapubic tube in conjunction with long-term antibiotics, of which three died from infections related to the USF. Out of the remaining 19 patients receiving some form of urinary diversion, five had recurrent osteomyelitis, of which four did not undergo cystectomy in conjunction with surgery for the USF.
Conclusions: Urethral endourologic interventions in patients previously subjected to pelvic RT should be performed cautiously.

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References

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Published

2023-04-24

How to Cite

Brändstedt, J., Abrahamsson, J., Baseckas, G., Bobjer, J., Gerdtsson, A., Gunnlaugsson, A., Kollberg, P., Lydrup, M.-L., Nyberg, M., Wenger, D., Sörenby, A., Tham, J., Warnolf, Åsa, & Liedberg, F. (2023). Urosymphyseal fistula after pelvic radiotherapy in a tertial referral centre – a rare entity with significant comorbidity requiring multidisciplinary management. Scandinavian Journal of Urology, 58, 4–10. https://doi.org/10.2340/sju.v58.5765

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Section

Original research article