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Case Reports
. 2022 Apr 11;14(4):e24032.
doi: 10.7759/cureus.24032. eCollection 2022 Apr.

Conservative Management of a Prostate-Symphyseal Fistula With Osteomyelitis: A Case Report and Management of a Rare Complication

Gesine Peters  1 , Joshua Winston  2 , Fadi Nuwayhid  2 , Owen Pointon  3
Affiliations
Case Reports

Conservative Management of a Prostate-Symphyseal Fistula With Osteomyelitis: A Case Report and Management of a Rare Complication

Gesine Peters et al. Cureus. .

Abstract

This article presents the case of a 77-year old male who was found to have a prostate-symphyseal fistula with associated pubic symphysis osteomyelitis. He had a history of previous radiation for prostate cancer and two transurethral resections of the prostate. He was managed conservatively with long-term antibiotics and urinary diversion as he was a suboptimal surgical candidate. To our knowledge, this case report is the first reported successful conservative management of a prostate-symphyseal fistula.

Keywords: conservative management; osteomyelitis; pelvic radiation; prostate-symphyseal fistula; transurethral resection of prostate.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. MRI at the initial presentation.
The axial view shows a fistula tracking from the prostate coursing anteriorly to the symphysis pubis. There is an increased signal of the symphysis pubis, in keeping with osteomyelitis. MRI: magnetic resonance imaging
Figure 2
Figure 2. MRI at the initial presentation.
The sagittal view shows a fistula tracking from the prostate coursing anteriorly to the symphysis pubis. MRI: magnetic resonance imaging
Figure 3
Figure 3. Bone scan SPECT/CT.
Bone scan SPECT/CT axial image shows intense uptake in the anterior pubic bones. SPECT/CT: single-photon emission computed tomography/computed tomography
Figure 4
Figure 4. Gallium scan SPECT/CT.
Axial SPECT/CT gallium scan (48 hours post-gallium 67 citrate injection) shows minimal uptake within the pubic symphysis in comparison to the bone scan done previously. This is consistent with treated osteomyelitis. SPECT/CT: single-photon emission computed tomography/computed tomography
See this image and copyright information in PMC

References

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