Prostatosymphyseal Fistula and Pubic Osteomyelitis after Transurethral Resection of the Prostate: A Challenging Complication and Current Literature Review

Abstract

Transurethral prostate surgery can lead to a rare and late complication known as a prostatosymphyseal fistula. In the literature, there are only a limited number of reported cases of this type of fistula. This case underscores the complexities involved in disease management, as well as the challenges in establishing an initial diagnosis, given the inadequacy of conventional imaging methods to detect prostate-symphyseal fistulas. The presence of non-urological symptoms in patients often impedes the recognition of prostate-symphyseal fistulas, leading to a delay in diagnosis. In this case report, a patient who presented to the emergency department with complaints of sudden-onset difficulty walking and fever in the second month after bipolar transurethral resection of the prostate is presented. The diagnosis of pubic osteomyelitis and prostatosymphyseal fistula was made using advanced examinations such as contrast-enhanced pelvic computed tomography and magnetic resonance imaging. In the treatment, transperitoneal fistula tract excision and repair with an omental flap were performed. No complaints were observed during the 1-year postoperative follow-up. The surgeon’s vigilant approach is paramount for promptly identifying this rare complication.

Keywords

• osteomyelitis
• transurethral prostate resection
• prostatosymphyseal fistula