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Introduction: Anterior prostato-symphyseal fistulas are exceedingly rare and have life threatening complications including pubic osteomyelitis and intra-abdominal sepsis. To our knowledge, successful reconstruction of radiation induced prostato-symphyseal fistulas has not been well described. Our objective is to describe the management and outcomes of complex anterior prostate-symphyseal fistulas at our institution over a consecutive 10-year period.
Materials & Methods: We performed a retrospective review of patients undergoing surgical management for anterior prostato-symphyseal fistulas between January 1, 2006 and December 31, 2015. Patient demographics as well as preoperative, operative and postoperative data were reviewed, including etiology of fistula, surgical management, and outcomes.
Results: A total of 5 patients with anterior prostato-symphyseal fistulas underwent surgical repair. Previous pelvic radiation was identified as the etiology in 4 patients, while pelvic fracture was the etiology of the remaining 1 patient. All 4 patients with radiation-induced fistulas had pubic osteomyelitis. Of the 5 patients, 4 underwent pubic symphysis debridement, fistula closure and repair with an interposition rectus abdominis muscle flap, while 1 patient required permanent urinary diversion with creation of an ileal loop. At a mean follow up of 34 months, 100% of the patients undergoing repair with interposition rectus flap were closed with 1 procedure.
Conclusions: Radiation or trauma induced prostato-symphyseal fistulas can be successfully reconstructed with pubic symphysis debridement and fistula closure with an adjunct rectus abdominus interposition flap, avoiding urinary diversion in the majority of patients.