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

Brändstedt, Johan LU ; Abrahamsson, Johan LU ; Baseckas, Gediminas ; Bobjer, Johannes LU ; Gerdtsson, Axel LU ; Gunnlaugsson, Adalstein LU ; Kollberg, Petter ; Lydrup, Marie Louise LU ; Nyberg, Martin LU and Wenger, Daniel LU orcid , et al. (2023) In Scandinavian Journal of Urology 58. p.4-10
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... (More)

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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Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Urology
volume
58
pages
7 pages
publisher
Taylor & Francis
external identifiers
  • pmid:37096322
  • scopus:85153687399
ISSN
2168-1813
DOI
10.2340/sju.v58.5765
language
English
LU publication?
yes
id
392d032c-f7f0-4831-b259-3c659551e08a
date added to LUP
2023-07-13 11:09:08
date last changed
2024-11-16 21:24:17
@article{392d032c-f7f0-4831-b259-3c659551e08a,
  abstract     = {{<p>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 (&lt;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.</p>}},
  author       = {{Brändstedt, Johan and Abrahamsson, Johan and Baseckas, Gediminas and Bobjer, Johannes and Gerdtsson, Axel and Gunnlaugsson, Adalstein and Kollberg, Petter and Lydrup, Marie Louise and Nyberg, Martin and Wenger, Daniel and Sörenby, Anne and Tham, Johan and Warnolf, Åsa and Liedberg, Fredrik}},
  issn         = {{2168-1813}},
  language     = {{eng}},
  pages        = {{4--10}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Urology}},
  title        = {{Urosymphyseal fistula after pelvic radiotherapy in a tertial referral centre - a rare entity with significant comorbidity requiring multidisciplinary management}},
  url          = {{http://dx.doi.org/10.2340/sju.v58.5765}},
  doi          = {{10.2340/sju.v58.5765}},
  volume       = {{58}},
  year         = {{2023}},
}