Delayed Morbidity Associated With Surgical Management of Urosymphyseal Fistula

To characterize and identify factors associated with long-term morbidity of definitive urosymphyseal fistula (USF) treatment.

Retrospective chart review of a single institution database identified 57 patients who underwent operative treatment of USF between 2009 and 2022 with at least 90 days of follow-up. Delayed complications were considered those occurring ≥90 days following surgery. Morbidity related to surgery was assessed up to 10 years post-operatively. Statistical analysis was performed using Chi-Square, Fisher's exact, and Mann Whitney-U tests.

A total of 57 patients, median age of 71 years old, presented with USF. Delayed (>90 days) post-operative complications requiring major intervention occurred in 26 (46%) patients at a median time of 11 months. Twelve (21%) patients required image-guided drain placement, 5 (9%) required nephrostomy tubes, and 14 (25%) patients required additional major surgery. The use of omentum, rectus, or no flap made no difference in hernia occurrence or the type of hernia formed (P >.05). Patients with recurrent osteomyelitis had smaller width of pubic bone resection (48 vs 73 mm, P = .049). Delayed pelvic abscess formation was more common in patients who did not have flap interposition (40% vs 9%) (P = .03). De novo or worsening sacral insufficiency fractures occurred in 14 (25%) patients. The width of pubic bone resection was not associated with developing new or worsening sacral insufficiency fracture (P = .78). Durable resolution of pelvic pain was achieved in 40 (70%) patients and 49 (86%) patients were able to discontinue antibiotic therapy.

While definitive USF repair is associated with delayed morbidity, most male are rendered free of infection and have resolution of pain following surgical treatment.