[Infectious bacterial symphysitis (purulent infection of the pubic symphysis) in a urological setting-a descriptive...

Purulent infection of the pubic symphysis (infectious bacterial symphysitis, IBS) is a rare but serious disease of the symphysis and parasymphyseal structures. It can develop following surgery, interventions in the lower urinary tract, or pelvic radiation therapy.

We report on one of the largest urological cohorts with post-therapeutic IBS, with the aim of increasing awareness for this severe condition and optimizing diagnosis and treatment.

We conducted a descriptive retrospective data analysis at a university hospital over the years 2018-2022. Of the total collective, 25 patients were treated for underlying urological diseases and are part of this subgroup analysis.

Of the 25 patients with IBS, 24 were suffering from or had been treated for urological malignancies (19/24 [79%] prostate cancer; 5/24 [21%] urothelial cancer). Two patients had been treated for nonmalignant urological diseases. The average interval between surgery or intervention in the lower urinary tract due to the underlying urological disease and the diagnosis of IBS was 73.9 months (SD ± 55.7 months). Relevant fistula formations were detected in 14/25 (56%) cases, most frequently between bladder and symphysis (8/14, 57%). Of the 25 patients, 11 (58%) could be treated conservatively, while 14 (56%) had required complex, interdisciplinary, reconstructive, and, above all, multiple surgical procedures.

Purulent infection of the pubic symphysis is a severe clinical condition that can occur during-and even years after-urological and uro-oncological treatments. This study illustrates the importance of ruling out IBS even years after urological disease or surgery or interventions in the lower urinary tract. Interdisciplinary treatment involving colleagues from orthopedic and trauma surgery should always be sought, as should treatment in a center with the appropriate experience, case numbers, and infrastructure. As diagnosis and treatment are demanding, creation of an interdisciplinary guideline could be useful. We present an algorithm which includes diagnostic steps and rational therapeutic options.