Recurrent Pubic Osteomyelitis and Urosymphyseal Fistula in a Prostate Cancer Survivor: A Multidisciplinary Management...

A 67-year-old male with a history of prostate cancer, treated with prostatectomy and subsequent radiation for recurrence, presented with a complex clinical course of recurrent osteomyelitis and a persistent urosymphyseal fistula with associated phlegmon. Following stereotactic body radiation therapy (SBRT) for a T4 vertebral lesion, he developed pelvic osteomyelitis, from which Kocuria species was cultured. The progression of his disease led to a urosymphyseal fistula, necessitating a cystectomy with ileal conduit and pubic bone debridement. Despite this extensive surgical intervention, he presented one year later with recurrent ileal conduit phlegmon and osteomyelitis. This case highlights the significant diagnostic and management challenges of chronic, structurally complicated infections. It emphasizes the necessity for a multidisciplinary approach involving urology, orthopedics, infectious disease, and pain management to balance conservative (prolonged antibiotics) versus aggressive (surgical) interventions, while also considering the patient's quality of life.