Extirpative cultures reveal infectious pubic bone osteomyelitis in prostate cancer survivors with urinary-pubic symphysis fistulae (UPF).
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2020-05-07
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OBJECTIVE:To examine the infectious features of patients with urinary pubic symphysis fistula (UPF) and their association with osteomyelitis. METHODS:We conducted a review of our quality improvement database for 36 patients with UPF undergoing bone resection and extirpative surgery from October 2012 to January 2019. An assessment of bone and urine cultures was carried out along with surgical, radiologic and demographic data. We analyzed descriptive statistics and used Fisher Exact Tests and unpaired Welch t-tests to assess for associations with positive bone cultures. RESULTS:In our cohort, 33 patients (91.7%) had positive bone cultures with the three most common organisms being candida (22.0%), enterococcus (18.0%) and pseudomonas (10.0%). There was a correlation between positive pre-operative urine culture and positive bone culture (p< 0.01), with 63.0% of those with positive urine cultures growing the same organism on bone culture. CONCLUSIONS:In this series, 91.7% of patients undergoing extirpative surgery for UPF at our institution have positive bone cultures at time of pubic bone debridement. Additionally, we demonstrate a statistically significant correlation between positive urine cultures and positive bone cultures in these patients. This supports the need for a multidisciplinary approach including infectious disease, orthopedic surgery and reconstructive urology in order to address this complex clinical condition.
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Nosé, Brent D, William R Boysen, Arman A Kahokehr, Brian M Inouye, William C Eward, Edward F Hendershot and Andrew C Peterson (2020). Extirpative cultures reveal infectious pubic bone osteomyelitis in prostate cancer survivors with urinary-pubic symphysis fistulae (UPF). Urology. 10.1016/j.urology.2020.04.095 Retrieved from https://hdl.handle.net/10161/20687.
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William Curtis Eward
I am an Orthopaedic Oncologist, with dual clinical degrees (MD and DVM). I treat complex sarcomas in people and animals. My laboratory studies comparative oncology - discoveries we can make about cancer by analyses across different species.
Edward Ferguson Hendershot
Prosthetic Joint Infections
Orthopedic Infections
Surgical Site Infections
Tuberculosis
Andrew Charles Peterson
Dr. Peterson received his medical degree from Dartmouth Medical School in 1995 and completed his urology residency at Madigan Army Medical Center in 2002. He subsequently completed an advanced fellowship in Reconstructive Urology at Duke University in 2003. He then returned to Madigan Army Medical Center where he served as the Chief of Reconstructive Urology and the director of the urology residency.
Dr. Peterson joined the faculty at Duke in 2010 and currently serves as the Vice Chair for Education, the Urology Residency Program Director and directs the “Reconstructive Urology and Genitourinary Cancer Survivorship Fellowship”.
His research interests include improving the care of cancer survivors and the prevention of genitourinary side effects from various medical, surgical and radiation therapies for cancer. His clinical interests include reconstructive urology and bladder dysfunction in men and women; urinary incontinence in men; reconstruction for urethral stricture and trauma; new bladder construction and urinary diversion; video urodynamic study with particular value to patients with bladder-emptying problems and bladder-outlet symptoms; care of prostate cancer survivors with respect to sexual function and urinary continence, and urethral stricture disease after treatment with surgery or radiation. He is specifically skilled in the multidisciplinary management of complex genitourinary problems including scar tissue (bladder neck contracture, ureteral stricture), fistulas, radiation cystitis, and voiding dysfunction often seen in survivors of genitourinary cancers. He offers advanced surgical care including urethroplasty, placement of the artificial urinary sphincter (AUS), penile prosthesis, male sling, repair of recto-urethral fistula, and ureteral reimplantation for stricture.
During his 23 years in the United States Army Dr. Peterson achieved the rank of Colonel retiring from the Army Reserves in 2014. He is a graduate of the Command and General Staff College, and has been awarded the Expert Field Medical Badge, the Meritorious Service Medal with 3 oak leaf clusters, and the Bronze Star. He currently serves on the review panel of multiple peer reviewed journals. He is an active member of the Society for Genitourinary Reconstructive Surgeons and the Society for Government Service Urologists as well as the American Urological Association.
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