Osteitis pubis after Marshall-Marchetti-Krantz urethropexy: a pubic osteomyelitis.
OBJECTIVE
Our purpose was to review cases of osteitis pubis encountered at our institution after Marshall-Marchetti-Krantz retropubic urethropexy.


METHODS
The charts of patients diagnosed with osteitis pubis subsequent to Marshall-Marchetti-Krantz retropubic urethropexy from 1980 to 1994 were reviewed.


RESULTS
Fifteen cases of osteitis pubis were diagnosed after 2030 Marshall-Marchetti-Krantz procedures (0.74%). Onset of symptoms related to osteitis pubis began a mean of 69.8 days postoperatively (range 10 to 459 days). Although initial plain films of the symphysis pubis were normal in 7 (54%), radiographic abnormality was eventually demonstrated in all a mean of 25.7 weeks after surgery (range 4 to 78 weeks). A variety of conservative treatments resulted in symptomatic relief in 47%. Seven of the remaining patients underwent operative therapy with partial or complete relief noted in all. Subsequent bone cultures were positive in 5 (71%). At follow-up a mean of 58 months after the Marshall-Marchetti-Krantz procedure complete resolution of symptoms was noted in 33% and continued pain or ambulatory difficulty in the remainder. There was no relationship between postoperative urinary tract infections, postoperative complications, presenting sign of fever, elevated leukocyte count or sedimentation rate, and subsequent operative intervention (P > .05).


CONCLUSIONS
Osteitis pubis after urogynecologic surgery is an uncommon event requiring aggressive surgical and antibiotic therapy. When bone cultures are performed, a microbial cause may be demonstrated in as many as 71% of patients.
Department of Operative Gynecology, Mayo Clinic, Scottsdale, Arizona, USA.
D N
DN
Kammerer-Doak
J L
JL
Cornella
J F
JF
Magrina
C R
CR
Stanhope
J
J
Smilack
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010000:Osteitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011183:Postoperative Complications; D011630:Pubic Bone / Q000000981:diagnostic imaging; D011631:Pubic Symphysis / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*
D000900:Anti-Bacterial Agents