title: Pubic symphysis diastasis with urinary incontinence: collaborative surgical management.
abstract: Pubic symphysis diastasis during obstetric delivery occurs rarely. Symptoms usually respond to conservative management. A nulliparous 39-year-old delivered spontaneously with an audible pop noted. Pubic symphysis diastasis of 4.6 cm was diagnosed on pelvic X-ray. She developed severe pain with ambulation and stress urinary incontinence. After neither of these symptoms improved significantly in response to conservative management, the patient underwent open reduction internal fixation with plating of her pubic symphysis, and bladder neck sling placement using autologous rectus fascia. Postoperatively she experienced urinary retention, which resolved with continuous bladder drainage for 1 week. Both her urinary incontinence and pain resolved, and she had resumed normal activities 3 months following her surgery. Pubic symphysis diastasis is a rare obstetric complication with a paucity of literature to guide its management. A coordinated multidisciplinary approach to management is necessary when multiple organ systems are involved.
authors.affiliation: Department of Obstetrics & Gynecology, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA, 23708, USA, shshippey@yahoo.com.
authors.forename: Stuart
authors.initials: S
authors.lastname: Shippey
authors.forename: Jonathan
authors.initials: J
authors.lastname: Roth
authors.forename: Robert
authors.initials: R
authors.lastname: Gaines
mesh_terms: D000328:Adult; D015897:Comorbidity; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D017699:Pelvic Pain / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D046548:Pubic Symphysis Diastasis / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*