title: Prostato-symphyseal fistula after photoselective vaporization of the prostate: case series and literature review of a rare complication.
abstract: OBJECTIVE
  To report our experience with the management of prostato-symphyseal fistula (PSF) after photoselective vaporization (PVP) or transurethral resection of the prostate (TURP) and review cases of this complication in published reports.
  
  
  METHODS
  We report the management of 3 patients with PSF after PVP at our institution. A total of 5 published cases of PSF after PVP or TURP were identified from the National Library of Medicine MEDLINE database. A total of 8 patients were reviewed.
  
  
  RESULTS
  Overall, the mean age was 71 years (range, 50-83 years), and average follow-up was 4.3 months (range, 1-7 months). Mean prostate volume was 32 mL (range, 16-38 mL). Five patients developed PSF after PVP and 3 patients after TURP. The most common postoperative symptoms included difficulty ambulating (100%) and pelvic, groin, and/or lower abdominal pain (85%). Associated diagnoses included osteitis pubis (38%) and urinoma (50%). Infectious complications were urinary tract infection (25%), osteomyelitis (38%), and infected urinoma (38%). Average time to diagnosis of PSF was 3.5 months (range, 0.5-11 months). Operative intervention was necessary in 75% of patients.
  
  
  CONCLUSIONS
  This is the first reported case series on the management of PSF after PVP or TURP. This complication can be difficult to diagnose, manage, and may cause significant patient morbidity. Management requires a multidisciplinary approach. Patients commonly present with non-urologic symptoms leading to a delay in diagnosis. Further studies are needed to assess the incidence and optimal management of this complication.
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA. Electronic address: asanchez6@partners.org.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sanchez
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: Dayron
authors.initials: D
authors.lastname: Rodríguez
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: Jed-Sian
authors.initials: JS
authors.lastname: Cheng
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: McGovern
authors.affiliation: Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: Shahin
authors.initials: S
authors.lastname: Tabatabaei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005402:Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011469:Prostatic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011631:Pubic Symphysis