Magnetic resonance imaging to detect vesico-symphyseal fistula following robotic prostatectomy

• Main Authors: Ryan C. Hutchinson, David D. Thiel, Joseph M. Bestic
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Urologia 2013-04-01
• Series: International Brazilian Journal of Urology
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382013000200288

Pubic complications following radical prostatectomy are rare. Osteitis pubis typically presents with symptoms related to irritation of the pubic rami including pain with ambulation and adduction of the leg. A 60-year-old male with prostatic adenocarcinoma underwent uneventful robotic assisted laparoscopic prostatectomy. The patient noted the onset of severe pubic pain exacerbated by ambulation approximately one month post-surgery. An abdominal/pelvic CT scan was negative for acute pathology. Due to continued discomfort, a multiplanar MRI of the pelvis was performed with and without intravenous contrast material (20 ml Omniscan). The MRI demonstrated irregularity of the bladder base and proximal urethra with a fistulous tract extending anteriorly in direct communication with the pubic symphysis joint space. Vague periarticular marrow edema-like signal and enhancement at the pubic symphysis was thought to represent osteitis pubis. The patient's symptoms resolved after one month of urethral catheter drainage, intravenous antibiotics, and anti-inflammatory therapy.