Mp42-01 clinical factors associated with 90-day morbidity following surgical management of urosymphyseal fistula

You have accessJournal of UrologyCME1 Apr 2023MP42-01 CLINICAL FACTORS ASSOCIATED WITH 90-DAY MORBIDITY FOLLOWING SURGICAL MANAGEMENT OF UROSYMPHYSEAL FISTULA Elizabeth Bearrick, Jayson Kemble, Samuel Broida, Matthew Houdek, and Boyd Viers Elizabeth BearrickElizabeth Bearrick More articles by this author , Jayson KembleJayson Kemble More articles by this author , Samuel BroidaSamuel Broida More articles by this author , Matthew HoudekMatthew Houdek More articles by this author , and Boyd ViersBoyd Viers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urosymphyseal fistula (USF) is a devastating complication associated with prostate cancer therapy treatment. Definitive surgical management including fistula decompression, removal of devitalized bone, and tissue interposition remain the gold standard. Early postoperative outcomes remain underreported. The aim of this study was to characterize 90-day morbidity and clinical characteristics associated with adverse outcomes. METHODS: A retrospective chart review of a single institutional database identified 54 patients who underwent operative treatment for USF. Clinical characteristics and 90-day morbidity were assessed. RESULTS: In total, 46/54 (85%) patients had a history of prior pelvic radiation. Cystectomy with urinary conduit was common (N=39, 72%) and 7 (13%) underwent a robotic approach. Discordance between intra and preoperative cultures was present in 34 (67%) including 10/21 (48%) with fungal growth. Median length of stay was 9 days (IQR 7-15), 90-day Clavien-Dindo grade ≥3 complications occurred in 19 (35%), including reoperation in 7 (13%) and rehospitalization in 11 (20%). Discharge to a skilled care facility was required in 5 (9%). At least one preoperative inflammatory marker (WBC, ESR, and CR) was available in 52 (96%) patients, and pre-op albumin was available in 38 (70%). Patients with a WBC >9.6×109/L while on pre-op antibiotic therapy were more likely (RR 1.60) to have culture discordance (93% vs 54%; p=0.019). Patients with pre-op ESR >28.0 mm/h (N=38) while on antibiotic therapy were more likely to have a longer hospital stay (10 days vs 6 days; p=0.007). Patients with a pre-op albumin <3.5g/dl (N=9) were more likely to have a prolonged hospital stay (13 days vs 8 days; p=0.03) or require discharged to skilled care (75% vs 18%, p=0.35). Those with CRP greater than 100.0mg/L had higher rates Clavien grade ≥3 complications (41% vs 11%, p=0.25). ESR >65 mm/h was associated with reintervention for osteomyelitis (83% vs 35%, p=0.36). CONCLUSIONS: Preoperative clinical features including ESR, CRP, WBC, and albumin are associated with an increased risk of morbidity following treatment of USF. Earlier identification of these patients may be useful to ascertain patients who could benefit from further preoperative optimization. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e566 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Bearrick More articles by this author Jayson Kemble More articles by this author Samuel Broida More articles by this author Matthew Houdek More articles by this author Boyd Viers More articles by this author Expand All Advertisement PDF downloadLoading ...