World Journal of Urology

, Volume 34, Issue 2, pp 275–280 | Cite as

Pubic symphysitis after transurethral resection of the prostate

  • C. Ziesel
  • S. Frees
  • C. Thomas
  • R. Stein
  • R. Gillitzer
  • J. W. Thüroff
Original Article



Pubic symphysitis (PS) after urological operations is uncommon. This is a systematic single-institution review of patients with transurethral resection of the prostate (TUR-P) with the aim to determine the incidence of PS after TUR-P and to identify a risk profile.

Materials and methods

In the past 15 years, 12,118 transurethral operations were performed in our department, 33.4 % (n = 4045) were TUR-P, and 84.6 % (n = 3421) had routine suprapubic trocar placement. A systematic retrospective analysis identified 12 patients, who developed PS (0.297 %).


Median age was 69.5 years (64–83). All patients had voiding difficulties. Urine culture had been positive in three cases. All 12 TUR-Ps were monopolar resections, and n = 11 patients had a suprapubic trocar. Median resection weight was 47.5 g (10–100). Two patients had a perforation of the capsule. Histopathological examination revealed chronic prostatitis in nine cases. After 1.0 ± 1.2 months, all patients developed pain in the pubic region. All patients underwent MRI, which suggested PS. Symptomatic and antibiotic medications were administered. Final outcome was resolution of symptoms in all patients after 3.8 ± 5.6 months. No patient retained voiding difficulties.


PS remains a rare complication after TUR-P. We could not identify a single cause for developing PS. In our study, suprapubic trocar placement (11/12), chronic prostatic inflammation (9/12), previous UTI (3/12) and extended resection (2/12) were overrepresented. Inflammatory, thermic and/or surgical damage of the capsule may be causative. Patients require antibiotic and symptomatic medication. However, prognosis for remission is excellent.


TUR-P Pubic symphysitis Inflammation Complication 



Bis in die/twice daily


Colony forming units


Computed tomography

E. coli

Escherichia coli


Extended spectrum beta-lactamase




Magnetic resonance imaging


Non-steroidal anti-inflammatory drugs


Pubic symphysitis




Transurethral resection


Transurethral resection of the prostate


Urinary tract infection


White blood count


Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This retrospective study has been performed in accordance with the ethical standards of the Declaration of Helsinki. The manuscript does not contain prospective clinical studies.


  1. 1.
    Beer E (1924) Periostitis of symphysis and descending rami of pubes following suprapubic operations. Int J Med Surg 37:224Google Scholar
  2. 2.
    Briggs RC, Kolbjornsen PH, Southall RC (1992) Osteitis pubis, Tc-99m MDP, and professional hockey players. Clin Nucl Med 17(11):861–863CrossRefPubMedGoogle Scholar
  3. 3.
    Perry JD (1992) Exercise, injury and chronic inflammatory lesions. Br Med Bull 48(3):668–682PubMedGoogle Scholar
  4. 4.
    Eskridge C, Longo S, Kwark J, Robichaux A, Begneaud W (1997) Osteomyelitis pubis occurring after spontaneous vaginal delivery: a case presentation. J Perinatol 17(4):321–324PubMedGoogle Scholar
  5. 5.
    Bali K, Kumar V, Patel S, Mootha AK (2010) Tuberculosis of symphysis pubis in a 17 year old male: a rare case presentation and review of literature. J Orthop Surg Res 5:63PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Bayrakci K, Daglar B, Tasbas BA, Agar M, Gunel U (2006) Tuberculosis osteomyelitis of symphysis pubis. Orthopedics 29(10):948–950PubMedGoogle Scholar
  7. 7.
    Kats E, Venema PL, Kropman RF (1997) A rare complication after endoscopic resection of the prostate: osteitis pubis due to a prostate-symphysis fistula. J Urol 157(2):624CrossRefPubMedGoogle Scholar
  8. 8.
    Kats E, Venema PL, Kropman RF, Kieft GJ (1998) Diagnosis and treatment of osteitis pubis caused by a prostate-symphysis fistula: a rare complication after transurethral resection of the prostate. Br J Urol 81(6):927–928CrossRefPubMedGoogle Scholar
  9. 9.
    Gillitzer R, Melchior SW, Jones J, Fichtner J, Thüroff JW (2001) Prostatosymphyseal fistula after transurethral resection of the prostate. J Urol 166(3):1001–1002CrossRefPubMedGoogle Scholar
  10. 10.
    Teichman JM, Tsang T, McCarthy MP (1992) Osteitis pubis as a complication of transrectal needle biopsy of the prostate. J Urol 148(4):1260–1261PubMedGoogle Scholar
  11. 11.
    Adam C, Graser A, Koch W, Trottmann M, Rohrmann K, Zaak D et al (2006) Symphysitis following transrectal biopsy of the prostate. Int J Urol 13(6):832–833CrossRefPubMedGoogle Scholar
  12. 12.
    Burns JR, Gregory JG (1977) Osteomyelitis of the pubic symphysis after urologic surgery. J Urol 118(5):803–805PubMedGoogle Scholar
  13. 13.
    Andonian S, Rabah DM, Aprikian AG (2002) Pseudomonas aeruginosa sacroiliitis and osteomyelitis of pelvic bones after radical prostatectomy. Urology 60(4):698CrossRefPubMedGoogle Scholar
  14. 14.
    Matthews K, Govier FE (1997) Osteitis pubis after periurethral collagen injection. Urology 49(2):237–238CrossRefPubMedGoogle Scholar
  15. 15.
    Goldberg RP, Tchetgen MB, Sand PK, Koduri S, Rackley R, Appell R et al (2004) Incidence of pubic osteomyelitis after bladder neck suspension using bone anchors. Urology 63(4):704–708CrossRefPubMedGoogle Scholar
  16. 16.
    Seigne JD, Pisters LL, von Eschenbach AC (1996) Osteitis pubis as a complication of prostate cryotherapy. J Urol 156(1):182CrossRefPubMedGoogle Scholar
  17. 17.
    Frederick RW, Carey JM, Leach GE (2004) Osseous complications after transvaginal bone anchor fixation in female pelvic reconstructive surgery: report from single largest prospective series and literature review. Urology 64(4):669–674CrossRefPubMedGoogle Scholar
  18. 18.
    Garcia-Porrua C, Picallo JA, Gonzalez-Gay MA (2003) Osteitis pubis after Marshall–Marchetti–Krantz urethropexy. Joint Bone Spine 70(1):61–63CrossRefPubMedGoogle Scholar
  19. 19.
    Bouza E, Winston DJ, Hewitt WL (1978) Infectious osteitis pubis. Urology 12(6):663–669CrossRefPubMedGoogle Scholar
  20. 20.
    Benventi FA, Spellman R (1953) Unsuccessful attempts to produce osteitis pubis in dogs. J Urol 69(3):405–406Google Scholar
  21. 21.
    Steinbach HL, Petrakis NL, Gilfillan RS, Smith DR (1955) The pathogenesis of osteitis pubis. J Urol 74(6):840–846PubMedGoogle Scholar
  22. 22.
    Mynors JM (1974) Osteitis pubis. J Urol 112(5):664–665PubMedGoogle Scholar
  23. 23.
    Chrouser KL, Leibovich BC, Sweat SD, Larson DW, Davis BJ, Tran NV et al (2005) Urinary fistulas following external radiation or permanent brachytherapy for the treatment of prostate cancer. J Urol 173(6):1953–1957CrossRefPubMedGoogle Scholar
  24. 24.
    Lane BR, Stein DE, Remzi FH, Strong SA, Fazio VW, Angermeier KW (2006) Management of radiotherapy induced rectourethral fistula. J Urol 175(4):1382–1387 (discussion 1387–1388) CrossRefPubMedGoogle Scholar
  25. 25.
    Netsch C, Bach T, Gross E, Gross AJ (2011) Rectourethral fistula after high-intensity focused ultrasound therapy for prostate cancer and its surgical management. Urology 77(4):999–1004CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • C. Ziesel
    • 1
  • S. Frees
    • 1
  • C. Thomas
    • 1
  • R. Stein
    • 1
  • R. Gillitzer
    • 2
  • J. W. Thüroff
    • 1
  1. 1.Department of Urology, Medical CenterJohannes Gutenberg University, MainzMainzGermany
  2. 2.Department of UrologyHospital DarmstadtDarmstadtGermany

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