V12-12: Robotic Cystoprostatectomy with Pubectomy and Ileal Conduit for Patients with Osteomyelitis Pubis
Osteomyelitis pubis is a rare complication of pelvic radiation and prostate surgery. This chronic condition has substantial impact on quality of life. Medical therapy has limited role and surgical resection is usually needed. Open prostatectomy or cystoprostatectomy with pubectomy is associated with difficult post-operative recovery. We report our early experience in robotic cystoprostatectomy with pubis symphysis debridement
We present an instructional video of a 77 y.o. male with history of prostate cancer. s/p open radical prostatectomy 19 years prior to his surgery, complicated with multiple Bladder neck contractures over the years. He underwent salvage radiation therapy for biochemical failure. Developed urinary incontinence. Later he underwent an attempted bladder sling placement, followed by AUS and Urolume urethral stent. Due to AUS pump erosion and eventual explanation few months later. Every 6 months thereafter he was repeatedly treated for stones encrusting. He then developed OM of the pelvic bone for the last 4 years, complicated by bacteremia and extended IV antibiotics.
Up to 2016 four patients with chronic post radiation osteomyelitis pubis underwent robotic cystectomy with pubic symphysis debridement and ileal conduit urinary diversion. One patient needed a temporary loop colostomy. Average robotic operative time: 175 minutes. Average hospital Stay 5.3 days. Median EBL 75 ± 40 ml. Antibiotics were stopped within 4 weeks. One had high grade complication and none had recurrence of the osteomyelitis.
Robotic cystectomy with pubic symphysis debridement is a feasible alternative to open cystectomy with open resection of pubis symphysis. It may provide faster recovery.