Timing for Repair of Urosymphyseal Fistula After Diagnosis Determines the Incidence Postoperative Outcomes

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PURPOSE: There is limited evidence regarding the optimal timing of urosymphyseal fistula (USF) repair. Our aim was to conduct a comparative analysis evaluating the postoperative complications and surgical outcomes among patients undergoing surgery for USF, comparing those treated in an early versus delayed fashion. METHODS: Fifty-eight patients with diagnosis of USF and who underwent fistula decompression, pubic bone resection, and urinary tract reconstruction were included. Patients who underwent USF repair within 100 days of diagnosis were classified as having early repair, while those treated after 100 days were considered to have delayed repair. RESULTS: Thirty-one underwent delayed USF repair (53.4%), while 27 underwent early repair (46.6%). Most patients were male (96.8%). The median age (72 years vs. 69 years, p = 0.13) and mean BMI (28.7 vs. 28.6, p = 0.97) were comparable between groups. The rate of overall 90-day complications following USF repair was comparable between groups (77.4% vs. 63%, p = 0.228). We did not find a difference between the rates early complications among groups. The rates of long-term recurrent pain (46.7% vs. 11.1%, p = 0.004), recurrent osteomyelitis (20% vs. 0%, p = 0.014), and fistula (23.3% vs. 3.7%, p = 0.033) were higher in the delayed USF repair group compared to the early USF repair group. The follow up time was similar between groups too (25.43-months vs. 32.8-months, p = 0.257). CONCLUSION: While early USF repair might not affect the incidence of early complications within 90 days post-surgery, it is associated with reduced rates of long-term recurrent pain, recurrent osteomyelitis, and fistula recurrence compared to delayed USF repair.

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