OSTEITIS PUBIS AFTER MARSHALL-MARCHETTI-KRANTZ URETHROPEXY - A PUBIC OSTEOMYELITIS

OBJECTIVE: Our purpose was to review cases of osteitis pubis encounter ed at our institution after Marshall-Marchetti-Krantz retropubic ureth ropexy. STUDY DESIGN: The charts of patients diagnosed with osteitis p ubis subsequent to Marshall-Marchetti-Krantz retropubic urethropexy fr om 1980 to 1994 were reviewed. RESULTS: Fifteen cases of osteitis pubi s were diagnosed after 2030 Marshall-Marchetti-Krantz procedures (0.74 %). Onset of symptoms related to osteitis pubis began a mean of 69.8 d ays postoperatively (range 10 to 459 days). Although initial plain fil ms of the symphysis pubis were normal in 7 (54%), radiographic abnorma lity was eventually demonstrated in all a mean of 25.7 weeks after sur gery (range 4 to 78 weeks). A variety of conservative treatments resul ted in symptomatic relief in 47%. Seven of the remaining patients unde rwent operative therapy with partial or complete relief noted in all. Subsequent bone cultures were positive in 5 (71%). At follow-up a mean of 58 months after the Marshall-Marchetti-Krantz procedure complete r esolution of symptoms was noted in 33% and continued pain or ambulator y difficulty in the remainder. There was no relationship between posto perative urinary tract infections, postoperative complications, presen ting sign of fever, elevated leukocyte count or sedimentation rate, an d subsequent operative intervention (P >.05). CONCLUSIONS: Osteitis pu bis after urogynecologic surgery is an uncommon event requiring aggres sive surgical and antibiotic therapy. When bone cultures are performed , a microbial cause may be demonstrated in as many as 71% of patients.