Urethral-pubic symphysis leak and osteomyelitis following GreenLight™ photoselective photovaporization of the prostate

Authors

  • Michael Kim University of Toronto
  • Aiden Kooyman University of British Columbia
  • Sharon E. Fishberg University of Toronto
  • Jenn A. Locke Kelowna General Hospital, University of British Columbia
  • Sarah Neu University of Toronto
  • Sender Herschorn University of Toronto

DOI:

https://doi.org/10.5489/cuaj.9473

Keywords:

Urethral-Pubic Symphysis Leak, GreenLight laser photoselective vaporization of prostate

Abstract

Introduction: Lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement are common in the aging male population. In patients where surgical management is warranted, GreenLight photoselective photovaporization (GreenLight-PVP) of the prostate is an option. Prostatic capsule perforation and urethral-pubic symphysis leak is a rare but highly morbid complication of this procedure.

Methods: In this case study compilation, cases of urethral-pubic symphysis leak following Greenlight-PVP were reported on and described. Following this, a literature search across several different platforms was performed.

Results: Four cases of urethral-pubic symphysis leak following GreenLight-PVP are reported on, and an additional seven cases from literature are tabulated.

Conclusions: From these cases, it is seen that patients with this complication often present with difficulty ambulating, urinary retention, pubic symphysis tenderness, and groin pain. Investigations included urine culture, pubic bone culture, imaging (computed tomography cystogram or magnetic resonance imaging of the pelvis), and cystoscopy. Non-surgical management includes urinary diversion and antibiotics and is the first-line treatment. Second-line surgical management includes open prostatectomy, robotic prostatectomy, or sequestration sequestrectomy of pubic symphysis and repair of the prostate. Additionally, early recognition of this complication can lead to significant improvement in patient quality of life.

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Published

2026-03-16

How to Cite

Kim, M., Aiden Kooyman, Fishberg, S. E., Locke, J. A., Neu, S., & Herschorn, S. (2026). Urethral-pubic symphysis leak and osteomyelitis following GreenLight™ photoselective photovaporization of the prostate. Canadian Urological Association Journal, 20(7). https://doi.org/10.5489/cuaj.9473

Issue

Vol. 20 No. 7 (2026): CUAJ July

Section

Residents' Room

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