Chronic Pelvic Actinomycosis Following a Bone Anchored Sling Procedure

Abramov, Yoram; Sand, Peter K.; Gandhi, Sanjay; Botros-Brey, Sylvia; Goldberg, Roger P.

doi:10.1097/01.ju.0000124436.54829.29

Cited by 7 publications

(1 citation statement)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To our knowledge, there has been no previous case of vaginal erosion due to Actinomyces sp infection of the TVT device. Abramov et al 4 reported a case of chronic pelvic actinomycosis following a bone anchored sling procedure presenting 14 months after surgery with vaginal discharge. After partial removal of the sling and a six‐month course of oral penicillin, the patient still complained of vaginal discharges.…”

Section: Discussionmentioning

confidence: 99%

Recurrent vaginal erosion of tension free vaginal tape due to Actinomyces infection

Bafghi¹,

Colomb

Fanny³

et al. 2005

BJOG

View full text Add to dashboard Cite

Case reportThe tension-free vaginal tape (TVT) is a minimally invasive polypropylene monofilament mesh sling that is known to be an effective treatment for female urinary incontinence. 1The efficacy and the simplicity of the technique have made of it the treatment of choice for this common condition.1 Infection is an extremely rare complication of the TVT usually presenting with leucorrhea and/or purulent collections in the retropubic space. 2 We report a case of TVT infection due to actinomycosis presenting as recurrent vaginal erosions of the mesh.A 46-year-old woman presented with dyspareunia and vaginal discharge. She had had a TVT (Gynecare) inserted two years before for urinary stress incontinence. Pelvic examination revealed the exposure of a 1 Â 0.5 cm portion of mesh within the vagina. She underwent transvaginal excision of the exposed part of the mesh. Postoperative course was uneventful, and bacterial cultures were sterile. Two months later, a pelvic examination revealed a new area of mesh erosion away from the previous one. The patient underwent a transvaginal removal of the entire sling, and multiple biopsies of vaginal tissue around the eroded area were taken and sent for histological examination. Postoperative course was uneventful. Histology of the biopsy specimen and mesh revealed PAS-positive granules with structures radiating from the periphery, characteristic of Actinomyces sp infection, although cultures remained sterile. The patient received a one-month course of intravenous penicillin G (10 7 IU/day) followed by a four-month course of oral amoxicillin (3 g/day). At six-month follow-up, she was well with no signs of urinary incontinence and pelvic examination was normal. DiscussionVaginal erosion is a rare complication of TVT device occurring in 0.7% of the cases.3 It is reasonable to believe that erosion may occur in the presence of multiple factors, such as inadequate vaginal incision suturing, impaired wound healing, wound infection or foreign body rejection.3 One theory suggests that subclinical infection of mesh results in wound separation that presents as exposure of the mesh.

show abstract

Section: Discussionmentioning

confidence: 99%

Recurrent vaginal erosion of tension free vaginal tape due to Actinomyces infection

Bafghi¹,

Colomb

Fanny³

et al. 2005

BJOG

View full text Add to dashboard Cite

show abstract

Complications of Sling Surgery

Sutherland¹

2007

Female Urology

View full text Add to dashboard Cite

Actinomyces infection associated with the transobturator sling

2009

View full text Add to dashboard Cite

We present a case of Actinomyces infection associated with the transobturator sling. The patient had a transobturator sling complicated only by a left vaginal sulcal perforation. She subsequently developed mesh erosion that led to two partial mesh resections performed in the operating room at 6 weeks and again at 6 months after the initial surgery. She subsequently required a groin dissection and removal of the entire left side of the sling due to persistent infection. The presence of a foreign body is believed to create an environment that makes growth of the bacteria more likely. With increased use of artificial mesh in incontinence and prolapse surgery, we may see increasing numbers of these types of infections.

show abstract

Chronic Pelvic Actinomycosis Following a Bone Anchored Sling Procedure

Cited by 7 publications

References 2 publications

Recurrent vaginal erosion of tension free vaginal tape due to Actinomyces infection

Recurrent vaginal erosion of tension free vaginal tape due to Actinomyces infection

Complications of Sling Surgery

Actinomyces infection associated with the transobturator sling

Contact Info

Product

Resources

About