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

Abstract

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.

An unusual case of vaginal tape exposure following tension-free vaginal tape

“…But there is another school of opinion that these patients need long-term follow-up [8] though this could be difficult due to time and cost involved.…”