Vaginocutaneous fistula and buttock abscess formation 7 years after polypropylene transobturator tape insertion

Abstract

Surgical treatment for stress urinary incontinence (SUI) using transobturator tape insertion is widely accepted. However several postoperative complications were reported in the literature including infections, abscess and fistula formation. Here we report a case of 57 year old female who presented with abscess and left vaginocutaneous buttock fistula 7 years after transobturator polypropelene tape insertion. Treatment included abscess drainage with dissection of the fistulous tract and removal of the left arm of the transobturator tape along with antibiotic coverage. Sinus drainage stopped after 3 days. Stress urinary incontinence didn't recur. Suspicion of fistula formation should rise in patients presenting with bothersome vaginal or cutaneous discharge after transobturator tape insertion. This case is particular since it describes a fistula complication with polypropelene tape which is unusual with this type of tapes. Treatment of such complication should always consist of surgical removal of the mesh to allow closure of the fistulous tract.

Mycobacterium avium pelvic abscess with vaginocutaneous fistula after transobturatory sling surgery

“…Typically, these infections have long incubation periods 10 . The few cases described in the literature show us that suspicion of fistula formation should rise in patients presenting with bothersome vaginal or cutaneous discharge after transobturator mesh insertion; as described by Abdallah at al 6 .…”

“…Fistulas are typically late complications, with rare reports of vaginocutaneous fistulas 4,6,7 and a single report of vaginofemoral fistula in literature 8 . We did not find any report of vaginocutaneous fistulas from abscesses caused by NTM, as reported in this study.…”

“…The composition of the sling meshes is one of the reasons to worry about the formation of fistulas, since it determines the piece's potential to internally erode the urinary tract and vagina, in addition to a certain degree of bacterial colonization. Individual patient characteristics, such as age, estrogenic status and sexual activity can also influence the likelihood of mesh erosion 4,6 . Risk factors for mesh erosion and fistulization include a history of pelvic irradiation, presence of cancer, infection and menopause 6 .…”

“…Individual patient characteristics, such as age, estrogenic status and sexual activity can also influence the likelihood of mesh erosion 4,6 . Risk factors for mesh erosion and fistulization include a history of pelvic irradiation, presence of cancer, infection and menopause 6 .…”

A case of tape infection 19 years after insertion of a tension‐free vaginal tape sling

“…Long‐term complications of TVT surgery include the formation of a urethrovaginal fistula, tape erosion, and tape infection 5–7 . Few patients with fistula or abscess formation after TVT surgery have been cured by conservative treatment alone, suggesting that surgical treatment is necessary.…”