Obturator and Thigh Abscess after Transobturator Tape Implantation for Stress Urinary Incontinence

Jürgen Zumbé, Daniel Porres, Pier-Luigi Degiorgis, Stephen Wyler
2008 Urologia internationalis  
had been inserted 2 years previously for stress urinary incontinence. She had been treated in the surgical department of another hospital 9 months before for multiple and recurrent right-sided thigh abscesses with repeated incisions and drainages over a period of 5 weeks. Microbiology had grown Chlamydia trachomatis, but as the patient had not suffered from vaginal discharge or pain no gynecological examination was performed. Finally, under continuous administration of antibiotics, symptoms had
more » ... otics, symptoms had resolved and secondary wound closure had been possible. At presentation she had fever (38.5 ° C), her right thigh was tender and swollen, inspection of the vagina showed perforation of the TVT-O through the vaginal mucosa below the urethral orifice. White cell count was 13.6/nl ( ! 10) and CRP 29.1 mg/dl ( ! 0.5). A magnetic resonance imaging study was performed of the pelvis and thighs which revealed an obturator abscess of 2 ! 1.1 ! 2.7 cm and a large thigh abscess of 4.7 ! 1.8 ! 4.3 cm on the right side, joined together ( fig. 1 ) . The TVT-O was removed under anesthesia and the obturator and thigh abscesses were incised and drained, she received oral antibiotics (Cefuroxim) and further follow-up was uneventful. Microbiology did not grow any pathologic bacteria. Two months after operation the wounds were seen to be closing and the patient was asymptomatic. Discussion The TVT-O sling is becoming a widely accepted procedure for the treatment of female urinary incontinence [1] . Our case reveals an unusual complication arising with considerable latency after the procedure; the diagnosis was initially missed and lead to considerable mor- Abstract We report a case of obturator and thigh abscess 2 years after transobturator tape implantation (TVT-O) for stress urinary incontinence. Fifteen months after sling implantation repeated incisions and drainages of multiple recurrent thigh abscesses were performed. The source of infection, an eroded TVT-O, was only identified on readmission 9 months later when vaginal discharge was reported by the patient. Magnetic resonance imaging was performed because of tenderness and pain in the leg which revealed a large obturator and thigh abscess. The TVT-O was completely excised and the abscesses drained. Further follow-up was uneventful. This new technique of sling placement via the obturator route may be associated with novel infectious complications. Symptoms and signs as well as imaging modalities and conservative versus surgical management are discussed and the literature reviewed. A 42-year-old female presented to our emergency department with vaginal discharge and increasing pain in her right thigh. Her right thigh was tender and swollen, inspection of the vagina showed perforation of the transobturator tape (TVT-O) which
doi:10.1159/000167853 pmid:19077416 fatcat:fh2h2saxlzdoblhuare3gd2khu