A late complication of transobturator tape: abscess and myositis

Abstract

The aim of the present study was to investigate a late complication of transobturator tape (TOT) implant: abscess and myositis. The case report included a 53 years-old vaginal multipara, subject to transobturator tape procedure in 2004, who came to the observation of the Department of Obstetrics and Gynecology (University of Catania, Italy) with a late vaginal polypropylene mesh erosion. She reported growing pain at her left leg, walking difficulty, fever and persistent stress urinary incontinence (SUI). She also described a shooting pain originating from the left inguinal ligament radiating down her left leg. Obturator internus and adducent muscles of the left thigh were involved. Ultrasounds and magnetic resonance imaging (MRI) clearly revealed the course of the mesh tape through the obturator muscles with myositis and abscess. The patient was treated by removing the polypropylene tape through the vaginal erosion. Her symptomatology improved within 3 weeks after the tape removal. Although developed to minimize surgical morbidity, the TOT procedure is not risk-free. Like for all the synthetic sling materials, the risk of erosion and resulting ascending infection from contamination exists. Because of the rarity of this complication, the Authors performed an assessment of this condition. Erosion may predispose the patient to secondary complications: abscess and myositis with great difficulty in deambulation. Imaging diagnosis is very effective. Ultrasound imaging is a useful method to investigate the whole pelvic floor condition. Moreover, MRI is a precise diagnostic procedure. This case not only proved the failure of the TOT for the treatment of stress incontinence, but also all the associated concerns. The study emphasizes the observation that abscess and symptomatic myositis may result into late disabling complications, although starting from a mini-invasive procedure.