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Published on: February 10, 2014
Metastatic osteomyelitis after pubovaginal sling using bone anchors
M E Franks1, J P Lavelle, T Yokoyama
1Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Urology
|August 5, 2000
Summary
A rare case of osteomyelitis and vertebral metastasis occurred after pubovaginal sling surgery using bone anchors. This complication led to significant morbidity, including chronic pain, necessitating careful patient selection and informed consent regarding bone anchor risks.
Area of Science:
- Urogynecology
- Surgical Complications
- Infectious Disease
Background:
- Pubovaginal slings are used for treating stress urinary incontinence.
- Bone anchors are sometimes employed to secure the sling material.
- Standard slings using fascia or allografts have a well-established safety profile.
Observation:
- A patient developed osteomyelitis with metastasis to the T10 vertebra.
- The complication was directly linked to the use of bone anchors in a pubovaginal sling procedure.
- This specific complication has not been previously reported with standard sling materials.
Findings:
- Bone anchor use in pubovaginal slings can lead to severe infectious complications, including vertebral osteomyelitis.
- Morbidity associated with this complication includes prolonged intravenous antibiotics, multiple revision surgeries, and chronic pelvic pain.
- Risk factors for wound infection, such as diabetes, obesity, and prior surgeries, may increase susceptibility.
Implications:
- Careful consideration of bone anchor use is warranted, especially in patients with risk factors for surgical site infections.
- Informed consent must explicitly detail the potential for severe complications like vertebral metastasis associated with bone anchors.
- Alternative sling materials or fixation methods should be considered to mitigate risks in vulnerable populations.
