Infected midurethral tape presenting as an ischiorectal abscess

Area of Science:

• Urology
• Gynecology
• Surgical Infections

Background:

• Midurethral sling procedures, including intravaginal slingplasty (IVS), are common treatments for female stress urinary incontinence.
• Complications, though infrequent, can include infection and fistula formation.
• Ischiorectal abscesses are deep perianal infections, typically presenting with severe pain and swelling.

Observation:

• A patient developed recurrent ischiorectal abscesses, initially misdiagnosed as fistula in ano.
• Examination revealed a fistulous tract from the perianal area to the vagina, involving eroded and infected IVS mesh.
• Resolution of the abscess was achieved only after complete removal of the IVS tape.

Findings:

• This is the first reported case of an ischiorectal abscess secondary to intravaginal slingplasty.
• Erosion and infection of the midurethral sling mesh can lead to deep pelvic abscess formation.
• Surgical removal of the infected mesh is crucial for resolving such complications.

Implications:

• Clinicians should consider IVS complications in patients presenting with recurrent perianal or pelvic abscesses.
• Understanding the types of meshes used in IVS and their potential for erosion is important for risk assessment.
• This case underscores the need for vigilance regarding late infectious complications after midurethral sling surgery.