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Retzius-Sparing Robot-Assisted Radical Prostatectomy

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Vesicosacrofistulization after robotically assisted laparoscopic sacrocolpopexy.

Mallika Anand¹, Staci L Tanouye, John B Gebhart

¹From the Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.

Female Pelvic Medicine & Reconstructive Surgery

|April 26, 2014

Summary

Vesicosacrofistulization is a rare but serious complication following sacrocolpopexy surgery. Prompt diagnosis and multidisciplinary treatment are crucial for managing diskitis and osteomyelitis after this procedure.

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Area of Science:

Urogynecology
Minimally Invasive Surgery
Infectious Disease

Background:

Sacrocolpopexy is a surgical procedure for pelvic organ prolapse.
Robotically assisted laparoscopic sacrocolpopexy is an increasingly common approach.
Diskitis and osteomyelitis are potential complications.

Observation:

A 70-year-old woman developed fever, back, and leg pain 3 months after sacrocolpopexy.
Initial treatment for L5-S1 spondylodiskitis with antibiotics failed.
Further evaluation revealed a vesicosacrofistulization to the sacrum.

Findings:

Surgical mesh removal, debridement, and antibiotic therapy resolved the infection.
The patient recovered fully within one year.
Vesicosacrofistulization can lead to severe spinal infections post-sacrocolpopexy.

Implications:

Preventing mesh placement on the bladder and L5-S1 disk space is key.
Maintain a high suspicion for diskitis in patients with persistent symptoms.
Multidisciplinary care is essential for suspected fistulization complications.