Anchor-Related Granulomatous Reaction After Single-Incision Mid-urethral Sling Placement: A Case Report

Urinary incontinence is a common condition in adult women, significantly affecting quality of life, daily activities, and psychosocial well-being. Stress urinary incontinence (SUI) is the most frequent subtype, and it often coexists with pelvic organ prolapse (POP), as both conditions result from pelvic floor dysfunction and share risk factors such as childbirth and menopause. The Altis® mid-urethral sling (Coloplast Corp., Minneapolis, MN, USA) is a minimally invasive mesh implant designed to treat stress urinary incontinence in women by providing urethral support. Although it demonstrates high success rates, potential complications, such as early-onset groin pain, urinary tract infection, voiding difficulties, subepithelial erosion or mesh extrusion, labial nodule, or paraurethral granuloma, may arise, sometimes requiring medical or surgical intervention. Our patient, a 43-year-old woman (P2002), developed severe early-onset groin pain, subepithelial vaginal erosion, a left paraurethral granuloma, and a labial subcutaneous nodule following the placement of an Altis® single incision sling system for stress urinary incontinence confirmed by urodynamic studies. Her symptoms began within days of the procedure. On examination, there was ulceration of the left vaginal wall with granulation tissue, though no mesh fibers were visible. MRI showed inflammation along the left sling's anchoring arm. The patient underwent surgical excision of the granuloma, removal of the left sling arm, and resection of the labial nodule, resulting in complete resolution of her symptoms. This case highlights an uncommon early complication of single-incision mid-urethral sling placement related to anchor-associated granulomatous inflammation. Early-onset groin pain and subepithelial vaginal erosion may occur without visible mesh exposure. Prompt recognition and targeted surgical management can result in symptom resolution and favorable clinical outcomes.