Case report: Osteomyelitis following a transobturator sling (TVT‐O)

Abstract

The estimated prevalence of urinary incontinence (UI) among women in Europe is 35%, of whom 70% have stress (stress urinary incontinence [SUI]) or mixed UI.1 Tensionfree tape procedures have become widespread for treatment of SUI. The technique, which is effective, is nonetheless associated with a risk of complications.2 The complications of the tension-free vaginal tape (TVT) are related to the retropubic access route and include tape erosion, bowel injury, bladder injury and vascular injury, including haematoma.3 As an alternative procedure to the retropubic slings, the transobturator approach to apply the sling has been adopted. This access route limits the potential risks of bladder lesions and does not traverse the pelvic/abdominal cavities. The first method of transobturator suburethral suspension was described by Delorme4 presented as an outside–in technique (i.e. passing the insertion device from lateral to medial through the obturator foramen to emerge in a vaginal incision) (TOT ; Medical Mentor Systems, Leiden, the Netherlands). In 2003, the transobturator route had been used with and inside–out technique reported by de Leval5 (i.e. beginning at a vaginal incision and passing the insertion device laterally through the obturator foramen) (TVT-O ; Ethicol, Somerville, NJ, USA). This is the first case report of a patient presenting with osteomyelitis following a TVT-O procedure.