CHRONIC PELVIC ACTINOMYCOSIS FOLLOWING A BONE ANCHORED SLING PROCEDURE

Abstract

Pelvic actinomycosis is a rare disease that has most commonly been reported in intrauterine device users. To our knowledge we report the first case of chronic pelvic actinomycosis following a bone anchored sling procedure. CASE REPORT A 58-year-old woman presented with a chronic, foul smelling vaginal discharge. Four years earlier she had undergone a bone anchored suburethral sling procedure for stress urinary incontinence using titanium bone anchors with preattached polypropylene sutures and a gelatin coated polypropylene sling. Fourteen months later she complained of increased vaginal discharge and underwent transvaginal excision and removal of the sling elsewhere. However, the bone anchors and polypropylene sutures were left in situ. On sling cultures Actinomyces israelii was isolated, and the patient received a 6-month course of oral penicillin. Despite these measures, the vaginal discharge persisted. On initial pelvic examination she was noted to have bilateral periurethral tracts, which seemed to be leading to the pubic rami. They were surrounded by granulation tissue and were draining a yellowish discharge. The patient underwent revision of these tracts while under general anesthesia. As suspected, they led to the posterior pubic bone where the titanium bone anchors were embedded, with polypropylene sutures attached. A 70-degree cystoscope facilitated direct visualization of both anchors. The sutures as well as the right bone anchor, which had extruded from the bone, were easily removed. The left bone anchor was deeply embedded in the bone without any evidence of abscess or surrounding bony destruction. All attempts to remove it were unsuccessful. An orthopedist was consulted, who agreed that the morbidity associated with transabdominal removal of this engaged an