Infected Pubic Symphysitis After Periurethral Injection with a Bulking Agent

Abstract

Background: Urinary incontinence affects about 45% of all women, and stress urinary incontinence accounts for about 40%. Many women opt for surgical treatment when conservative management fails. One of the surgical treatments is bulking, that refers to a minor transurethral procedure where a bulking agent is injected into the submucosa of the urethra. Infected pubic symphysitis is an infection of the pubic symphysis that causes subpubic pain, disability and ultimately immobility. It is known to be a rare complication to urogenital procedures but has never been described after a bulking injection. Case Report: We present three women with a story of infected pubic symphysitis after bulking injections. They all experienced pain within the first week after the injections. They all had pubic bone or groin pain and were not able to support properly on both legs due to pain. White blood cell counts and C-reactive protein were elevated, and Magnetic resonance imaging or computerized tomography scan showed signs of symphysitis. All women were treated with long term antibiotics and seen by or discussed with the orthopedic surgeons. Conclusion: This review reports on a serious outcome, symphysitis, even after a minor surgical treatment. In our cases no fatality was observed, but two of the women still have chronic pain more than one year after the bulking injections. Due to these three cases, the standard procedure has now changed, and a pre-treatment of antibiotics is given to all women undergoing the bulking procedure.