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Osteomyelitis of the Pubis Following Suspension of the Neck of the Bladder with Use of Bone Anchors. A Report of Four Cases*
MARK ENZLER, M.D.†; HOWARD J. AGINS, M.D.†; MONICA KOGAN, M.D.†; JAMES KUDURNA, M.D.†; PETER SAND, M.D.†; REBECCA WURTZ, M.D.†; PATRICK CULLIGAN, M.D.†, EVANSTON, ILLINOIS
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Investigation performed at Evanston Hospital, Evanston
J Bone Joint Surg Am, 1999 Dec 01;81(12):1736-40
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We report on four patients who had a retropubic abscess (three with osteomyelitis) with involvement of the adjacent soft tissues following a procedure to correct stress urinary incontinence with use of pelvic bone screws to serve as anchors for sutures that were placed to support the bladder neck. The ages of the patients ranged from seventy-one to eighty years old. None of the patients had a known previous urinary tract infection. Two of the procedures were performed at our institution, and two were performed at different outside institutions. The patients were seen because of suprapubic pain, swelling, and erythema between four and twenty-four weeks after the procedure. Two had received courses of orally administered antibiotics because of wound drainage within a week to ten days after the original procedure. Computerized tomography scans of the pelvis showed soft-tissue swelling behind the symphysis pubis and erosion of the adjacent bone. The abscess was drained in all patients, and infected bone was excised, with removal of a total of two to three centimeters of bone, in three patients. In all patients, the sinus tract was excised, extensive soft-tissue débridement was performed, and the suspension sutures and bone anchors were removed. In one patient, débridement was necessary on two occasions. Cultures were positive for Pseudomonas aeruginosa and Staphylococcus aureus in one patient, Pseudomonas aeruginosa and coagulase-negative Staphylococcus in one patient, Staphylococcus aureus in one patient, and Citrobacter species and a gram-positive coccus in one patient. Each of the four patients was managed intravenously with antibiotics, with the dosage determined according to her age and renal function, for six weeks. Suspension of the bladder with use of pelvic screws as suture anchors may increase the risk of osteomyelitis because the screw-suture combination passes through the vaginal lumen before it is anchored into bone.
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