Articles   |    
Osteomyelitis of the Pubis Following Suspension of the Neck of the Bladder with Use of Bone Anchors. A Report of Four Cases*
View Disclosures and Other Information
Investigation performed at Evanston Hospital, Evanston
J Bone Joint Surg Am, 1999 Dec 01;81(12):1736-40
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


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.
Figures in this Article

    First Page Preview

    View Large
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    CT - Yale University School of Medicine
    MA - Boston University Orthopedic Surgical Associates
    OH - OhioHealth Research and Innovation Institute (OHRI)