Incidence of pubic osteomyelitis after bladder neck suspension using bone anchors.
OBJECTIVE
To determine the incidence of pubic osteomyelitis after bladder neck suspension using suprapubic bone anchors.


METHODS
The target population consisted of 290 consecutive women who underwent bladder neck suspension using suprapubic bone anchors between June 1994 and November 1999 at two referral centers. A structured telephone questionnaire was designed to elicit any history of clinical symptoms suspicious for pubic osteomyelitis. Positive responses were followed up by a detailed review of the medical records. Nonresponders were evaluated by chart review, with negative cases included only if the documented follow-up reached 1 year.


RESULTS
The sample consisted of 225 women, representing 77.6% of the study population, with a mean age of 69.7 years (range 40 to 88) and a mean follow-up of 31.8 months (range 13.4 to 42.2). Of the 225 women, 179 (80%) completed the telephone survey; 46 patients (20%) were evaluated by long-term chart review. Three patients (1.3%) reported positive responses to the screening questionnaire and were confirmed to have developed pubic osteomyelitis. Each had undergone exploratory laparotomy, anchor removal, bony debridement, and prolonged parenteral antibiosis. The most common noninfectious complaints were irritative voiding symptoms and pubic or groin pain responding to "conservative" therapy (3.5%), including 1 case of osteitis pubis. One subject underwent repeated operation because of erosion of the sling sutures into the bladder.


CONCLUSIONS
The estimated incidence of osteomyelitis after bone-anchored bladder neck suspension was 1.3%. Although postoperative osteomyelitis is rare, each case incurs substantial morbidity and a complicated postoperative course.
Goldberg
Roger P
RP
Evanston Continence Center, Northwestern University Medical School, Evanston, Illinois 60201, USA.
Tchetgen
Marie Blanche
MB
Sand
Peter K
PK
Koduri
Sumana
S
Rackley
Raymond
R
Appell
Rodney
R
Culligan
Patrick J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000453:epidemiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011630:Pubic Bone / Q000601:surgery*; D017568:Rectus Abdominis / Q000601:surgery; D012189:Retrospective Studies; D013525:Surgical Instruments; D013536:Suture Techniques; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D014621:Vagina / Q000601:surgery