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Query: UMLS:C0027121 (myositis)
 4,538 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The tension-free vaginal tape (TVT) procedure has long been considered the gold standard for female stress incontinence. Since its introduction in 1995, several other tapes and other minimally invasive treatments have arisen. The transobturator tape (TOT) procedure reproduces the natural suspension of the urethra through the obturator and puborectalis muscles. The TOT procedure was reportedly developed in an effort to prevent bladder perforation associated with the TVT and is generally considered to be a procedure with low morbidity. At our institution, we report the first case of infected mesh with subsequent myositis of adductor muscles after a TOT procedure. To our knowledge, this is the first case reporting this complication, citing specifically that the anatomical structures traversed by the tape, including both muscle and fascia, can be at risk for infection and ultimately require removal of the sling material. We performed a MEDLINE literature search using key words such as "transobturator tape," "tension free vaginal tape," and "adductor and obturator complications" to ascertain any reported adductor or obturator muscle complications after placement of TOT. Further, we reviewed the literature to elucidate the consequences of using different mesh materials, specifically their effects on erosion. We reported our case of a 43-year-old woman who presented with right-leg cellulitis and vaginal discharge after having a TOT placed for stress incontinence. Inflammation of the adductor muscles was demonstrated on computed tomography (CT) scan and ultrasound. On physical exam, the mesh had visibly eroded through the vaginal wall. Our patient underwent excision of the mesh material. She ultimately had an uneventful postoperative course and was discharged home in good condition on the postoperative day 2. The mesh material removed was ObTape. We believe our study is the first case report to discuss the complication of infected adductor muscles and erosion of the tape during post-TOT procedure. After a careful review of the literature, there is no mention of myositis of adductor muscles as a possible complication after the TOT procedure. In fact, the literature has deemed this minimally invasive treatment as a safe and effective procedure with minimal complications including only de novo urgency or urinary retention. The site of infection is of particular interest and can be explained by the course through the anatomical structures that are unique to this particular procedure. Ultimately, the treatment for this procedure was the removal of the mesh along with broad-spectrum antibiotics. In conclusion, the burden falls upon the surgeons to report in a timely fashion both successes and complication for the TOT procedure given their relatively limited experience. This is paramount in determining patients' risks.
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PMID:Adductor brevis myositis following transobturator tape procedure: a case report and review of the literature. 1757 93

The aim of the present study was to investigate a late complication of transobturator tape (TOT) implant: abscess and myositis. The case report included a 53 years-old vaginal multipara, subject to transobturator tape procedure in 2004, who came to the observation of the Department of Obstetrics and Gynecology (University of Catania, Italy) with a late vaginal polypropylene mesh erosion. She reported growing pain at her left leg, walking difficulty, fever and persistent stress urinary incontinence (SUI). She also described a shooting pain originating from the left inguinal ligament radiating down her left leg. Obturator internus and adducent muscles of the left thigh were involved. Ultrasounds and magnetic resonance imaging (MRI) clearly revealed the course of the mesh tape through the obturator muscles with myositis and abscess. The patient was treated by removing the polypropylene tape through the vaginal erosion. Her symptomatology improved within 3 weeks after the tape removal. Although developed to minimize surgical morbidity, the TOT procedure is not risk-free. Like for all the synthetic sling materials, the risk of erosion and resulting ascending infection from contamination exists. Because of the rarity of this complication, the Authors performed an assessment of this condition. Erosion may predispose the patient to secondary complications: abscess and myositis with great difficulty in deambulation. Imaging diagnosis is very effective. Ultrasound imaging is a useful method to investigate the whole pelvic floor condition. Moreover, MRI is a precise diagnostic procedure. This case not only proved the failure of the TOT for the treatment of stress incontinence, but also all the associated concerns. The study emphasizes the observation that abscess and symptomatic myositis may result into late disabling complications, although starting from a mini-invasive procedure.
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PMID:A late complication of transobturator tape: abscess and myositis. 1827 56