Vesicosacrofistulization After Robotically Assisted Laparoscopic Sacrocolpopexy

Abstract

Diskitis after sacrocolpopexy for pelvic organ prolapse has been increasingly reported in the literature. We present a case of vesicosacrofistulization resulting in diskitis and osteomyelitis after robotically assisted laparoscopic sacrocolpopexy performed at an outside institution. A 70-year-old woman with uterovaginal prolapse and stress urinary incontinence underwent robotic supracervical hysterectomy with sacrocolpopexy and transobturator sling placement at an outside hospital. Postoperatively, she had recurrent urinary tract infections; by 3 months postoperatively, fevers and leg and back pain had developed. She was given a diagnosis of L5-S1 spondylodiskitis. After 3.5 weeks of intravenous antibiotic therapy failed, further evaluation revealed a fistulous tract to the sacrum. She was transferred to our institution and underwent sacrocolpopexy mesh removal, L5-S1 debridement, antibiotic treatment, and physical therapy. One year after this repair surgery, she has returned to her usual activities with no current symptoms of infection, prolapse, urinary incontinence, or back pain. Vesicosacrofistulization is a serious complication of sacrocolpopexy that can result in diskitis and osteomyelitis. Prevention involves avoiding placing mesh on the bladder and at the L5-S1 disk space during open or minimally invasive sacrocolpopexy. A high index of suspicion for diskitis, even several months after surgery, should be maintained to expedite evaluation. If fistulization of pelvic structures to the sacrum is suspected, a multidisciplinary evaluation and treatment approach should be considered to optimize patient care.