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CASE REPORT
Year : 2003  |  Volume : 20  |  Issue : 1  |  Page : 60-61
 

Vesicocutaneous fistula : A rare delayed complication of polypropylene mesh hernioplasty


Department of Urology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Amlesh Seth
Department of Urology, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Vesicocutaneous fistula, mesh, hernia, hernioplasty.


How to cite this article:
Goel A, Seth A, Kumar R. Vesicocutaneous fistula : A rare delayed complication of polypropylene mesh hernioplasty. Indian J Urol 2003;20:60-1

How to cite this URL:
Goel A, Seth A, Kumar R. Vesicocutaneous fistula : A rare delayed complication of polypropylene mesh hernioplasty. Indian J Urol [serial online] 2003 [cited 2019 Jun 25];20:60-1. Available from: http://www.indianjurol.com/text.asp?2003/20/1/60/37128



   Case Report Top


A 35-year-old lady presented with a two-year history of recurrent lower abdominal pustules discharging pus and urine. She had undergone a prolene mesh hernioplasty for a lower abdominal incisional hernia 8 years earlier. She did not have any significant voiding symptoms. At pres­entation she had 2 fistulae over the lower abdomen [Figure - 1]. Radiological evaluation revealed normal upper tracts and a bladder calculus [Figure - 2], while a fistulogram confirmed the communication with the bladder. Cystoscopy revealed a normal urethra with the calculus adherent to the prolene mesh protruding into the anterior bladder wall. She was operated upon and the mesh along with the calculus was removed. The bladder was repaired and a suprapubic cath­eter was left. It was difficult to comment on the exact plane in which the mesh was implanted because of significant tissue reaction and loss of tissue planes. She is well at eight months' follow-up.


   Comments Top


Mesh repair of incisional abdominal hernias is one of the most commonly performed surgeries and is associ­ated with a low complication rate. Mesh erosion into the bladder is rare because of the thick muscular wall although few cases of prostheses eroding the bladder have been re­ported in the literature following various procedures. Klinge et al investigated the local tissue reaction to meshes and concluded that inflammatory reaction around allo­plastic materials persisted for many years. [1] There was evi­dence of persistent foreign body reaction and they recommended further studies to evaluate the long-term tis­sue response to these materials. This patient developed these fistulae 6 years after an apparently successful re­pair. Enterocutaneous fistula 14 years after prosthetic mesh repair of ventral incisional hernia has also been reported [2] emphasizing the fact that long-term effects of these mate­rials on the body must be evaluated further. Vesicocu­taneous fistula due to a large 1,365-gram vesical stone in a 30-year-old male with a history of previous cystolitho­tomy has also been reported .[3] This patient did not have any significant voiding symptoms as also seen in our pa­tient.

This case report highlights one of possible complica­tions involving the urinary tract following implantation of prosthetic materials in the body.[3]

 
   References Top

1.Klinge U. Klosterhalfen B, Muller M. Schumpelick V. Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg 1999; 165: 665-7.  Back to cited text no. 1    
2.Chew DK. Choi LH. Rogers AM. Enterocutaneous fistula - 14 years after prosthetic mesh repair of a ventral incisional hernia: a life­long risk? Surgery 2000; 127: 352-3.  Back to cited text no. 2    
3.Motiwala HG. Joshi SP. Visana KN. Baxi H. Giant vesical calculus presenting as vesicocutaneous fistula. Urol Lit 1992; 48: 115-6.  Back to cited text no. 3    


    Figures

  [Figure - 1], [Figure - 2]



 

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