Preventing infections associated with pelvic sling placement.(Gynecology)

ST. LOUIS -- Infections associated with pelvic sling placement can be prevented with presurgical screening and treatment of skin and vaginal infections, according to Sebastian Faro, M.D.

Cystitis is the most common infection reported in the literature in association with transvaginal tape (TVT) placement. Superficial skin infections also have been reported, as well as abscesses in the periurethral space and the labia majora. In addition, there have been two case reports of necrotizing fasciitis after TVT placement, he said at the 14th International Pelvic Reconstructive and Vaginal Surgery Conference.

The risk factors associated with the placement of TVT, as well as transobturator slings (TOS), include placement of a foreign body; bacterial entrance to deep tissues during and after the procedure via incisions in both the skin and the anterior vaginal wall; the close proximity of the rectum, which can result in fecal flora such as bacteroides, enterococcus, and Escherichia coli, contaminating the vagina; bacterial colonization of the sling; and collection of blood and serum, which can encourage abscess formation, said Dr. Faro of the University of Texas, Houston.

In a review of his experience with 37 TVT cases and 12 TOS cases during the course of 1 year, he reported no infections in the TOS patients and 2 cases each of cystitis and pelvic cellulitis in the TVT patients.

Dr. Faro ...