Suprapubic abscess and vaginal fistula 22 years after bladder neck suspension with dacron buttresses

BACKGROUND: Erosion and fistula formation are known complications of nonabsorbable materials in gynecologic surgery. The majority are diagnosed within months after surgery. CASE: A 45-year-old woman who had recurrent vaginal discharge for 4 years presented with a suprapubic abscess with a fistulous retropubic tract into the right side of the vagina 22 years after a bladder neck suspension with Dacron buttresses. The abscess was incised and drained, and the buttresses were removed (suprapubically and vaginally). The patient recovered well with antibiotics. The vagina and suprapubic skin were closed by second intention. CONCLUSION: Erosion and fistula formation can present more than two decades after using permanent material in pelvic reconstructive surgery. These complications should be included in the differential diagnosis of unexplained pelvic symptoms.