|Year : 2003 | Volume
| Issue : 1 | Page : 60-61
Vesicocutaneous fistula : A rare delayed complication of polypropylene mesh hernioplasty
Apul Goel, Amlesh Seth, Rajeev Kumar
Department of Urology, All India Institute of Medical Sciences, New Delhi, India
Department of Urology, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
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
| Case Report|| |
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|| |
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.  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  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 . 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.
| References|| |
|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. |
|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. |
|3.||Motiwala HG. Joshi SP. Visana KN. Baxi H. Giant vesical calculus presenting as vesicocutaneous fistula. Urol Lit 1992; 48: 115-6. |
[Figure - 1], [Figure - 2]