Ramaswamy Manikandan ms mch, 15 Langtree Close, Ellenbrook, Manchester M28 7XT, United Kingdom. Email: email@example.com
Abstract Burch colposuspension remains one of the successful operations for genuine stress incontinence. We report a patient who developed an intravesical foreign body granuloma post-Burch colposuspension. Any patient developing unexplained lower urinary tract symptoms following bladder or pelvic surgery for incontinence must be evaluated endoscopically in order to exclude this complication.
Stress incontinence is a common problem with a variety of surgical procedures described for treating it. Burch colposuspension remains one of the successful operations performed for stress incontinence. We report an unusual complication 4 years after this procedure.
A 45-year-old woman, who had undergone Burch colposuspension four years previous for stress incontinence presented with an episode of frank hematuria. Flexible cystoscopy revealed a polypoid lesion on the anterior wall of the bladder. Upper tract imaging and other routine investigations were all normal. On resecting the lesion the cause was found to be the suture material used for the Burch colposuspension (Fig. 1). This was removed endoscopically using biopsy forceps. Histopathological examination of the lesion showed it to have features of chronic inflammation and prominent von Brunn's nests (Fig. 2).
Foreign bodies in the bladder may be self-inserted or iatrogenic. Foreign body granulomas in the bladder are uncommon, especially due to iatrogenic causes. Burch colposuspension is a successful operation for stress incontinence. Endoscopic bladder neck suspension has been reported to cause foreign body granuloma due to delayed migration of the suture material.1–3 Early or late migration of the suture may occur and late migration may be due to gradual erosion of the suture into the bladder as a result of chronic low-grade inflammatory process.2 This may also account for the late presentation of our patient as well. The other possibility is inadvertent suturing of the bladder wall although in this particular case there was no suggestion in the original operative notes of this happening. This also highlights the value of doing a post-procedure cystoscopy, although many surgeons do not routinely do this. The incidence of suture migration following Burch colposuspension has been reported to be 1 in 300 by Dwyer et al.4 Patients may present with lower urinary tract symptoms, pelvic pain or recurrent urinary infections. If left undetected these eventually calcify and may be picked up on X-ray later on.1 An endoscopic evaluation should be performed in any patient presenting with urinary symptoms following any operation for incontinence. Endoscopic removal of the offending material should be done before attempting open methods. Removal of the suture results in the resolution of the symptoms.