Suprapubic Granuloma after Retropubic Sling

Background:Stress urinary incontinence is a debilitating condition which occurs in 10-20% of females. Surgical management of stress urinary incontinence is increasingly common. Suburethral slings are most efficacious in treatment of stress urinary incontinence. Graft materials in these procedures can be synthetic or biologic. Common reported complications include bladder perforation, hematoma, vaginal extrusion of implant, de novo urgency symptoms, urinary tract infections and voiding dysfunction. Case:A 43-year-old para 5 woman presented to our department with complaint of a left suprapubic growing mass. Her medical history was significant for stage III cervical cancer treated with chemoradiation three years prior. Her past surgical history included a retropubic porcine dermis Pelvilace sling (Bard Medical, Covington GA) placement and cystoscopy 10 months prior to presentation. The clinical presentation was highly suggestive of local reaction to porcine dermis suburethral sling, however the diagnosis of recurrence of cervical cancer could not be excluded. The patient underwent definitive management with incision and drainage of a large pocket of pus, suprapubic exploration and resection of an indurated mass. The pathology report revealed poorly formed granuloma and no evidence of cancerous cells. The patient had an uncomplicated postoperative course and remains continent and asymptomatic 24 months post operatively. Conclusion:We present a rare case of granuloma formation secondary to reaction to porcine dermis graft that presented as a suprapubic mass.