Mesh infection of a male sling.

A 52-year-old man presented with purulent drainage from the scrotum and medial superior left thigh approximately 5 months after a second surgical procedure to remove fragments of an AdVanceTM male sling from the left thigh. Medical history began 6 years earlier when he underwent robot-assisted laparoscopic prostatectomy for high grade prostate cancer. One year postoperatively he was treated with adjuvant intensity modulated radiation and hormonal therapy for biochemical recurrence. Two years later he underwent the first AdVance sling placement for sphincteric incontinence refractory to conservative measures, and the next year he underwent a second AdVance sling placement for recurrent incontinence. Shortly after the second AdVance sling placement, the patient reported perineal pain as well as purulent drainage from the left thigh. Excision of purulent peri-urethral segments of 2 AdVance male slings and part of the segment of the sling in the left thigh were excised. A second surgery was performed to remove a fragment of the sling in the left thigh because of recurrent drainage. Cystoscopy showed no erosion of the sling into the urinary tract. Magnetic resonance imaging (MRI), the best study to identify sinus tracts, fistulas and abscesses in the perineum or proximal thigh, revealed a 3 cm abscess in the gracilis muscle of the