Suprapubic Granuloma after Retropubic Sling

A 43-year-old multipara presented 10 months post-operative from a retropubic sling with complaint of a growing left suprapubic mass. Her medical history was significant for stage III cervical cancer treated with chemoradiation, including vaginal brachytherapy three years prior. The patient was followed by gynecologic oncology and had no recurrent malignancy, but had developed a short vagina post-radiation. The patient had undergone a retropubic porcine dermis Pelvilace suburethral sling (Bard Medical, Covington GA) placement and cystoscopy for stress urinary incontinence (SUI). The procedure was complicated by fibrotic vaginal tissue and a recognized 3 millimeter rightsided dome cystotomy, requiring modification to a transobturator approach on the right side. The modified transobturator approach was performed by securing the right arm of the sling to the Obturator Internus fascia with 2-0 polydioxanone sutures using the Capio device. Her post-operative course was uncomplicated until the appearance of a left-sided suprapubic mass 10 months after sling placement.