Publications by authors named "Christopher Savvas"

2 Publications

  • Page 1 of 1

Urethral bulking agent found in a urethral caruncle which did not respond to topical oestrogens: A case report.

Case Rep Womens Health 2020 Oct 27;28:e00268. Epub 2020 Oct 27.

Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, SE5 9RS, UK.

Background: Urethral caruncles are lesions occurring at the urethral orifice, around the posterior lip of the urethra. They are the most common benign growth of the female urethra. They are often asymptomatic and found incidentally on clinical examination. When symptomatic they commonly present with bleeding. Treatment includes vaginal oestrogens or, failing that, surgical excision. We present an unusual finding after excision of a urethral caruncle.

Case: A patient with a background of stress urinary incontinence had numerous pelvic surgeries, including colposuspension, tension-free vaginal tape (TVT) and Macroplastique (a urethral bulking agent). She developed bleeding from a 3 cm urethral caruncle, which did not improve with vaginal oestrogens. She proceeded to have a surgical excision of the caruncle. Histology revealed a foreign material with surrounding foreign-body-type multinucleate giant cell reaction. The material was compatible with Macroplastique.

Conclusion: This case report describes an unusual and unexpected histological finding. Macroplastique is injected in the urethra, 10-15 mm from the bladder neck. We suspect the caruncle dragged the Macroplastique material out through the urethral meatus. If urethral caruncles are not adequately treated with vaginal oestrogens, surgery should be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.crwh.2020.e00268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609486PMC
October 2020

An unusual late complication with tension-free vaginal tape (TVT): A case report.

Case Rep Womens Health 2020 Oct 25;28:e00252. Epub 2020 Aug 25.

Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK.

Background: Stress urinary incontinence is a common problem affecting women's quality of life. The retropubic mid-urethral sling accounts for the majority of surgical interventions for stress incontinence. Complications of the procedure are rare. We present an unusual late complication with tension-free vaginal tape (TVT).

Case: Two years after insertion of a TVT for stress incontinence, a patient noticed a foreign body intermittently exiting through her anus. Initial clinical examinations and investigations were unremarkable. Five years after insertion she represented with faecal matter in the vagina and a TVT erosion. Imaging confirmed a colo-vaginal fistula. She underwent a vaginal excision of the TVT but this did not cure her problem and she subsequently had a laparoscopic sigmoid colectomy. Thereafter she remained well and asymptomatic.

Conclusion: This case report describes an unusual late complication. It is likely that the left arm of the mesh entered the serosa of the sigmoid colon and eroded into it over time. Complications associated with TVT are rare, but when they occur they need to be recorded. Only surgeons who have experience and expertise in the procedure should perform it, such as subspecialty trained urogynaecologists.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.crwh.2020.e00252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479271PMC
October 2020
-->