Case Report PercutaneousBoneAnchorSlingUsingSyntheticMeshAssociatedwith Urethral Overcorrection and Erosion A. Walter, P. Magtibay and J. L. Cornella Division of Gynecologic Surgery, Mayo Clinic-Scottsdale, Scottsdale, Arizona, USA Abstract: Percutaneous bone anchor bladder neck suspension has been recommended as a less morbid alternative to traditional anti-incontinence procedures. Speci®cally, it has reported to be associated with shorter duration of hospitalization, catheterization and urinary retention,andequivalentshort-termcurerates.Recently, therehavebeenreportsofpubicosteomyelitisassociated with bone anchor placement, and high incidences of recurrent incontinence. To improve the effectiveness of the procedure the placement of a suburethral synthetic collagen-impregnated mesh without tension was recom- mended. A speci®c device is included with the kit Suture Spacer Microvasive/Boston Scienti®c Corp., Natick, MA)) to prevent overcorrection of the urethro- vesical junction. We present a case of urethral erosion and complete urinary retention secondary to use of a percutaneous bone anchor sling using a ProteGen mesh Microvasive/Boston Scienti®c Corp., Natick, MA). Signi®cant postoperative urethral overcorrection was noted despite intraoperative use of the Suture Spacer. Keywords: Bone anchor; Erosion; Pubovaginal sling; Urethra Case Report An 84-year-old caucasian female para 2 was evaluated for complete urinary retention requiring indwelling transurethral catheterization following percutaneous bone anchor sling placement with a 3.5 6 1.7 cm ProteGen mesh 6 months previously. The operation was performed elsewhere and the operative note indicated the use of Suture Spacer to prevent urethrovesical junction UVJ) overcorrection. Initial evaluation at our institution revealed no evidence of vaginal graft erosion. Pelvic¯oordefectsincludedagradeIIIenterocele,grade II paravaginal defect and grade II rectocele Baden± Walker Halfway system [1]). Q-tip testing identi®ed the urethrovesical angle to be 7308 from the horizontal. Abdominal X-ray revealed no evidence of pubic osteomyelitis. Cystoscopic examination revealed erosion of the suspensory mesh through the posterior urethral mucosa immediately distal to the UVJ. The patient was taken to surgery for the correction of urinary retention and pelvic ¯oor relaxation, urethral reconstruction and prevention of recurrent stress incon- tinence. Retropubic urethrolysis was initially performed including removal of the previously placed permanent suture material. A modi®ed Mayo±McCall culdoplasty was then performed, followed by transvaginal removal of the mesh and three-layer overlapping urethral reconstruction. A posterior colpoperineorrhaphy com- pleted the transvaginal portion of the procedure. A signi®cantparavaginaldefectwasnotedandaretropubic paravaginal repair performed, both as an integral component of a site speci®c repair and to prevent the recurrence of stress urinary incontinence, as described by Carr et al. [2]. Suprapubic and transurethral catheters were placed at the conclusion of the procedure to facilitate prolonged bladder drainage and to splint the urethra during healing. The patients postoperative recovery was uneventful and she resumed normal voiding function by postoperative day 30. Subjectively, shenotedmildstressandurgencyincontinence12weeks postoperatively. Examination at that time revealed the Int Urogynecol J 2000) 11:328±329 ß 2000 Springer-Verlag London Limited International Urogynecology Journal Correspondence and offprint requests to: DrAndrewWalter,Division of Urogynecology, Department of Obstetrics and Gynecology, David Grant Medical Center, 101 Bodin Circle, Travis AFB, CA 94535, USA.