A NEW NEEDLE LOCALIZATION TECHNIQUE TO SURGICALLY REMOVE ERRANT BONE ANCHORS

M. Roenneburg, M.D.

   Background: Suburethral sling procedures for the primary treatment of stress urinary incontinence are being used with increasing frequency. Bone anchors are designed as a minimally invasive alternative to more traditional sling procedures, but are not without risk.

   Cases: Two patients presented with complaints of pain following sling procedures with the use of bone anchors. In the first case, radiographs demonstrated the bone tack to be in the corpus cavernosum of her clitoris. In the second case, both bone screws were in the mons pubis and the synthetic sling had eroded into her urethra. The bone anchors were not palpable on examination of either patient. Needles were guided to the bone anchors under fluoroscopy in the operating room from two different angles to establish a vector for localization. A small incision was then made between the needles and extended directly down to the bone anchor for excision.

   Conclusion: The use of fluoroscopy and two-needle vector localization minimized the amount of dissection required to remove the errant bone anchors and limited injury to the surrounding structures. New surgical tools can bring new and unexpected complications, which we must be prepared to treat.

   Key Words: sling procedures, bone anchors, needle localization