Sterile Abscess Formation following Periurethral Injections for Stress Urinary Incontinence—An Underestimated Complication

Urethrovaginal fistula associated with ‘sterile abscess’ formation following periurethral injection of dextranomer/hyaluronic acid co‐polymer (Zuidex™) for the treatment of stress urinary incontinence—a case report

“…The dextranomer/hyaluronic acid co-polymer product Zuidex TM and the Implacer TM device are no longer marketed in this indication. Nevertheless, we feel it is important to highlight this complication so that colleagues are aware that the phenomenon of 'sterile abscess' formation is perhaps not only more common than has previously been thought, 5 but potentially also has much more serious implications, especially in those women previously treated with this compound.…”

“…‘Sterile abscess’ or pseudocyst formation has been described with glutaraldehyde cross‐linked collagen (Contigen ® ; Bard, Crawley, UK), 2 pyrolytic carbon‐coated beads (Durasphere ® ; Carbon Medical Technologies Inc, St Paul, MN, USA), 3 and dextranomer/hyaluronic acid co‐polymer 4 . Recent reports suggest that this may occur in up to 22% of women where the latter material has been used 5 . We report the first case of urethrovaginal fistula in a patient with ‘sterile abscess’ formation following periurethral injection of dextranomer/hyaluronic acid co‐polymer for the treatment of SUI.…”

“…4 Recent reports suggest that this may occur in up to 22% of women where the latter material has been used. 5 We report the first case of urethrovaginal fistula in a patient with 'sterile abscess' formation following periurethral injection of dextranomer/hyaluronic acid co-polymer for the treatment of SUI.…”

Periurethral Injections of Non-Animal Stabilised Hyaluronic Acid/Dextranomer Gel and Sterile Abscess Formation

“…One of them was a symptomatic non-sterile abscess. Coull et al state in their series the incidence of sterile abscess formation was 22% [1] and Herschorn and Satel at the EAU annual meeting in 2008 reported this particular complication to be as high as 28% [3]. This is in stark contrast to the incidence of 4% reported by Chapple et al, in the biggest series to date with this type of injectable.…”

“…We read with interest the case report by Coull et al, recently published in your esteemed journal [1]. We have recently reviewed our experience with non-animal stabilised hyaluronic acid/dextranomer gel (NASHA/Dx) using the Zuidex TM system from 2 units in the South Thames region and have also reported on the increasing emergence of abscess/granuloma formation post-treatment [2].…”