Description

An 85-year-old lady returned to the urology clinic for review 10 months postcystoscopically guided proximal urethral Zuidex injection for the treatment of stress urinary incontinence. Zuidex is a combination of dextranomer and hyaluronic acid. It is used as a minimally invasive alternative to surgical stress urinary incontinence procedures. She had urinary urgency and a tenderness in the vaginal region. Clinical inspection revealed a periurethral erythematous, warm, tender swelling; causing apparent outlet obstruction (figure 1). A transvaginal puncture was performed under aseptic technique (figure 2). Five millilitre of sterile pus was withdrawn. The procedure was well tolerated. The pseudoabscess did not recur. Postprocedure however, the stress urinary incontinence deteriorated. The reported incidence of pseudoabscess formation following Zuidex injection varies from 101 to 15%.2 It does not appear to be related to the volume of Zuidex injected. They can present up to 13 months postinjection.1 Periurethral pseudoabscesses very rarely resolve spontaneously and often require multiple operative interventions.

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Figure 1

A fluctuant mass is clearly visible protruding from the introitus. The external urethral meatus is placed at the most anterior aspect of the pseudoabscess.

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Figure 2

Approximately 5 mls of purulent appearing material was aspirated.