Sacral Osteomyelitis After Robotically Assisted Laparoscopic Sacral Colpopexy

Osteomyelitis associated with using synthetic mesh for laparoscopic sacral colpopexy is rare. We present a patient who developed Staphylococcus sacral osteomyelitis after sacral colpopexy with synthetic mesh and titanium tack fixation to the sacral promontory in the absence of mesh erosion or fistula formation. The patient presented with low back pain 6 weeks postoperatively. Magnetic resonance imaging, bone aspirate, and culture confirmed sacral osteomyelitis and discitis 10 weeks after surgery. The patient underwent 8 weeks of outpatient antibiotic treatment. Six months after surgery, serial laboratory values have demonstrated excellent response to antibiotic treatment, and the patient has clinically improved without the need for mesh removal. We recommend a high index of suspicion for osteomyelitis in patients who present with back pain after sacral colpopexy. Osteomyelitis can occur as a complication of laparoscopic, robotic sacral colpopexy using mesh in the absence of abscess or fistula formation.