Conservative Treatment of a Pelvic Abcesses After a Laparoscopic Sacropexy: Case Report

Background: Ureteral injuries during pelvic surgeries, particularly following promontofixation for anterior vaginal prolapse, are noteworthy due to their frequency and potential complications. This case report highlights a novel conservative management approach for a ureteral injury associated with mesh-related infection. Case Presentation: We present a case of a patient who developed urinary abscesses around the mesh after undergoing a promontofixation procedure. The ureteral injury was identified, and instead of opting for surgical intervention, a double J stent was placed to manage the injury. Additionally, ultrasound-guided paracentesis was performed to drain the abscesses. Cultures revealed a multidrug-resistant strain of E. coli, sensitive to imipenem, leading to a 30-day intravenous treatment. Over the follow-up period, inflammatory markers decreased, and imaging showed a reduction in abscess size. The patient was monitored closely without the need for drainage or antibiotics, ultimately resulting in complete resolution of the abscesses after six months. Conclusions: This case underscores the importance of recognizing ureteral injuries in pelvic surgeries and presents a conservative management strategy that can mitigate the risks associated with surgical mesh excision. By integrating drainage, targeted antibiotics, and vigilant follow-up, clinicians can effectively manage such complications while minimizing patient morbidity.