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Necrotizing Postsurgical Infection Complicating Midurethral Sling Procedure With Unrecognized Cystotomy

Mahal, Amandeep Singh MD*; Bradley, Catherine S. MD, MSCE*†

Female Pelvic Medicine & Reconstructive Surgery: May/June 2012 - Volume 18 - Issue 3 - p 183–185
doi: 10.1097/SPV.0b013e3182544dee
Case Reports

Abstract: A 39-year-old woman with stress urinary incontinence underwent a retropubic midurethral sling procedure. On postoperative day 1, she presented with persistent abdominal pain and fever. A computed tomographic scan showed subcutaneous lower abdominal wall edema and gas above the fascia suggesting a necrotizing soft tissue infection. She was surgically debrided twice, which included removal of the mesh sling on postoperative day 4. Cystoscopy suggested unrecognized bladder perforation had occurred during the initial procedure, and record rerevealed untreated bacteriuria before sling placement. The patient required wound vacuum therapy and a later secondary wound closure procedure. Six months after the initial surgery, she was reevaluated for stress urinary incontinence and underwent a transobturator midurethral sling procedure with resolution of these symptoms. Necrotizing postsurgical infection is a rarely described complication of midurethral slings. Treatment for this potentially life-threatening complication includes aggressive surgical debridement, administration of broad-spectrum antibiotic, removal of infected implants, and supportive therapy. Unrecognized bladder injury and preoperative bacteriuria are discussed as potential risk factors for postsling necrotizing infection.

Patient with rare necrotizing infection following mid urethral sling. A comprehensive review of cases in literature, risk factors and possible pathogenesis is discussed.

From the Departments of *Obstetrics and Gynecology, and †Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, IA.

Reprints: Amandeep Singh Mahal, MD, c/o University of Iowa Hospitals and Clinics, Department of Obstetrics and Gynecology, 200 Hawkins Dr, Iowa City, IA 52242. E-mail:

Dr Mahal has no disclosures. Dr Bradley is a consultant for Astellas/GSK and received research support from Pfizer.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins