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Unrecognized Bladder Perforation Leading to Severe Progressive Cellulitis and Candidal Infection

Fenderson, Jacquia L. MD*; Washington, Blair B. MD, MHA; Hampton, Brittany Star MD; Myers, Deborah MD

Female Pelvic Medicine & Reconstructive Surgery: March/April 2012 - Volume 18 - Issue 2 - p 130–131
doi: 10.1097/SPV.0b013e3182447a30
Case Reports
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Background Retropubic midurethral slings are a minimally invasive surgical procedure used in the treatment of stress urinary incontinence and are typically associated with high cure rates and low complication rates. Bladder perforation is a known intraoperative complication that, if left unrecognized, can have significant morbidity.

Case A 47-year-old underwent a retropubic midurethral sling, anterior colporrhaphy, and cystoscopy. She developed a suprapubic wound cellulitis that progressed to involve the right trunk and flank as well as persistent fever for more than 48 hours despite broad-spectrum antibiotics. Upon return to the operating room, the patient was found to have an unrecognized bladder perforation with mesh in the bladder. Wound culture was remarkable for Candida parapsilosis and Escherichia coli.

Conclusion Unrecognized bladder perforation and nonbacterial causes of infection should be considered in patients with severe progressing cellulitis despite broad-spectrum antibiotic coverage after retropubic midurethral sling placement.

This is a case report of an unrecognized bladder perforation, which led to a fungal cellulitis, after a retropubic midurethral sling placement.

From the *Division of Medical Education, Department of Obstetrics and Gynecology, Women & Infants’ Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, RI; †Urogynecology & Reconstructive Pelvic Surgery, Virginia Mason Medical Center, Seattle, WA; and ‡Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Women & Infants’ Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, RI.

Reprints: Jacquia L. Fenderson, MD, Division of Medical Education, Women & Infants’ Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, 101 Dudley St, Providence, RI 02903. E-mail: jfenderson@wihri.org.

The authors declare that they have nothing to disclose.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins