Labial cellulitis and suprapubic urine leakage after midurethral sling: A rare presentation of unrecognized bladder neck perforation

Document Type : CASE REPORT


1 Department of Urology, Isfahan Kidney Transplantation Research Center, AL-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Isfahan Kidney Transplantation Research Center, AL-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Operating Room, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran


Retropubic midurethral sling (MUS) is safe and effective surgery used for the treatment of stress urinary incontinence in women. Bladder neck perforation is a rare intraoperative complication. If this complication missed in intraoperative cystoscopy may have serious morbidity. A 52-year-old woman underwent a retropubic MUS. She presented with early and unusual symptoms such as suprapubic and labial cellulitis and urine leakage through the suprapubic incision 1 week after surgery which was due to a missed bladder neck perforation during surgery. In cystoscopy after MUS revealed mesh traversing the bladder neck and it was removed. The missed bladder perforation may have early and unusual symptoms and cystoscopy must be done more carefully and obsessively in patients with risk factors.


Mostafaei H, Sadeghi-Bazargani H, Hajebrahimi S, Salehi-Pourmehr H, Ghojazadeh M, Onur R, et al. Prevalence of female urinary incontinence in the developing world: A systematic review and meta-analysis – A Report from the Developing World Committee of the International Continence Society and Iranian Research Center for Evidence Based Medicine. Neurourol Urodyn 2020;39:1063-86.  Back to cited text no. 1
Kershaw V, Nicholson R, Ballard P, Khunda A, Puthuraya S, Gouk E. Outcome of surgical management for midurethral sling complications: A multicentre retrospective cohort study. Int Urogynecol J 2020;31:329-36.  Back to cited text no. 2
Bach F, Toozs-Hobson P. What can we learn from large data sets? An analysis of 19,000 retropubic tapes. Int Urogynecol J 2017;28:629-36.  Back to cited text no. 3
Keltie K, Elneil S, Monga A, Patrick H, Powell J, Campbell B, et al. Re: Complications following Vaginal Mesh Procedures for Stress Urinary Incontinence: An 8 Year Study of 92, 246 Women. Scientific Reports 2017;7:1-9.  Back to cited text no. 4
Zargham M, Saberi N, Khorrami MH, Mohamadi M, Nourimahdavi K, Izadpanahi MH. stress urinary incontinence and pelvic organ prolapse correction by single incision and using monoprosthesis: three-year follow-up. Adv Biomed Res 2018;7.  Back to cited text no. 5
Novara G, Galfano A, Boscolo-Berto R, Secco S, Cavalleri S, Ficarra V, et al. Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: A systematic review and meta-analysis of randomized controlled trials comparing tension-free midurethral tapes to other surgical procedures and different devices. Eur Urol 2008;53:288-308.  Back to cited text no. 6
Osborn DJ, Dmochowski RR, Harris CJ, Danford JJ, Kaufman MR, Mock S, et al. Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation. Int J Urol 2014;21:1167-70.  Back to cited text no. 7
Ozdemir A, Cakır S, Sözen H, Namazov A, Akdemir Y, Karateke A. Development of bladder stone after tension free vaginal tape procedure: A case report. J Turk Ger Gynecol Assoc 2011;12:256-8.  Back to cited text no. 8
Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN, Lee J. Risk factors for trocar injury to the bladder during mid urethral sling procedures. J Urol 2009;182:174-9.  Back to cited text no. 9
Kuhlmann PK, Dallas K, Masterson J, Patel DN, Chen A, Castaneda P, et al. Risk factors for intraoperative bladder perforation at the time of midurethral sling placement. Urology 2021;148:100-5.  Back to cited text no. 10
Ghazi MJ, Almayali JA, Mosawi MN, Athari MH. Efficacy and perioperative morbidity of suprapubic midurethral sling surgery for females with stress urinary incontinence. Eur J Mol Clin Med 2020;7:109-16.  Back to cited text no. 11