title: Unrecognized bladder perforation leading to severe progressive cellulitis and candidal infection.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Women & Infants' Hospital of Rhode Island, Providence, RI, USA. jfenderson@wihri.org
authors.forename: Jacquia L
authors.initials: JL
authors.lastname: Fenderson
authors.forename: Blair B
authors.initials: BB
authors.lastname: Washington
authors.forename: Brittany Star
authors.initials: BS
authors.lastname: Hampton
authors.forename: Deborah
authors.initials: D
authors.lastname: Myers
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002175:Candida / Q000302:isolation & purification*; D002481:Cellulitis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D003558:Cystoscopy; D004926:Escherichia coli / Q000302:isolation & purification*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012086:Reoperation; D012421:Rupture / Q000150:complications / Q000209:etiology; D012720:Severity of Illness Index; D053825:Suburethral Slings / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents