title: Necrotizing postsurgical infection complicating midurethral sling procedure with unrecognized cystotomy.
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.
authors.affiliation: Department of Obstetrics, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, USA. Amandeep-mahal@uiowa.edu
authors.forename: Amandeep Singh
authors.initials: AS
authors.lastname: Mahal
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Bradley
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001437:Bacteriuria / Q000175:diagnosis / Q000628:therapy; D003558:Cystoscopy; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D054843:Negative-Pressure Wound Therapy; D011183:Postoperative Complications; D013290:Streptococcal Infections / Q000175:diagnosis / Q000628:therapy; D053825:Suburethral Slings / Q000009:adverse effects*; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents