# Bilateral emphysematous pyelonephritis and emphysematous cystitis: Potential catastrophic complication of mid-urethral sling surgery

## TL;DR

A diabetic patient developed severe kidney and bladder infections after mid-urethral sling surgery, highlighting the need for careful post-operative monitoring.

## Contribution

This is the first reported case of bilateral emphysematous pyelonephritis and emphysematous cystitis following mid-urethral sling surgery.

## Key findings

- Bilateral emphysematous pyelonephritis and emphysematous cystitis occurred five days after mid-urethral sling surgery.
- Post-operative voiding protocols are essential to prevent catastrophic complications.
- Long-term renal function may normalize after bilateral emphysematous pyelonephritis.

## Abstract

To our knowledge we present the first case of bilateral emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC) diagnosed, in a diabetic patient with urinary retention, five days after ambulatory robotic hysterectomy and mid-urethral sling (MUS). Her urethral catheter was removed prior to discharge. This report describes a potentially catastrophic event that should have been prevented. Adhering to appropriate voiding trial protocols should continue to be an essential part of the discharge process.

•Monitor post-op voiding event after surgery with bladder outlet obstruction risk.•Optimal approach to patients with emphysematous pyelonephritis is not clear.•Classifications systems should guide but not decide treatment.•Long term renal function may normalize after bilateral emphysematous pyelonephritis.

Monitor post-op voiding event after surgery with bladder outlet obstruction risk.

Optimal approach to patients with emphysematous pyelonephritis is not clear.

Classifications systems should guide but not decide treatment.

Long term renal function may normalize after bilateral emphysematous pyelonephritis.