Iatrogenic Bladder Diverticulum 11 Years After Sacrospinous Ligament Fixation for Apical Prolapse

Female Pelvic Med Reconstr Surg. 2017 Jan/Feb;23(1):e8-e9. doi: 10.1097/SPV.0000000000000348.

Abstract

Introduction: In this case, we describe a bladder diverticulum due to apical vaginal suspension to the sacrospinous ligament presenting 11 years after surgery. This case report explores her signs and symptoms, diagnostic work-up, surgical intervention, and postoperative course.

Case description: A 71-year-old G2P2 presented with symptoms of urinary urgency. Work-up including cystoscopy and retrograde fistulogram revealed a bladder diverticulum extending to the level of the sacrospinous ligament. Her surgical history was significant for a sacrospinous ligament fixation 11 years before her symptoms. The iatrogenic bladder diverticulum was removed via robotic-assisted laparoscopic excision. Her postoperative course was benign beyond a urinary tract infection. Her urgency symptoms resolved after treatment.

Conclusions: Iatrogenic injuries can present distant from initial surgery. Permanent foreign material, including suture, may increase the risk of complications. A high level of suspicion is necessary to diagnose complications given the subtle presentation.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Diverticulum / diagnostic imaging
  • Diverticulum / etiology*
  • Diverticulum / surgery
  • Female
  • Humans
  • Hysterectomy / adverse effects*
  • Iatrogenic Disease*
  • Magnetic Resonance Imaging
  • Pelvic Organ Prolapse / surgery
  • Postoperative Complications / etiology*
  • Robotic Surgical Procedures
  • Sutures / adverse effects*
  • Time Factors
  • Tomography, X-Ray Computed
  • Urinary Bladder / abnormalities*
  • Urinary Bladder / diagnostic imaging
  • Urinary Bladder / surgery

Supplementary concepts

  • Bladder Diverticulum