Bladder perforation: A missed diagnosis post-transobturator
With the advent of midurethral slings, the treatment of Stress urinary incontinence (SUI) has revolutionized from a major surgery to a simple day care procedure. The conundrum on the choice of sling still exists between transobturator tape (TOT) and tension-free transvaginal tape (TVT).

Published in the Journal of Mid-life Health, the authors report a case of post-TOT bladder perforation which was left undiagnosed for 5 years and patients' symptoms were attributed to recurrent UTI.

A 50-year-old posthysterectomy female presented to our outpatient department (OPD) with a complaint of leakage of urine on straining and dysuria in 2014. A detailed history was elicited which revealed history of total abdominal hysterectomy 2 years back followed by TOT 6 months after hysterectomy for stress incontinence. However, postsurgery, the SUI was not relived, and the patient had dysuria which was treated for recurrent UTI for 2 years.

Her routine investigations were done. A urine routine microscopy and urine culture was obtained which was negative. The patient was posted for a repeat TOT at our center. Post-TOT symptoms of stress incontinence resolved. Patient voided normally. Postvoid residual volume was insignificant.

Two months later, the patient presented to us with burning micturition and was again treated for UTI. There was interim resolution of symptoms which would reappear every 2–3 months. The patient presented chronically with lower abdominal pain, dysuria, and dyspareunia for 3 years in the OPD which was treated for recurrent UTI and local treatment for dyspareunia.

However, for the past 6 months, there was exasperation of symptoms with tenderness below the bladder neck on per vaginal examination and lower abdominal pain and constant dysuria. Urine routine microscopy and urine culture were normal. The patient was thus posted for cystoscopy.

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