{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:18:32Z","timestamp":1779110312579,"version":"3.51.4"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Midurethral sling (MUS) surgery is a standard treatment for stress urinary incontinence in women. Obturator-route MUS procedures reduce retropubic morbidity, but rare concealed hemorrhagic complications can be severe and rapidly progressive. This report describes a complex case of life-threatening hemorrhage, upper urinary tract extravasation, and delayed infection involving a persistent pelvic collection after obturator-route MUS. Methods: We reviewed the clinical course, imaging findings, interventions, and follow-up of a 77-year-old woman who developed severe complications after outpatient obturator-route MUS. A descriptive narrative summary of published hemorrhagic complications after TOT or TVT-O procedures was also performed. Result: On postoperative day 1, the patient presented with left lower abdominal pain, dizziness, vomiting, tachycardia, and severe anemia. Contrast-enhanced computed tomography showed active bleeding from the left obturator artery, an 11.5 cm pelvic hematoma with bladder displacement, and upper urinary tract contrast extravasation at the left renal pelvis and ureteropelvic junction. Emergency transcatheter arterial embolization and left percutaneous nephrostomy were performed, followed by delayed antegrade double-J ureteral stenting. Four months later, she developed E. coli urosepsis with a persistent 7.9 cm paravesical collection. Persistent symptoms despite initial antibiotic therapy required broad-spectrum antibiotics and percutaneous catheter drainage. The drainage fluid was serous, and S. hominis isolated from the drainage culture was interpreted as a contaminant; therefore, the collection was managed as a clinically suspected infection involving a persistent pelvic collection rather than as a microbiologically confirmed infected hematoma. Conclusions: After obturator-route MUS, severe abdominal or pelvic pain, dizziness, tachycardia, hypotension, or abrupt hemoglobin decline should prompt contrast-enhanced CT to evaluate for concealed pelvic arterial bleeding and associated urinary tract extravasation. Early multidisciplinary coordination and follow-up of persistent pelvic collections may be important in complex cases.<\/jats:p>","DOI":"10.3390\/jcm15103875","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:36:40Z","timestamp":1779107800000},"page":"3875","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Life-Threatening Hemorrhage, Upper Urinary Tract Extravasation, and Delayed Infection Involving a Persistent Pelvic Collection After Obturator-Route Midurethral Sling Surgery: A Case Report and Narrative Summary of Published Cases"],"prefix":"10.3390","volume":"15","author":[{"given":"In Ae","family":"Cho","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju 52727, Republic of Korea"},{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea"},{"name":"Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu Jin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeesun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju 52727, Republic of Korea"},{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea"},{"name":"Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9943-2863","authenticated-orcid":false,"given":"Hyen Chul","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju 52727, Republic of Korea"},{"name":"Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea"},{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Changwon 51472, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeong Kyu","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju 52727, Republic of Korea"},{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea"},{"name":"Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Won Jun","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju 52727, Republic of Korea"},{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea"},{"name":"Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6499-9085","authenticated-orcid":false,"given":"Jae Yoon","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University College of Medicine, Jinju 52727, Republic of Korea"},{"name":"Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea"},{"name":"Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s00345-008-0239-2","article-title":"Prevalence of urinary incontinence in Korean women: Results of a National Health Interview Survey","volume":"26","author":"Lee","year":"2008","journal-title":"World J. 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