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

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