"Stalagnate in Bladder": Synechiae Post Anti-Incontinence Surgery in Women

Anti-incontinence suspension procedures in women include Burch colposuspension or needle suspension procedures. Even though bladder injury is a known complication of any needle urethral or colposuspension procedure in women, it is rare. Delayed presentation may occur with lower urinary tract symptoms or hematuria. However, synechiae formations in bladder have rarely been reported. In this study, we report two cases presenting late with synechiae formation inside the bladder as a result of the suspension suture actually passing through the bladder and thus sewing the posterior and anterior walls of bladder together. Two ladies presented late after Burch colposuspension with nonresolving urinary symptoms. Both these ladies demonstrated a "smiley bladder sign" caused by a filling defect on cystogram. Cystoscopy revealed a synechial pillar attaching the anterior and the posterior walls, reminiscent of stalagnate-like column in the bladder cavity in both cases. Both cases were managed endoscopically with laser incision avoiding injury to the ureteral orifices. A rare previously undescribed complication of Burch colposuspension and its typical appearance on cystogram is reported along with its endoscopic management. These cases highlight the use of intraoperative cystoscopy to prevent such complications.