Retroperitoneal mass presenting as stress urinary incontinence: A rare case presentation

Introduction: The management of urologic injuries at the time of midurethral sling placement is well described but lacks specific guidance on when further anatomic investigation may be warranted. We present a rare case of an upper urinary tract problem and retroperitoneal mass causing lower urinary tract symptoms, specifically severe stress urinary incontinence. Case Report: A 54-year-old female with stress urinary incontinence underwent attempted retropubic midurethral sling placement that was abandoned after repeated urinary tract injury at time of placement. A computed tomography (CT) urogram that was completed after repair of the injury identified a large retroperitoneal mass encasing the right kidney and ureter. Subsequent resection of this mass resulted in immediate resolution of the patient’s stress urinary incontinence. Conclusion: Though urologic injuries at time of midurethral sling placement can be due to anatomic variation, further investigation is not often pursued. In the absence of relevant guidelines, clinically significant anatomic abnormalities may often be missed and left unaddressed. Though we present a rare case of stress urinary incontinence (SUI) that resolved after large mass resection, there are several risk factors present in this case that may inform clinicians when to pursue further evaluation and management.