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Urinary extravasation Burch colposuspension Ureteral obstruction Abstract We report an unusual case of unilateral ureteral obstruction with secondary urinary extravasation by forniceal rupture as a complication of the Burch colposuspension procedure. Surprisingly, this complication has never been described before. K.P.J. Delaere, MD, Department of Urology, De Wever Hospital, PO Box 4446, NL-6401 CX Heerlen (The Netherlands) Operative complications of the Burch colposuspension are infrequent and mostly include bladder trauma and venous bleeding. Ureteral injuries can also occur but seem to be extremely rare. As far as we know only 2 cases of intraoperative damage to the ureter resulting in obstructive uropathy have been published [1,2]. Moreover, perirenal urinary extravasation due to ureteral blockage as a complication of retropubic surgery for genuine stress incontinence has not been described previously. We now present such a case. Case Report A 46-year-old woman presented with a history of stress urinary incontinence of 2 years. She had undergone neither urological nor gynecological surgery before. Physical examination revealed no cys-tocele. Urodynamic investigation showed a stable bladder function and urethral sphincter incompetence. The patient was admitted to the Department of Obstetrics and Gynecology and a retropubic colposuspension was performed by Burch’s method [3]. Postopera-tively she developed fever and increasing pain in the right loin. Urinary drainage through the bladder catheter was normal. An excretory urogram (intravenous pyelogram) (IVP) was performed on the second postoperative day (fig. 1). Strongly marked extravasation of contrast material from the right renal pelvis and calyces was seen and there was no opacification of the corresponding ureter. It was assumed that the vaginal sutures on the right side had been placed too close to the ureterovesical junction. Under general anesthesia ureteral catheterization was attempted but without success. Reex-ploration was performed and the sutures from the right side were removed. A repeat IVP after 7 days disclosed a normally functioning right kidney with a thin ureter. At 6 months’ follow-up the patient had no more complaints of incontinence and voiding was normal.