Gossypiboma in the prostatic fossa presenting as bladder outlet obstruction following open prostatectomy: a case report

Abstract

Introduction and importance: Gossypiboma, also known as a retained surgical sponge, is a rare but preventable postoperative complication that results from the inadvertent retention of textile surgical materials within the body. Post-prostatectomy gossypiboma is exceedingly uncommon and poses diagnostic challenges due to its nonspecific and delayed clinical presentation. This case highlights a rare intraprostatic gossypiboma discovered incidentally during transurethral prostate surgery, underscoring the importance of meticulous surgical counts and long-term vigilance in postoperative patients. Case presentation: We report the case of a 73-year-old male with progressive lower urinary tract symptoms of 3 years’ duration, who had undergone an open prostatectomy for presumed benign prostatic hyperplasia 1 year earlier. During transurethral resection of the prostate for persistent bladder outlet obstruction, a retained surgical gauze embedded within the prostatic bed was unexpectedly identified, associated with purulent material. Endoscopic removal was unsuccessful, necessitating conversion to an open suprapubic approach for complete extraction. The patient had an uneventful postoperative recovery following appropriate surgical and antibiotic management. Discussion: Gossypiboma remains underreported due to medicolegal concerns, yet it represents a significant source of postoperative morbidity. Risk factors include emergency surgery, hemorrhagic operative fields, inadequate sponge counts, and changes in operative plans. In urologic surgery, retained sponges are particularly rare and may masquerade as infection, malignancy, or recurrent obstruction. This case illustrates an unusual intraprostatic location, delayed presentation, and diagnostic difficulty, emphasizing the need for heightened suspicion in patients with persistent or unexplained postoperative symptoms. Conclusion: This study provides several learning points, such as post-prostatectomy gossypiboma should be considered in patients presenting with unexplained persistent lower urinary tract symptoms after prostate surgery. Symptoms are vague, and intraoperative diagnosis remains common. High diagnostic suspicion and conversion to open prostatectomy, if we fail to remove the foreign body with the resectoscope, are the mainstays of treatment.