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Minimally Invasive Management of Retropubic Bleeding and Hematoma Evacuation After a TVT Secur or Mini-Sling Procedure

O’Boyle, Amy L. MD*; DiCarlo-Meacham, Angela MD; Hernandez, Sandra MD*

Female Pelvic Medicine & Reconstructive Surgery:
doi: 10.1097/SPV.0000000000000059
Case Reports
Abstract

Background: Retropubic hematomas may complicate up to 4.1% of tension-free vaginal tape (TVT) procedures in the surgical treatment of stress urinary incontinence. Symptomatic or expanding hematomas often require intervention, usually accomplished through an abdominal incision.

Case: A 43-year-old woman underwent transvaginal management of venous bleeding and evacuation of a 1500-mL retropubic hematoma after a TVT Secur or “mini-sling” procedure.

Conclusions: Significant bleeding can complicate even the least invasive surgical approach to treat stress urinary incontinence. Transvaginal evacuation of a symptomatic retropubic hematoma with instillation of a hemostatic agent may be a safe alternative to laparotomy in a hemodynamically stable patient.

In Brief

A case of a massive retropubic hematoma following a TVT-Secur single incision mini-sling, managed through the original vaginal incision.

Author Information

From the *Walter Reed National Military Medical Center, Bethesda, MD; and †Naval Hospital Okinawa, Okinawa, Japan.

Reprints: Amy L. O’Boyle, MD, Division of Urogynecology, Department of Women’s Health, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600. E-mail: amyoboyle@aol.com; amy.l.o’boyle.mil@health.mil.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

The authors have declared they have no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins