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Delayed Diagnosis of Vascular Injury With a Retropubic Midurethral Sling

Aslam, Muhammad Faisal MD, MRCOG; Denman, Mary Anna MD, MCR

doi: 10.1097/AOG.0b013e31829919b3
Case Report

BACKGROUND: Retropubic midurethral slings are the mainstay of treatment for female stress urinary incontinence. Complications of this approach may have long-term implications.

CASE: A 55-year-old woman underwent tension-free vaginal tape (TVT) placement. Five years later back pain and gross hematuria prompted cystoscopy and diagnosis of bladder mesh erosion. During surgery to remove the mesh, the left arm of the mesh was found to be through the external iliac vein. The right mesh arm traversed the bladder, laterally around the obturator nerve and right iliac vein, exiting through the peritoneal cavity.

CONCLUSION: Neurovascular injury is a rare but serious consequence of TVT. Delayed diagnosis is possible. This case highlights the importance of using recognized landmarks and established surgical technique for TVT placement.

Use of anatomic landmarks and proper surgical technique for retropubic midurethral sling placement are critical to avoid serious neurovascular injury.

Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.

Corresponding author: Muhammad Faisal Aslam, MD, MRCOG, Department of Obstetrics and Gynecology, Mail Code L466, OHSU, SW Sam Jackson Park Road, Portland, OR 97239; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists.