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Retroperitoneal Hemorrhage After Sacral Neurostimulator Placement for Urgency Urinary Incontinence

Kinman, Casey L. MD*; Hobson, Deslyn T.G. MD*; Agrawal, Anubhav MD*; Vyleta, Martin S. MD; Francis, Sean L. MD*

Female Pelvic Medicine & Reconstructive Surgery: July/August 2017 - Volume 23 - Issue 4 - p e29–e31
doi: 10.1097/SPV.0000000000000428
Case Report
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Sacral neuromodulation (SNM) is an effective therapy for patients who experience urinary incontinence, idiopathic urinary retention, and fecal incontinence. Although typically a low-risk procedure, rarely, it can be associated with significant hemorrhage. A 61-year-old woman on chronic anticoagulation underwent uncomplicated implantation of SNM for refractory urgency urinary incontinence. Anticoagulation was held on the day of surgery and resumed on postoperative day 1. On postoperative day 2, the patient developed an extensive retroperitoneal hemorrhage. This was successfully treated by angioembolization of the left lateral sacral artery with the InterStim device left in situ. At 6-month follow-up, the device was functioning properly, and the patient's urinary symptoms were well controlled. Retroperitoneal hemorrhage is a rare complication after SNM placement. Conservative management with angioembolization should be considered as a first-line approach.

Extensive retroperitoneal hemorrhage following sacral nerve stimulator placement can be treated successfully with angioembolization.

From the *Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, and †Division of Vascular and Interventional Radiology, Department of Radiology, University of Louisville, Louisville, KY.

Reprints: Casey L. Kinman, MD, Department of Obstetrics and Gynecology, University of Louisville, 550 S Jackson St, 1st Floor, Louisville, KY 40202. E-mail: casey.kinman@louisville.edu.

S.L.F. has provided medicolegal testimony within the past 36 months. All other authors have no disclosures to report.

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