Vaginal revision of intravesical tension-free vaginal tape 44 h after initial placement: a case report

Int Urogynecol J (2007) 18: 223–225 DOI 10.1007/s00192-006-0122-x

CASE REPORT

Lisa C. Labin . Abraham N. Morse . Stephen B. Young

Vaginal revision of intravesical tension-free vaginal tape 44 h after initial placement: a case report

Received: 28 November 2005 / Accepted: 10 March 2006 / Published online: 21 April 2006 # International Urogynecology Journal 2006

Abstract Unintentional cystotomy is a known complication of the tension-free vaginal tape procedure and is commonly diagnosed intraoperatively. Delayed diagnosis does occur and various reparative techniques have been described, some requiring laparotomy with intentional cystotomy and repair. We report a case where a 46-year-old woman underwent vaginal reconstructive surgery including placement of a tension-free vaginal tape, which was complicated by unilateral cystotomy. A delayed diagnosis of intravesical tape placement was made requiring reoperation. The patient underwent a minimally invasive transvaginal procedure for removal and immediate replacement of the malpositioned arm of the tape. We conclude that a transvaginal approach may be an acceptable technique for revision and replacement of the tension-free vaginal tape where cystotomy is identified within 44 h after the initial procedure. With this technique, a more invasive surgery including laparotomy with cystotomy might successfully be avoided. Keywords TVT . Urinary incontinence . Postoperative complications . Bladder perforation

range of the frequency of bladder perforation associated with the TVT procedure with extremes of