Embolization in the Treatment of a Major Retropubic Hemorrhage Following Tension-Free Vaginal Tape: A Case Report and Literature Review

Hansen Margrethe Foss,Prien-Larsen Jens,Carstensen Mads Henrik,Alling-Møller Lars

doi:10.23937/2469-5742/1510034

Abstract

Embolization in the Treatment of a Major Retropubic Hemorrhage Following Tension-Free Vaginal Tape: A Case Report and Literature Review

Highlights

The Tension-Free Vaginal Tape (TVT) was introduced in 1996 and is widely used in surgical treatment of urinary incontinence due its low risk of surgical complications and high long-term cure rate [1]
The patient was successfully treated by arterial embolization; the postoperative course was greatly protracted due to persistent subfebrilia and eventually the hematoma was removed by laparoscopy
Case reports have shown favorable outcomes of arterial embolization following insertion of a synthetic Midurethral Sling (MUS) complicated by arterial hemorrhage [5,6,7,8,9,10,11,12,13]. This case report describes an injury to the right obturator artery following a TVT procedure complicated by arterial hemorrhage successfully treated by embolization, but with a protracted postoperative course

Summary

Introduction

The Tension-Free Vaginal Tape (TVT) was introduced in 1996 and is widely used in surgical treatment of urinary incontinence due its low risk of surgical complications and high long-term cure rate [1]. Case reports have shown favorable outcomes of arterial embolization following insertion of a synthetic Midurethral Sling (MUS) complicated by arterial hemorrhage [5,6,7,8,9,10,11,12,13] This case report describes an injury to the right obturator artery following a TVT procedure complicated by arterial hemorrhage successfully treated by embolization, but with a protracted postoperative course. The patients presented with fever of 38.9 °C and diffuse lower abdominal pain She received intravenous broad-spectrum antibiotics, the pain abated and an enhanced Computed Tomography (CT) scan revealed a reduced hematoma sized 11 cm × 6 cm. Due to persistent low-grade fever on postoperative day 21, an enhanced CT scan was performed excluding injury to the urinary tract, showing a 1.4 cm × 6 cm pelvic mass representing either a small abscess or a residual hematoma. The patient was well-being and reported no stress urinary incontinence

Discussion

Ko JK One day Perineal