Arterial Injury Associated with Tension-Free Vaginal Tapes-SECUR Procedure Successfully Treated by Radiological Embolization

Jung, Yunho; Lee, Woo Jung; Shin, Tae Seung; Han, Chang Hee; Kang, Sung Hak; Lee, Yong Seok

doi:10.5213/inj.2010.14.4.275

Cited by 11 publications

(11 citation statements)

References 8 publications

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“…However, although in the cases of TVT-S included here major intra-operative complications are not reported, serious adverse outcomes after TVT-S procedures have been documented; there are a number of reports of significant bleeding complications requiring laparotomy [21,22]. Recently, a case of internal pudendal artery injury after a TVT-S procedure was reported, which required radiological embolization to achieve haemostasis [23]. Furthermore, a case of a retained finger pad necessitating re-exploration in theatre has been documented after a TVT-S procedure, something which is not a risk after other MUS approaches [24].…”

Section: Discussionmentioning

confidence: 99%

TVT‐Secur mini‐sling for stress urinary incontinence: a review of outcomes at 12 months

Walsh¹

2011

BJU International

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What’s known on the subject? and What does the study add?Although synthetic mid‐urethral slings are now generally accepted as the first‐line surgical treatment of female stress incontinence, there is concern that newer slings are being used prematurely, before sufficient evidence exists. The 3rd generation “mini‐slings” are inserted via a single incision which, theoretically, reduces iatrogenic morbidity. It is vital, however, that efficacy is not compromised. To date, a number of papers have examined short‐term outcome data following the TVT‐Secur, with wide variations in reported cure rates at up to one year.This is the largest review of outcomes following TVT‐Secur published to date (n= 1178 cases from 10 studies). Cure rate, both objectively and subjectively, was 76%, which is similar to more established mid‐urethral slings. Intra‐operative vaginal perforation rates and rates of mesh exposure in the first 12 months post‐operatively were both 2%. The incidence of de novo OAB was 10%. No serious complications were recorded amongst this large cohort. Although the TVT‐Secur appears to be a safe procedure, its long‐term efficacy moving forward requires close scrutiny.• Synthetic mid‐urethral slings (MUSs) are considered the first choice surgical procedure for stress urinary incontinence. Recent publications have raised concerns about the efficacy of third generation single‐incision mini‐slings. The present paper is a systematic review of studies reporting 12‐month outcomes after the TVT‐Secur (TVT‐S) procedure.• Pubmed/Medline online databases, abstracts from recent International Continence Society and International Urogynecological Association annual scientific meetings and the Clinicaltrials.gov and Controlled‐trials.com online trial registries were searched for English‐language articles containing the terms ‘TVT‐Secur’, ‘TVT Secur’ or ‘mini‐sling’. The primary outcomes were objective and subjective cure rates at 12 months. Secondary outcomes included peri‐operative (vaginal perforation, urinary retention, urinary tract infection [UTI]) and postoperative (mesh exposure, de novo overactive bladder (OAB), dyspareunia and return to theatre) complication rates.• Among 1178 women undergoing the TVT‐S procedure, from 10 studies, both objective and subjective cure rate at 12 months was 76%, with objective cure significantly higher in women undergoing the ‘U‐type’ approach. Vaginal perforation was a complication in 1.5% of cases, with a 2.4% incidence of mesh exposure in the first year. The incidence of de novo OAB symptoms was 10%. Rates of urinary retention (2.3%), UTI (4.4%), dyspareunia (1%) and return to theatre for complications (0.8%) were low. In the first year after a TVT‐S procedure 5% of women required repeat continence surgery.• Longer‐term studies and randomized comparisons with more established MUSs are required before TVT‐S should be routinely used in the surgical treatment of stress urinary incontinence.

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Section: Discussionmentioning

confidence: 99%

TVT‐Secur mini‐sling for stress urinary incontinence: a review of outcomes at 12 months

Walsh¹

2011

BJU International

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“…In our series three major complications occurred in the TVT-Secur group, and other authors have reported bladder perforation, bleeding from the corona mortis, severe bleeding from the internal obturator muscle, injury of the internal pudendal artery and even male dyspareunia [12,[36][37][38][39]. Our results indicate that despite the manufacturer's recommendation not to perform a urethrocystoscopy following an obturator membrane-anchored TVT-Secur procedure, peroperative bladder and urethral perforation should be ruled out.…”

Section: Discussionmentioning

confidence: 55%

One-year results of a prospective randomized, evaluator-blinded, multicenter study comparing TVT and TVT Secur

et al. 2012

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“…The patient was in fair general health postoperative- sis in arterial injuries following synthetic MUSs [5][6][7][8][9][10][11][12][13]. Unlike previous cases, the present postoperative course was greatly protracted due to persistent infection, multiple assessments and ultimately, removal of the hematoma.…”

Section: Case Reportmentioning

confidence: 77%

“…In the last decade; embolization has gained favor for the treatment of acute hemorrhage in different anatomical areas within several surgical specialisms for the treatment of acute hemorrhage [4]. 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].…”

mentioning

confidence: 99%

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

Hansen

Carstensen²,

Prien-Larsen³

et al. 2017

Int Arch Urol Complic

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55-year-old para 2 woman was brought to the emergency department following insertion of a tension-free vaginal tape complaining of lower abdominal pain and vertigo. The subsequent angiography localized a significant bleeding from the right obturator artery and a retropubic hematoma 17.5 cm × 10.0 cm in size. The patient was successfully treated by arterial embolization; however, the postoperative course was greatly protracted due to persistent subfebrilia and eventually the hematoma was removed by laparoscopy. This case illustrates that embolization should be considered an important alternative for management of arterial bleeding following synthetic midurethral slings. However, removal by laparoscopy or laparotomy may be necessary in large hematomas subsequently to embolization.

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Arterial Injury Associated with Tension-Free Vaginal Tapes-SECUR Procedure Successfully Treated by Radiological Embolization

Cited by 11 publications

References 8 publications

TVT‐Secur mini‐sling for stress urinary incontinence: a review of outcomes at 12 months

TVT‐Secur mini‐sling for stress urinary incontinence: a review of outcomes at 12 months

One-year results of a prospective randomized, evaluator-blinded, multicenter study comparing TVT and TVT Secur

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

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