Obturator Infected Hematoma and Urethral Erosion Following Transobturator Tape Implantation

Gamé, X.; Mouzin, Marc; Vaessen, Christophe; Malavaud, Bernard; Sarramon, Jean‐Pierre; Rischmann, P.

doi:10.1097/01.ju.0000115881.28311.f8

Cited by 51 publications

(32 citation statements)

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“…In the literature, there are no data on serious complications either, or perhaps with the exception of obturator-infected hematoma and urethral erosion [5] and bladder injury in the outside-in approach [6]. There are two techniques of transobturator approach, outside-in or inside-out, and both procedures are applied at our department.…”

Section: Discussionmentioning

confidence: 99%

“…The first is the insideout transobturator vaginal tape (TVT-O) approach [1] where a helical needle is introduced through the obturator membrane by way of a small suburethral incision from the vaginal side, and the outside-in (Monarc) approach [2] where the helical needle is introduced through the obturator membrane from the outer, dermal side. Reports in the literature show that both approaches are equally successful, and peri-operative complications are relatively rare [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Complications and short-term results of two different transobturator techniques for surgical treatment of women with urinary incontinence: a randomized study

But

Faganelj²

2008

Int Urogynecol J

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The aim of the study was the analysis of perioperative complications in women who were randomly assigned to receive two different techniques for the treatment of stress and mixed urinary incontinence. Our study included 120 women in whom we performed either TVT-O or Monarc procedure in local anesthesia. The duration of the operation and its likely complications were followed up. The success of treatment was evaluated after 3 months. Surgical time was identical for both procedures (13 min). The prevalence of vaginal wall perforation and laceration was higher during the outside-in procedure. The inside-out procedure was more painful (p < 0.000), the pain persisted significantly longer (21.6 vs 7.5 days; p = 0.03) and was more intense after discharge in these patients. In conclusion, inside-out and outside-in procedures are equally successful methods for the treatment of urinary incontinence at 4 months, however, inside-out procedure appears to be more painful.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complications and short-term results of two different transobturator techniques for surgical treatment of women with urinary incontinence: a randomized study

But

Faganelj²

2008

Int Urogynecol J

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“…1 Its transperineal passage is said to minimise or avoid damage of intra-abdominal structures including the bladder. 2 There have been several reports of complications following this technique, including bladder injury, 3 urethral erosion, 4 obturator infected haematoma 5 and vaginal wall erosion. 4 Transobturator tape placement involves transperineal passage of the prolene mesh tape.…”

Section: Discussionmentioning

confidence: 99%

“…The synthetic mesh promotes the development of infection and therefore must be totally removed in the presence of infection to obtain a cure. 4 We therefore advise that a high index of suspicion for bladder damage be encouraged and that routine cystoscopy be performed after TOT insertion, in order to allow immediate recognition of bladder perforation, removal of the tape and avoidance of this life-threatening complication. Surgeons performing this procedure should therefore also be trained and competent in cystoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…2 There have been several reports of complications following this technique, including bladder injury, 3 urethral erosion, 4 obturator infected haematoma 5 and vaginal wall erosion. 4 Transobturator tape placement involves transperineal passage of the prolene mesh tape. An anatomical study of the course of the tape undertaken by Delmas 2 states that the tape does not enter the pelvis and therefore the bladder cannot be involved.…”

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Case report: Necrotising fasciitis following unrecognised bladder injury during transobturator sling procedure

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Broome

2006

BJOG

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A 69-year-old multipara presented with a history suggestive of genuine stress incontinence. The diagnosis was confirmed urodynamically, and the woman underwent a transobturator sling procedure as described by Delorme. 1 A monofilament polypropylene tape was used (Aris TM Trans-obturator tape; Porges, Le Plessis Robinson, France). Immediately postoperatively, a catheter was passed and clear urine obtained. The procedure was uneventful, and the woman was discharged later the same day.Five days later, the woman was reviewed and was found to be generally unwell. She had no episodes of incontinence since the procedure. On examination, her abdomen was found to be erythematous and tender in the suprapubic area. Her temperature at this time was 38.3°C. A diagnosis of cellulitis was made, and the woman was commenced on erythromycin intravenously (as she was allergic to penicillin) and admitted to the hospital.She underwent a cystoscopy that confirmed a bladder perforation and had the tape completely removed. This was performed by opening the vaginal incision, grasping the tape and sliding it out of position. The vaginal incision was then resutured with interrupted stitches. The urine was extremely offensive and the tape obviously infected.Over the following 2 days, the erythema of her lower abdomen spread upward to the level of the umbilicus, and after consultation with a consultant microbiologist, the parenteral antibiotics were changed to cefotaxime, gentamicin and metronidazole. She became apyrexial on this regimen.Five days later, despite an improvement in her general condition and remaining apyrexial, the skin over the lower abdomen became crepitant and began to slough (Figure 1). A decision was made to perform a surgical debridement which showed a large quantity of pus and during which, 488 g of tissue was removed including skin and subcutaneous fat (Figures 2 and 3). The affected area extended from the level of the umbilicus to the suprapubic area and laterally extended beyond the midaxillary line bilaterally. The level of the peritoneum had not been breached and so intraperitoneal exploration was avoided. The woman returned to theatre 24 hours later for a further exploration and no further debridement was necessary. Culture of the pus grew Enterococcus sensitive to amoxycillin, gentamicin, teicoplanin and vancomycin. Three weeks later, a final debridement and split-skin graft was performed. The woman was finally discharged 2 weeks later, a total of 7 weeks after her original operation. DiscussionThe transobturator sling procedure is a relatively new minimally invasive surgical procedure devised for the treatment of genuine stress incontinence. 1 Its transperineal passage is said to minimise or avoid damage of intra-abdominal structures including the bladder. 2 There have been several reports of complications following this technique, including bladder injury, 3 urethral erosion, 4 obturator infected haematoma 5 and vaginal wall erosion. 4 Transobturator tape placement involves transperineal passage of the prolene...

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Complications of Sling Surgery

Sutherland¹

2007

Female Urology

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Obturator Infected Hematoma and Urethral Erosion Following Transobturator Tape Implantation

Cited by 51 publications

References 2 publications

Complications and short-term results of two different transobturator techniques for surgical treatment of women with urinary incontinence: a randomized study

Complications and short-term results of two different transobturator techniques for surgical treatment of women with urinary incontinence: a randomized study

Case report: Necrotising fasciitis following unrecognised bladder injury during transobturator sling procedure

Complications of Sling Surgery

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