Urethrovaginal fistula 11 years after a bone anchor sling using woven polyester and treatment with a Martius flap

Abstract

Introduction We encountered a urethrovaginal fistula diagnosed 11 years after a bone anchor sling. Case presentation A 58‐year‐old woman underwent a bone anchor sling to treat stress urinary incontinence. At age 69, mid‐urethral sling was planned because of a recurrent stress urinary incontinence diagnosis, but a urethrovaginal fistula was found immediately before the procedure. After removing woven polyester, the previous sling material, simple fistula closure was carried out but failed. Usage of a vaginal speculum and powerful medical lamps during a stress test revealed leakage from both the urethrovaginal fistula and the external urethral meatus. She underwent another fistula closure using a Martius flap. Subsequently, a 1‐h pad test improved from 195 to 5.1 g/h. The remaining mild stress urinary incontinence did not necessitate further treatment. Conclusion Anti‐incontinence procedures using synthetic materials can cause urethrovaginal fistula. Attention must be paid to the possibility of urethrovaginal fistula when patients complain of worsened incontinence postoperatively.