A case of iatrogenic urinary incontinence following an intravaginal sling with transobturator passage

L. Pirtea, D. Grigoras

Abstract: The use of synthetic mesh in the treatment of urinary stress incontinence represents a modern approach, but specific complication can occur. A case of urinary incontinence, manifested when patient changed position from supine to standing, is presented. The symptoms appeared after a previous intravaginal sling insertion, with transobturator passage, for urinary stress incontinence. The tape got hooked in the pubococcygeus muscles, and their contraction stretched opens the urethra. The patient presented urine loss, on getting off a chair or out of bed, similar to “tethered vagina” syndrome after prior anterior vaginal repair. Urodynamic and ultrasound exams were used in order to make the differential diagnosis with internal urethral sphincter deficiency, and tape sliding under the urinary bladder neck. The surgical cure was resection of the tape and reinsertion of a retropubic tape. The result was very promising, without notice the urine loss when getting up. We found only one description in literature of the “tethered vagina” case after transobturator tape insertion.
Keywords: urinary incontinence, intravaginal sling