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[Bladder injury after TVT transobturator].
Jean-François Hermieu1, Aurel Messas, Vincent Delmas
1Clinique Urologique, Hôpital Bichat, 46, rue Henri Huchard, 75018 Paris. jean-francois.hermieu@bch.ap-hop-paris.fr
Summary
The transobturator approach for stress urinary incontinence surgery may still cause bladder injuries, despite earlier beliefs. This case report highlights a rare complication during transobturator tape (TVT) insertion.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Female Pelvic Medicine
Background:
- The transobturator (TO) approach for treating female stress urinary incontinence (SUI) was developed as a safer alternative to the retropubic transvaginal tape (TVT) placement.
- This technique aims to reduce bladder injury risk by avoiding dissection in the prevesical space, particularly in patients with prior pelvic surgery.
- However, anatomical studies suggest potential risks remain with the TO approach.
Observation:
- This report details the first documented case of a bladder injury occurring during the transobturator insertion of a TVT sling.
- The injury occurred despite the theoretical advantages of the TO approach in preserving the retropubic space and avoiding direct bladder manipulation.
Findings:
- Bladder injury is a potential complication even with the transobturator approach for SUI surgery.
- The anatomical course of the obturator pathway does not entirely preclude intraoperative bladder trauma.
Implications:
- Surgeons should remain vigilant for bladder injury during TO tape placement, even in the absence of prevesical space dissection.
- This finding necessitates careful surgical technique and potentially enhanced intraoperative monitoring for TO procedures.
- Further anatomical and clinical studies may be warranted to fully understand and mitigate the risk of bladder injury with the TO approach.