Transobturator tape, bladder perforation, and paravaginal defect: a case report

Area of Science:

• Urology
• Gynecologic Surgery
• Female Pelvic Medicine

Background:

• Transobturator midurethral slings (TOT) are a common surgical treatment for stress urinary incontinence.
• TOT procedures are associated with a lower risk of vascular and visceral injury compared to retropubic slings.
• Routine cystoscopy is often omitted during TOT placement due to perceived lower risk.

Observation:

• A case of a bladder perforation that occurred during a TOT procedure and went unrecognized is presented.
• The injury was discovered during a subsequent sling removal procedure.
• A subtle paravaginal defect was suspected as a contributing factor to the bladder perforation.

Findings:

• The case demonstrates that bladder perforation can occur during TOT placement, even when perceived risks are low.
• The absence of immediate recognition of the injury highlights potential diagnostic challenges.
• A paravaginal defect may increase the risk of visceral injury during TOT placement.

Implications:

• Routine cystoscopy should be considered during transobturator midurethral sling placement to ensure early detection of potential bladder injuries.
• Surgeons should maintain a high index of suspicion for visceral injury, especially in the presence of subtle anatomical variations.
• This case underscores the importance of thorough intraoperative assessment to prevent delayed diagnosis and management of complications.