The management of massive haematomas after insertion of retropubic mid-urethral slings

The retropubic mid-urethral sling (MUS) is the most commonly performed procedure for the treatment of stress urinary incontinence and is associated with a low risk of complications. Large retropubic haematomas occur sporadically and may have life-threatening consequences. Because of their infrequent nature, there is a dearth of information regarding this serious complication. The aim of this study was to identify the incidence of large haematomas and any lessons learnt from their treatment.

A retrospective cohort study was conducted between December 1999 and June 2014. Massive haematoma was defined as a haematoma greater than 8 cm and/or a drop in haemoglobin of more than 4 g/dl. The hospital notes of all patients diagnosed with a massive haematoma were reviewed and a detailed history, operation details and the information on the management of haematoma were obtained.

Seven (0.33 %) patients were identified with a massive retropubic haematoma out of a total of 2,091 retropubic MUS procedures performed. Six patients presented acutely with symptoms within 24 h. Haemoglobin levels dropped on average by 5.7 g/dl (range 2.9 to 8.6). The size of the haematoma ranged from 8 to 12 cm in diameter. Six patients required surgical drainage of the haematoma. Three patients received evacuation within 2 post-operative days. Haematomas were removed via laparotomy, vaginal drainage or suprapubic drainage.

Massive retropubic haematomas are uncommon but serious complications of MUS procedures. Our experience suggests that to reduce short- and long-term complications, early evacuation of massive haematomas via the suprapubic approach is recommended.