Embolization in Patient with Hypovolemic Shock after Transobturator Sling Procedure

Area of Science:

• Urology
• Vascular Surgery
• Minimally Invasive Surgery

Background:

• Suburethral slings are a standard treatment for stress urinary incontinence (SUI).
• The transobturator technique (TOT) was developed to reduce complications associated with the retropubic approach.
• TOT aims to minimize risks such as blind needle insertion and perforation.

Observation:

• A case report details an injury to a branch of the left obturator artery during a TOT procedure.
• The injury resulted in significant bleeding and hemodynamic instability in the patient.
• This complication occurred despite the perceived safety benefits of the TOT technique.

Findings:

• Vascular injury, specifically obturator artery damage, is a potential risk of the transobturator sling procedure.
• Prompt recognition and intervention are crucial for managing severe hemorrhage following TOT.
• Embolization proved an effective treatment for controlling the arterial bleeding.

Implications:

• Surgeons performing TOT procedures must be aware of potential vascular complications.
• Enhanced anatomical knowledge and careful surgical technique can help mitigate obturator artery injury risks.
• Embolization should be considered a viable option for managing intractable bleeding after suburethral sling placement.