Recognition of occult bladder injury during the tension-free vaginal tape procedure.
OBJECTIVE
To identify signs and the etiology of occult bladder injury during the tension-free vaginal tape sling procedure.


METHODS
The charts of 140 women who underwent a tension-free vaginal tape procedure were reviewed, and complications were tabulated and analyzed. The tension-free vaginal tape procedure was performed in six fresh-frozen pelves to demonstrate the mechanism of the occult bladder injury.


RESULTS
Occult bladder injury was suspected when cystoscopy instillation fluid flowed from the plastic sheath that covers the prolene tape after the extraction of the tension-free vaginal tape trocar. Three of six cases of intraoperative bladder injury had occult bladder injury identified on repeat cystoscopic inspection. The bladder injury caused by the rough edge at the point of attachment of the tension-free vaginal tape to the trocar was reproducible in three of 12 tension-free vaginal tape applications in fresh-frozen pelves. Traction on the tension-free vaginal tape reapproximates the injured bladder edges and potentially promotes spontaneous healing.


CONCLUSIONS
Bladder injuries may go unrecognized during a tension-free vaginal tape procedure. Continuous seepage of water through the prolene plastic sleeve is suggestive of occult bladder injury and requires repeat cystoscopy to identify the potential site of injury.
Abbas Shobeiri
S
S
Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA. Shobeiri@yahoo.com
Garely
Alan D
AD
Chesson
Ralph R
RR
Nolan
Thomas E
TE
D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D008145:Louisiana / Q000453:epidemiology; D008499:Medical Records; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D001743:Urinary Bladder / Q000293:injuries*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina / Q000601:surgery*