Hemorrhagic complications associated with tension-free vaginal tape procedure.
OBJECTIVE
We sought to assess the frequency, symptoms, and management of hemorrhagic complications in patients undergoing tension-free vaginal tape (TVT) procedure.


METHODS
Over a 5-year period the clinical course of all 336 consecutive patients undergoing TVT procedure in our hospital was recorded, including diagnostic approaches and management strategies for both increased intraoperative blood loss and clinically relevant hematoma.


RESULTS
In 87 patients (26%), TVT procedure was combined with other gynecologic surgeries, and 249 patients (74%) underwent TVT alone. In 7 cases (2.1%), increased intraoperative blood loss (250-400 mL) was managed by electro-coagulation, manual compression, tamponade, and/or insertion of a drain. The postoperative course in these patients was uncomplicated. In 14 women (4.1%) who did not show increased bleeding during the operation, retropubic hematoma developed, the volume of which exceeded 300 mL in 4 cases (1.2%). These required surgical intervention. In the first case we performed open laparotomy, whereas in the following cases the hematoma could be successfully drained by endoscopy. Postoperative development of a hematoma did not lead to recurrence of stress incontinence.


CONCLUSIONS
Bleeding complications during or after TVT procedure are rare events. Increased intraoperative bleeding can usually be managed with electro-coagulation, compression, and drainage.


METHODS
II-3.
Flock
Felix
F
Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany. felix.flock@medizin.uni-ulm.de
Reich
Andreas
A
Muche
Rainer
R
Kreienberg
Rolf
R
Reister
Frank
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D019736:Prostheses and Implants; D014550:Urinary Incontinence, Stress / Q000601:surgery*