title: Urethral necrosis and proximal urethro-vaginal fistula resulting from tension-free vaginal tape.
abstract: Urethral erosion is an uncommon complication after sub-urethral sling placement using the TVT procedure. Strangulation necrosis of the entire distal urethra with a fistulous connection between proximal urethra and vagina is a devastating complication that has not been previously reported, resulting in significant morbidity and the necessity for challenging management. This is a report of a 64-year-old woman with stress urinary incontinence who underwent a TVT resulting in a large fistula between the proximal urethra and the vagina, and the necrosis of the entire urethra distal to the fistula. This problem necessitated a staged reconstruction involving three separate procedures. Initially, she underwent debridement and removal of the TVT fragments, a secondary vaginal flap urethroplasty with a labial fibro-fatty graft to restore urethral length, and a tertiary coaptive occlusive sling to restore continence.
authors.affiliation: Department of Urology, Hackensack University Medical Center, 20 Prospect Avenue, Suite 715, Hackensack, NJ 07601, USA. andrewsiegel@optonline.net
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Siegel
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods; D014521:Urethra / Q000473:pathology*; D014522:Urethral Diseases / Q000209:etiology*; D014548:Urinary Fistula / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods; D014624:Vaginal Fistula / Q000209:etiology*