title: The management of massive haematomas after insertion of retropubic mid-urethral slings.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, UK, ME7 5NY. aswini@doctors.net.uk.
authors.forename: Aswini
authors.initials: A
authors.lastname: Balachandran
authors.affiliation: Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, UK, ME7 5NY.
authors.forename: Natasha
authors.initials: N
authors.lastname: Curtiss
authors.affiliation: Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, UK, ME7 5NY.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Duckett
mesh_terms: D004739:England / Q000453:epidemiology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*
keywords: Complications; Haematoma; Management; Mid-urethral sling; Retropubic haematoma; Tension-free vaginal tape