Yonsei Med J.  2005 Dec;46(6):874-876.

Occult Intraperitoneal Bladder Injury after a Tension-Free Vaginal Tape Procedure

• Chung BS
• Lee T
• Kim JS
• Lee HJ

Abstract

Occult bladder injury may sometimes go unrecognized during tension-free vaginal tape (TVT) procedures. We report a case of occult intraperitoneal bladder injury that occurred during a TVT procedure. There was no sign of bladder perforation on the initial cystoscopy, which was performed just after the insertion of the trocar. Signs of general peritonitis appeared after the patient started to void the next day. A postoperative cystogram and cystoscopy showed an intraperitoneal bladder injury and a pinhead-sized ulcerative lesion in the right lateral wall of the bladder. We suspect that at the time of initial cystoscopy, the trocar passed through the submucosal area without violating the bladder mucosa. The occult bladder injury may have been caused after the initial cystoscopy by advancing the rough edge of the prolene tape during the extraction of the trocar. This report is the first description of such an occult bladder injury during a TVT procedure.

Keyword

Bladder; injury; tension-free vaginal tape

MeSH Terms

Vagina/surgery
Urologic Surgical Procedures/adverse effects
Urinary Incontinence, Stress/*surgery
Urinary Bladder/*injuries/radiography
*Postoperative Complications
Peritonitis/diagnosis/etiology
Humans
Female
Cystoscopy
Adult

Figure

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  Fig. 1 Computerized tomography of the abdomen and pelvis shows multiple dilated bowel loops and abnormal fluid collection in the intraperitoneal space.

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  Fig. 2 This cystogram shows extravasation of contrast media from the bladder to the intraperitoneal space.

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  Fig. 3 This cystoscopic finding shows a pinhead-sized ulcerative lesion on the right lateral wall of the bladder. This did not form a distinct visible passage to the peritoneal cavity.

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