barmet.gif (455 bytes)

MTS, 42 years old, white, no deliveries, carrier of mixed urinary incontinence (association of stress urinary incontinence and urge incontinence) shown objectively by urodynamic techniques, accordingly to the recommendations of the International Society of Continence2. After clinical treatment with tolterodine 4mg/per day there was an improvement of urgency and persistence of stress urinary incontinence.
On the 08/26/99 a TVT was done on the same patient, following the technique described by Ulmsten3. During the pasing of the needle there was a bladder perforation to the left, diagnosed by the intra operatory cystoscopy undertaken by routine. The needle was removed (as was taught to us) through a section of the prolene tape in the midline (below the middle urethra). This way we maintained the tape on the right, adequately passes and we removed the tape on the left which was responsible for the bladder perforation. We again passed the left tape with no problem, (this new tape was also divided in half). Both ends of the right and left tapes were then sutured in the midline (below the middle urethra) with vicryl thread rapid 3-0 (Ethicon). The rest of the procedure evolved with no incidentes, as usual. In the first month follow-up the patient complained of a foreign object in her vagina, stress urinary incontinence, urgency and urge incontinence. In the exam we noticed the extrusion of the tape through the edge of the surgical scar. The TVT was then removed with local anesthesia in the visible area. The symptoms continued except with improvement of the urgency and frequency, controlled by the medication (tolterodine 4mg/per day).
After 3 months, she related a 3/3 hour frequency with no nycturia and relevant stress urinary incontinence. A cystoscopy and urodynamic was done, the cystoscopy was normal and the urodynamic is showed mild vesical instability associated to important stress urinary incontinence. A new operation was proposed to the patient, attempting to have a new TVT done and she accepted the proposal. The procedure was executed on the 01/06/00, the procedure was accomplished with no abnormality, and in the 3 to 5 month follow-up the patient related the disappearance of all her symptoms (urgency, stress urinary incontinence and to coitus).