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Hemorrhagic Complications Associated With Tension-Free Vaginal Tape Procedure

Felix Flock, MD^*, Andreas Reich, MD^*, Rainer Muche, PhD, Rolf Kreienberg, MD^* and Frank Reister, MD^*

From the *Department of Obstetrics and Gynecology and Department of Biometry and Medical Documentation, University of Ulm, Ulm, Germany.

Address reprint requests to: Felix Flock, MD, Department of Obstetrics and Gynecology, University of Ulm, Prittwitzstr. 43, 89075 Ulm, Germany; e-mail: felix.flock{at}medizin.uni-ulm.de.

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.

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

LEVEL OF EVIDENCE: II-3