Interventional radiology in the management of vascular complications in urogynecology: a lower-extremity hematoma after transobturator sling-case report.

BACKGROUND

Mid urethral slings are currently considered the gold standard surgical treatment for stress urinary incontinence due to their high efficacy and favorable safety profile. Although vascular complications are uncommon, they may occasionally result in clinically significant bleeding.

CASE REPORT: We report the case of a 72-year-old woman with stress-predominant mixed urinary incontinence who underwent urethrocolpopexy with placement of a transobturator mid-urethral sling, combined with anterior and posterior colporrhaphy. During the procedure, friable tissue and difficult to control inguinal bleeding were observed. In the immediate postoperative period, progressive inguinal ecchymosis extending to the mons pubis raised concern for a vascular injury, although the patient remained hemodynamically stable, asymptomatic, and without a decline in hemoglobin levels. Given the clinical suspicion, the patient's risk factors, and the technical complexity of the procedure, computed tomography angiography and diagnostic arteriography were performed, both of which excluded active bleeding or vascular lesions. Conservative management and close clinical surveillance led to spontaneous resolution of the hematoma, and the patient was discharged without further complications.

CONCLUSION

This case highlights a large lower-extremity hematoma as a rare vascular complication associated with transobturator sling surgery and emphasizes the importance of an individualized diagnostic approach. Interventional radiology may serve as a valuable diagnostic and therapeutic tool, allowing exclusion of active bleeding and avoidance of unnecessary surgical reintervention, thereby optimizing patient outcomes.