Journal of minimally invasive gynecology · 2026
Delayed Distal Urethral Disruption After Transobturator Tape Placement: Diagnostic Pitfalls and Surgical Repair-A Video Case Report.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Courtois Charlotte, Curinier Sandra, Comptour Aurélie, Deshaies Anne, Chauvet Pauline, Campagne Loiseau Sandrine
Аннотация
OBJECTIVE: Transobturator tape (TOT) procedures are widely used for the treatment of stress urinary incontinence. Urethral complications are rare and may range from intraluminal sling exposure to urethrovaginal fistula. We report an exceptional case of distal urethral disruption without true fistula, revealed 6 years after TOT placement.
SETTING: Clermont Ferrand University Hospital, France. The study was approved by local Ethics Committee (IRB00013412, "CHU de Clermont Ferrand IRB #1," IRB number 2026-CF692) with compliance to the French policy of individual data protection.
PARTICIPANTS: A 70-year-old nulliparous smoker with chronic cough presented with recurrent urinary leakage of 2 years duration. Clinical examination showed a blind-ending urethral meatus. Urine leakage occurred through an anterior vaginal opening corresponding to the distal urethral outlet, while the sling was interposed between the urethral meatus and the displaced urethral lumen. Endoscopic evaluation confirmed a completely intact proximal urethra. These findings were consistent with distal urethral disinsertion and secondary ectopic urinary drainage through the vaginal defect.
INTERVENTIONS: The urethra was identified using 4 stay sutures, and the urethra was repositioned to its anatomical location following meatal dilatation. The suburethral sling was removed after dissection from the vaginal plane, with extension along both arms to the obturator fascia. The distal urethral was reapproximated to the urethral meatus using interrupted absorbable monofilament sutures.
CONCLUSION: Distal urethral disinsertion following TOT is a rare complication that may mimic urethrovaginal fistula but differs by the preservation of urethral integrity. No intraluminal urethral injury was identified, suggesting a mechanism of distal urethral disinsertion with a secondary ectopic urinary drainage rather than a true urethrovaginal fistula. The most likely mechanism is progressive urethral transection caused by chronic erosion of the sling in a patient with chronic cough, heavy smoking, and postmenopausal vaginal atrophy, contributing to impaired tissue healing. This video highlights key diagnostic features and demonstrates a reproductible surgical repair technique. Recognition of this entity is essential to guide appropriate management.
SETTING: Clermont Ferrand University Hospital, France. The study was approved by local Ethics Committee (IRB00013412, "CHU de Clermont Ferrand IRB #1," IRB number 2026-CF692) with compliance to the French policy of individual data protection.
PARTICIPANTS: A 70-year-old nulliparous smoker with chronic cough presented with recurrent urinary leakage of 2 years duration. Clinical examination showed a blind-ending urethral meatus. Urine leakage occurred through an anterior vaginal opening corresponding to the distal urethral outlet, while the sling was interposed between the urethral meatus and the displaced urethral lumen. Endoscopic evaluation confirmed a completely intact proximal urethra. These findings were consistent with distal urethral disinsertion and secondary ectopic urinary drainage through the vaginal defect.
INTERVENTIONS: The urethra was identified using 4 stay sutures, and the urethra was repositioned to its anatomical location following meatal dilatation. The suburethral sling was removed after dissection from the vaginal plane, with extension along both arms to the obturator fascia. The distal urethral was reapproximated to the urethral meatus using interrupted absorbable monofilament sutures.
CONCLUSION: Distal urethral disinsertion following TOT is a rare complication that may mimic urethrovaginal fistula but differs by the preservation of urethral integrity. No intraluminal urethral injury was identified, suggesting a mechanism of distal urethral disinsertion with a secondary ectopic urinary drainage rather than a true urethrovaginal fistula. The most likely mechanism is progressive urethral transection caused by chronic erosion of the sling in a patient with chronic cough, heavy smoking, and postmenopausal vaginal atrophy, contributing to impaired tissue healing. This video highlights key diagnostic features and demonstrates a reproductible surgical repair technique. Recognition of this entity is essential to guide appropriate management.