Delayed diagnosis of vascular injury with a retropubic midurethral sling

Background: Retropubic midurethral slings are the mainstay of treatment for female stress urinary incontinence. Complications of this approach may have long-term implications. Case: A 55-year-old woman underwent tension-free vaginal tape (TVT) placement. Five years later back pain and gross hematuria prompted cystoscopy and diagnosis of bladder mesh erosion. During surgery to remove the mesh, the left arm of the mesh was found to be through the external iliac vein. The right mesh arm traversed the bladder, laterally around the obturator nerve and right iliac vein, exiting through the peritoneal cavity. Conclusion: Neurovascular injury is a rare but serious consequence of TVT. Delayed diagnosis is possible. This case highlights the importance of using recognized landmarks and established surgical technique for TVT placement.