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Case Report
Severe affection of the obturator nerve in a young patient after tension free vaginal sling placement: Case report of a rare complication and review of the literature
1 Consultant, Department of Ob/Gyn, APK Clinics, Wiesbaden, Germany
2 Head of Department, Department of Ob/Gyn, St. Josefs-Hospital, Wiesbaden, Germany
Address correspondence to:
Vera Joser
Asklepios Paulinen Klinik, Geisenheimer Straße 10, 65197 Wiesbaden,
Germany
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Article ID: 100146Z08VJ2023
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How to cite this article
Joser V, Gabriel B. Severe affection of the obturator nerve in a young patient after tension free vaginal sling placement: Case report of a rare complication and review of the literature. J Case Rep Images Obstet Gynecol 2023;9(1):53–58.ABSTRACT
Introduction: Stress urinary incontinence affects up to 50% of women at some point in their lives. Tension-free vaginal mid-urethral sling procedure should be offered as a primary surgical treatment option to women with stress urinary incontinence.
Case Report: We report on the case of a 47-year-old patient presenting with heavy buttock and thigh pain, a severe walking disability necessitating the use of a walker after implantation of a retropubic sub-urethral sling (TVT-SERASIS) for the treatment of stress urinary incontinence in an external hospital. During the surgery in our hospital, it was revealed that the sling was placed incorrectly, charging the bladder wall as well as the left obturator nerve. We describe the diagnosis and operative management of this rare, but serious complication.
Conclusion: Our case provides supporting evidence for the limited value of imaging tools and the need of a surgical exploration under certain circumstances. In addition, we emphasize that removal of a sub-urethral sling should be performed under laparoscopic visualization when serious adverse events occur. Sub-urethral sling placement should be executed by experienced, dedicated pelvic floor surgeons.
Keywords: Complications, Mid-urethral sling (MUS), Obturator nerve injury, Stress urinary incontinence
SUPPORTING INFORMATION
Author Contributions
Vera Joser - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Boris Gabriel - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Vera Joser et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
