International Urogynecology Journal

, Volume 18, Issue 3, pp 343–346 | Cite as

Urethrovaginal fistula—a rare complication after the placement of a suburethral sling (IVS)

  • Christl Reisenauer
  • Diethelm Wallwiener
  • Arnulf Stenzl
  • Franz-Erich Solomayer
  • Karl-Dietrich Sievert
Case Report


A sixty-year-old woman with stress urinary incontinence had undergone a placement of an IVS (Tyco Health Care UK) in another hospital in February 2003. Seventeen months after the procedure, she complained about a suppurative discharge from the vagina and a recurrent severe stress urinary incontinence. The gynecological examination revealed an erosion of the sling into the vagina and a large urethrovaginal fistula bordered by granuloma. After removal of the sling, the urethrovaginal fistula was closed using a vaginal flap. A subsequent conservative treatment regime with duloxetine and pelvic floor training improved the stress urinary incontinence to the patient’s satisfaction.


Vaginal erosion Urethral fistula Suburethral synthetic sling Stress urinary incontinence Duloxetine 


  1. 1.
    Ulmsten U, Petros P (1995) Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 29(1):75–82 (Mar)PubMedGoogle Scholar
  2. 2.
    Glavind K, Sander P (2004) Erosion, defective healing and extrusion after tension-free urethropexy for the treatment of stress urinary incontinence. Int Uregynecol J 15(3):179–182 (May–Jun)CrossRefGoogle Scholar
  3. 3.
    Lim YN, Rane A (2004) Suburethral vaginal erosion and pyogenic granuloma formation: an unusual complication of intravaginal slingplasty (IVS). Int Urogynecol 15(1):56–58 (Jan–Feb)CrossRefGoogle Scholar
  4. 4.
    Biertho I, Dallemagne B, Dewandre JM, Markiewicz S, Monami B, Wahlen C, Weerts J, Jehaes C (2004) Intravaginal slingplasty: short term results. Acta Chir Belg 104(6):700–704 (Nov–Dec)PubMedGoogle Scholar
  5. 5.
    Baessler K, Hewson AD, Tunn R, Schuessler B, Maher CF (2005) Severe mesh complications following intravaginal slingplasty. Obstet Gynecol 106(4):713–716 (Oct)PubMedGoogle Scholar
  6. 6.
    Siegel AL, Kim M, Goldstein M, Levey S, Ilbeigi P (2005) High incidence of vaginal mesh extrusion using the intravaginal slingplasty sling. J Urol 174(4.1):1175–1176 (Oct)Google Scholar
  7. 7.
    Kuuva N, Nilsson CG (2002) A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 81:72–7713PubMedCrossRefGoogle Scholar
  8. 8.
    Lohse C, Weil A (2002) A rare complication with TVT: vaginal protusion of the tape. Int Urogynecol J 13:330–331CrossRefGoogle Scholar
  9. 9.
    McLennan MT (2004) Transurethral resection of transvaginal tape. Int Urogynecol J 15:360–362CrossRefGoogle Scholar
  10. 10.
    Madjar S, Tchetgen M-B, Antwerp AV, Abdelmalak J, Rackley RR (2002) Urology 59:601PubMedCrossRefGoogle Scholar
  11. 11.
    Lieb J, Das AK (2003) Urethral erosion of tension-free vaginal tape. Scand J Urol Nephrol 37(2):184–185PubMedCrossRefGoogle Scholar
  12. 12.
    Haferkamp A, Steiner G, Müller SC, Schumacher S (2002) Urethral erosion of tension-free vaginal tape. J Urol 167:250PubMedCrossRefGoogle Scholar
  13. 13.
    Vassallo BJ, Kleemann SD, Segal J, Karram MM (2003) Urethral erosion of a tension-free vaginal tape. Obstet Gynecol 101:1055–1058PubMedCrossRefGoogle Scholar
  14. 14.
    Wai CY, Atnip SD, Williams KN, Schaffer JI (2004) Urethral erosion of tension-free vaginal tape presenting as recurrent stress urinary incontinence. Int Urogynecol J 15:353–355Google Scholar
  15. 15.
    Merlin T, Arnold E, Petros P, MacTaggart P, Tulloch A, Faulkner K, Maddern G (2001) A systematic review of tension-free urethropexy for stress urinary incontinence: intravaginal slingplasty and tension-free vaginal tape procedures. BJU Int 88:871–880PubMedCrossRefGoogle Scholar
  16. 16.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A (2002) Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21(2):167–178PubMedCrossRefGoogle Scholar
  17. 17.
    Niknejad K, Plazak LS III, Staskin DR, Loughlin KR (2002) Autologous and synthetic urethral slings for female incontinence. Urol Clin North Am 29:597–6112PubMedCrossRefGoogle Scholar
  18. 18.
    Amid PK (1997) Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1:15–21CrossRefGoogle Scholar
  19. 19.
    Slack M, Sandhu JS, Staskin DR, Grant RC (2006) In vivo comparison of suburethral sling materials. Int Urogynecol J Pelvic Floor Dysfunct 17(2):106–110PubMedCrossRefGoogle Scholar
  20. 20.
    Falconer C, Soderberg M, Blomgren B, Ulmsten U (2001) Influence of different sling materials on connective tissue metabolism in stress urinary incontinent women. Int Urogynecol J 12(Suppl 2):19–23CrossRefGoogle Scholar
  21. 21.
    Amundsen CL, Flynn BJ, Webster GD (2003) Urethral erosion after synthetic and nonsynthetic pubovaginal slings: differences in management and continence outcome. J Urol 170:134–137PubMedCrossRefGoogle Scholar
  22. 22.
    Bafghi A, Benizri EI, Trastour C, Benizri EJ, Michiels J-F, Bongain A (2005) Multifilament polypropylene mesh for urinary incontinence: 10 cases of infections requiring removal of the sling. BJOG 112(3):376–378PubMedCrossRefGoogle Scholar
  23. 23.
    Sievert KD, Stenzl A (2005) A randomized controlled trial of duloxetine alone, pelvic floor muscle training alone, combined treatment and no active treatment in women with urinary stress incontinence. Int Braz J Urol 31(2):175–177 (Mar–April)CrossRefGoogle Scholar
  24. 24.
    van Kerrebroeck P, Abrams P, Lange R, Slack M, Wyndaele JJ, Yalcin I, Bump RC (2004) Duloxetine Urinary Incontinence Study Group. Duloxetine versus placebo in the treatment of European and Canadian women with stress urinary incontinence. BJOG 111(3):249–257 (Mar)PubMedCrossRefGoogle Scholar
  25. 25.
    Anderson K-E, Appel R, Cardozo L, Chappel C, Drutz H, Fourcroy J, Nishizawa O, Vela Navarette R, Wein A (2005) Pharmacological treatment of urinary incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. Health Publication, Plymouth, Massachusetts, pp 809–854Google Scholar
  26. 26.
    Abrams P et al and The Members of the Committees (2005) 3rd International Consultation on Incontinence. Recommendations of the International, Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. Health Publication, Plymouth, Massachusetts, pp 1589–1630Google Scholar

Copyright information

© International Urogynecology Journal 2006

Authors and Affiliations

  • Christl Reisenauer
    • 1
  • Diethelm Wallwiener
    • 1
  • Arnulf Stenzl
    • 2
  • Franz-Erich Solomayer
    • 1
  • Karl-Dietrich Sievert
    • 2
  1. 1.Department of Obstetrics and GynecologyUniversity of TuebingenTuebingenGermany
  2. 2.Department of UrologyUniversity of TuebingenTuebingenGermany

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