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International Urogynecology Journal

, Volume 26, Issue 10, pp 1449–1452 | Cite as

The management of massive haematomas after insertion of retropubic mid-urethral slings

  • Aswini BalachandranEmail author
  • Natasha Curtiss
  • Jonathan Duckett
Original Article

Abstract

Introduction and hypothesis

The retropubic mid-urethral sling (MUS) is the most commonly performed procedure for the treatment of stress urinary incontinence and is associated with a low risk of complications. Large retropubic haematomas occur sporadically and may have life-threatening consequences. Because of their infrequent nature, there is a dearth of information regarding this serious complication. The aim of this study was to identify the incidence of large haematomas and any lessons learnt from their treatment.

Methods

A retrospective cohort study was conducted between December 1999 and June 2014. Massive haematoma was defined as a haematoma greater than 8 cm and/or a drop in haemoglobin of more than 4 g/dl. The hospital notes of all patients diagnosed with a massive haematoma were reviewed and a detailed history, operation details and the information on the management of haematoma were obtained.

Results

Seven (0.33 %) patients were identified with a massive retropubic haematoma out of a total of 2,091 retropubic MUS procedures performed. Six patients presented acutely with symptoms within 24 h. Haemoglobin levels dropped on average by 5.7 g/dl (range 2.9 to 8.6). The size of the haematoma ranged from 8 to 12 cm in diameter. Six patients required surgical drainage of the haematoma. Three patients received evacuation within 2 post-operative days. Haematomas were removed via laparotomy, vaginal drainage or suprapubic drainage.

Conclusions

Massive retropubic haematomas are uncommon but serious complications of MUS procedures. Our experience suggests that to reduce short- and long-term complications, early evacuation of massive haematomas via the suprapubic approach is recommended.

Keywords

Complications Haematoma Management Mid-urethral sling Retropubic haematoma Tension-free vaginal tape 

Notes

Conflicts of Interest

None.

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Copyright information

© The International Urogynecological Association 2014

Authors and Affiliations

  • Aswini Balachandran
    • 1
    Email author
  • Natasha Curtiss
    • 1
  • Jonathan Duckett
    • 1
  1. 1.Department of Obstetrics and GynaecologyMedway Maritime HospitalGillinghamUK

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