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


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.


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.


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.


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.


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


Conflicts of Interest



  1. 1.
    Ulmsten U, Henriksson L, Johnson P, Varhos G (1996) An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 7:81–85CrossRefPubMedGoogle Scholar
  2. 2.
    Novara G, Artibani W, Barber M et al (2010) Updated systematic review and meta-analysis of the comparative data on colposuspensions. Pubovaginal slings and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Assoc Urol 58:218–238CrossRefGoogle Scholar
  3. 3.
    Deng D, Rutman M, Raz S, Rodriguez LV (2007) Presentation and management of major complications of midurethral slings: are complications under-reported? Neurourol Urodynam 26:46–52CrossRefGoogle Scholar
  4. 4.
    Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C (2013) Seventeen years’ follow-up of the tension free vaginal tape procedure for female urinary stress incontinence. Int Urogynecol J 24:1265–1269CrossRefPubMedGoogle Scholar
  5. 5.
    Rezapour M, Falconer C, Ulmsten U (2001) Tension-free vaginal tape (TVT) in stress incontinence women with intrinsic sphincter deficiency (ISD)—a long-term follow up. Int Urogynaecol J 12 [Suppl 2]:S12–S14CrossRefGoogle Scholar
  6. 6.
    Duckett JR, Tamilselvi JS (2005) Foley catheter tamponade of bleeding in the cave of Retzius after a tension free vaginal tape procedure. J Obstet Gynaecol 25(1):80–81CrossRefPubMedGoogle Scholar
  7. 7.
    Novara G, Galfamo A, Boscolo-Berto R et al (2008) Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials comparing tension-free midurethral tapes to other surgical procedures and difference devices. Eur Assoc Urol 53:288–309CrossRefGoogle Scholar
  8. 8.
    Yun SJ, Joon HL, Tae SS, Chang HH, Sung HK, Yong SL (2010) Arterial injury associated with tension-free vaginal tapes-SECUR procedure successfully treated by radiological embolization. Int Neurourol J 14:275–277CrossRefGoogle Scholar
  9. 9.
    Karram MM, Segal JL, Vassallo BJ, Kleeman SD (2003) Complication and untoward effects of the tension-free vaginal tape procedure. Obstet Gynecol 101:929–932CrossRefPubMedGoogle Scholar
  10. 10.
    Vierhout MW (2001) Severe haemorrhage complicating tension-free vaginal tape (TVT): a case report. Int Urogynecol J 12:139–140CrossRefGoogle Scholar
  11. 11.
    Pushkar DY, Godunov BN, Gvozdev M, Kasyan GR (2011) Complications of mid-urethral slings for treatment of stress urinary incontinence. Int J Gynecol Obstet 113:54–57CrossRefGoogle Scholar
  12. 12.
    Rezapour M, Ulmsten U (2001) Tension-free vaginal tape (TVT) in women with recurrent stress urinary incontinence—a long-term follow-up. Int Urogynecol J 12 [Suppl 2]:S9–S11CrossRefGoogle Scholar
  13. 13.
    Flock F, Kohorst F, Kreienberg R, Rich A (2013) Retziusscopy: a minimal invasive technique for the treatment of retropubic haematomas after TVT procedure. Eur J Obstet Gynaecol Reprod Biol 158:101–103CrossRefGoogle Scholar
  14. 14.
    Zorn KC, Daigle S, Belzile F, le Tu M (2005) Embolisation of a massive retropubic haemorrhage following a tension-free vaginal tape (TVT) procedure: case report and literature review. Can J Urol 12(1):2560–2563PubMedGoogle Scholar

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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