A 59-year-old woman underwent conservative treatment for four vaginal delivery, obese, with hormone replacement therapy.
Located Burch procedure, performed during 2003 by laparoscopy in another hospital.
On that occasion, surgery was indicated due to urinary incontinence diagnosed clinically, without urodynamic study.
Failure of the surgery evidenced from the immediate postoperative period.
At the time of consultation in our unit, in May 2006, symptoms of urinary incontinence were clinically detected against minimal efforts and emergency components.
The presence of stenosis was ruled out and urethral hypermobility was confirmed by Q-Tip-Test (quantification Tip Test).
Urodynamic study showed stress urinary incontinence type II and bladder without obstruction elements.
A TVT-O with classic technique was performed, however when the needle was passed on the right side, urine output stained with blood was observed through the urethral catheter.
For this reason a review cystoscopy was performed, which showed a deviation of the urethra to the right and the presence of the tape within the most proximal portion (close to the bladder).
The tape was removed under cystoscopy vision, verifying the retraction of the perforation in the urethral wall and absence of active bleeding.
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The tape was placed again, repeating the technique, with the precaution of completely removing the bladder and moving away as far as possible from the urethra.
A silicone catheter was left for 48 hours.
Stress urinary incontinence symptoms disappeared and Tolterodine 2 mg daily was indicated later for bladder symptoms.
In the first postoperative control, the presence of tape in the sub-middle-urethral portion was verified.
The patient has completed one year of follow-up and remains asymptomatic.
