**6. Bleeding**

Primicero et al (1999) reported one lesion of the external iliac vein in a patient with TVT which had to be repaired through laparotomy; Zilbert and Farrel (2001) reported one patient with laceration of the external iliac artery and a neurovascular bundle lesion of the obturator ramus when the TVT was applied. Kuuva and Nilssons (2002) reported in 1455 patients a lesion incidence of large vessels and nerves in 2 patients (0.1%). Flock et al (2004) reported in 7 patients with TVT, blood loss quantified at 250 to 400 ml (2.1%); Abouassaly et al (2004) reported major bleeding of 500 ml in 16 women (2.5%) (16/421) with TVT. Kristensen et al (2010) in 778 patients with TVT reported hemorrhage that needed transfusion in 5 patients (0.6%), Barry et al (2011) observed that bleeding is minor in the group of patients with Monarc, 49 ml; in the TVT group it was 64 ml (p < 0.05), likewise surgical time was 14.6 min with Monarc and 18.5 min with TVT (p < 0.001). Rajendra et al (2011) reported that of 419 patients with TVT-O, 3 patients (0.8%) had a blood loss over 200 ml. Dunn et al (2004) reported 30 cases with vascular injury including 2 fatalities.

Brink (2000) reported one case of intestinal lesion that was repaired with a good outcome for the patient. Although we have minimally invasive procedures, these also pose arterial complications as Jung et al (2010) reported in a patient with TVT-secur who presented a

Surgical Complications with Synthetic Materials 249

frequency of 6.8% with MONARC (5/73). Latthe et al (2010) in a systematic review of voiding disorder it is slightly lower in the TOT group than in the TVT-O group, but it wasn't statistically significant; for TOT the OR was 0.61 (IC 95% 0.35-1.07) and for TVT-O the OR

Abouassaly et al (2004) reported infection of the supra pubic wound in one patient (0.4%).

Flam et al (2009) had a patient with necrotizing fasciitis after placement of the TVT-O; they performed extensive debridement of the affected site, a colostomy, antibiotic therapy and 8

Fig. 1. 65-year-old with urinary incontinence, underwent a multifilament transobturator sling. At 14 months follow up, she experienced severe pelvic pain and vaginal discharge. Clinical examination revealed hyperthermia to 400C, sling exposure at right vaginal sulcus and severe cellulitis in the genital-crural fold: Classification: 3C T4 S 2 and 6C T4 S3

Lee et al(2011) in four of the five patients presented with symptom of chronic vaginal discharge and these patients have a chronic infection forming a sinus tract into the vagina or

other viscus, causing symptoms years after its mesh placement.

Kristensen et al (2010) reported infection of the urinary tract in 3.1%.

was 0.81 (IC 95% 0.48-1.31

sessions of hyperbaric oxygen. Fig. 1

**9. Infection** 

lesion of the internal pudendal artery. The complication was resolved with embolization of the artery guided with angiography, the treatment was successful. Jabureck et al (2011) documented that retropubic access surgery has a high lesion incidence of paraurethral, bladder and paravesical plexus vessels and even external iliac vessels.
