**18.2 Treatment of intra-operative complications**

Complications due to punctures are caused by the passage of the kit's trocar, it can injure the urethra or the bladder, therefore, during the retropubic inside-out or outside-in procedure, a cystoscopy using a 700 lens should be performed in order to see the dome of the bladder and lateral walls; and a 00 to 300 lens to properly evaluate the urethra; so that under this direct view we can see whether the trocar is inside the bladder or urethra before placing the mesh. In the event the trocar punctures the bladder or urethra, it can be removed and inserted again. If there is no evidence of puncture to the urethra and/or bladder, it is now possible to place the mesh and a cystoscopy should be repeated. In the event of bladder injury, the size of the puncture should be measured and if small, a continuous drainage should be left with a Foley catheter for 48 to 72 hours. When the bladder damage is larger, a primary repair is necessary with 2 layers of absorbing suture (vicryl) and a continuous drainage using a Foley Catheter for 5 to 7 days should also be placed.

Flock et al (2011) reported 7 patients with TVT who had hemorrhage of 250ml to 400 ml that was managed with cautherization, compression or tamponade. Zorn et al (2005) recommend an exploratory laparotomy to repair the vascular damage and for proper hemostasis, or an embolization in patients who present massive bleeding after placement of the TVT; if we have this technique it provides good results.

Hubka et al (2010) recommend the patient be placed in a proper position in order to stay away from the obturator neurovascular bundle, this way, the success rate increases and the number of neurovascular damage decrease.
