Obturator hematoma following transobturator sling

Sangeeta Ramani, Bogdan A Grigorescu, Gregory Ceus, George Lazarou
2018 Obstetrics & Gynecology International Journal  
Case A 33-year-old female gravida 4 para 4 presented to the office with complaints of urge and stress urinary incontinence since her vaginal delivery four years ago. Stress symptoms were more bothersome than urge. Her past medical and surgical history were unremarkable. On physical exam, positive Q-tip test > 35°, POPQ stage 2 anterior vaginal prolapses consistent with midline cystocele, and POPQ stage 2 posterior vaginal prolapse consistent with rectocele were noted. Urodynamic testing
more » ... stress urinary incontinence with Valsalva at maximal capacity and mild detrusor overactivity. She failed conservative management with pelvic floor exercises and declined pessary management or anticholinergics. Abstract Background: This is a rare case of hematoma formation following suburethral sling placement via the transobturator approach. Case: A 33-year-old woman presented with symptoms of urge and stress urinary incontinence. She underwent anterior and posterior colporrhaphy, and transobturator suburethral sling placement. She presented to the emergency room six days postoperatively with dizziness and mild vaginal bleeding. CT imaging revealed a 6.5 x 4.0 x 4.7cm hematoma in the left obturator region. Her symptoms subsided after conservative management. Subsequent follow-up visits showed improvement in her overall clinical status and no further intervention was required. Conclusion: Patients with small postoperative hematomas who are clinically stable and asymptomatic may be managed with appropriate pain management and imaging surveillance.
doi:10.15406/ogij.2018.09.00397 fatcat:os4c7d4zcjc27nwwxfwyme6yo4