Minimally invasive management of retropubic bleeding and hematoma evacuation after a TVT Secur or mini-sling procedure.

BACKGROUND: Retropubic hematomas may complicate up to 4.1% of tension-free vaginal tape (TVT) procedures in the surgical treatment of stress urinary incontinence. Symptomatic or expanding hematomas often require intervention, usually accomplished through an abdominal incision. CASE: A 43-year-old woman underwent transvaginal management of venous bleeding and evacuation of a 1500-mL retropubic hematoma after a TVT Secur or "mini-sling" procedure. CONCLUSIONS: Significant bleeding can complicate even the least invasive surgical approach to treat stress urinary incontinence. Transvaginal evacuation of a symptomatic retropubic hematoma with instillation of a hemostatic agent may be a safe alternative to laparotomy in a hemodynamically stable patient.