
M. Lucky et al. / Open Journal of Obstetrics and Gynecology 2 (2012) 289-290
290
vascular compromise or paresthesia. Her white cell count
and inflammatory markers remained normal, and there
was no evidence of localised cellulitis. She remained
afebrile.
A MRI scan showed abnormal oedema within the an-
tero-inferior aspect of the right obturator internus muscle.
No haematoma or abscess was seen. A decision was
made to return to theatre to remove part of the tape. The
lateral end of the tape on the right side was subsequently
removed through the original incision, without complica-
tion under general anaesthetic. There was no evidence of
infection at the time of or following the procedure. The
remainder of the tape was left in place. Upon recovery,
the patient immediately reported a dramatic cessation of
pain. The following day she was mobilizing well and she
was discharged 4 days after the original TOT procedure.
Her stress urinary incontinence returned a few days later.
She has subsequently had a successful colposuspension.
3. DISCUSSION
The TOT procedure is a safe and effective treatment op-
tion for women suffering with stress incontinence, asso-
ciated with a very low risk of complications [5]. The
procedure can be done under general or local anaesthetic.
The patient is placed in exaggerated lithotomy position
with thighs in hyperflexion and slight abduction. A
Foley’s catheter is placed in the urethra. Two small inci-
sions are made in the inferior part of the obturator for a-
men at the level of the clitoris. A 2 - 3 cm incision is
made in the midline of the vagina just under the mid-
urethra, allowing the mesh tape to be placed under the
urethra in the correct position. Blunt dissection is made
in the direction of the ischiopubic rami. A curved tun-
neler is then used to place the mesh. The distal segment
of the tunneler is manipulated to pass through the obtu-
rator membrane. The mesh is then passed through the
adductor brevis, obturator externus then obturator inter-
nus, using a pronating motion. The tunnelers carrying the
mesh are brought out through the skin incision in the
groin area. The mesh is then placed under the urethra
ensuring it is tension free. Excess tape is trimmed and
incisions are sutured.
We believe that this case report is the first to highlight
a possible complication of non-infective myositis result-
ing from the TOT procedure. In this case there was no
reason to suspect surgical error. The operation was car-
ried out by an experienced urologist who had done many
of these procedures before and there were no unexpected
problems. The symptoms experienced by the patient
could possibly be explained by the course of the tape
through the various anatomical structures resulting in
inflammation or irritation of muscle tissue. This case is
useful from an educational point of view in highlighting
a potential complication of this otherwise safe procedure.
This case also demonstrates that in patients with unila-
teral symptoms, not associated with infection, it may
only be necessary to remove part of the tap e thereby still
leaving a chance that the patient’s stress incontinence
may be improved in spite of further intervention.
4. CONCLUSION
It is important that should a patient suffer with any
neurological type symptoms following a TOT procedure
that imaging in the form of CT or MRI should be done
urgently to assess further, with a low threshold for re-
moving the entire or part of the tape.
REFERENCES
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