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Publications

Journal Article Ahead of print

PubMed: 42532202 DOI: 10.1016/j.jmig.2026.07.035

Delayed distal urethral disruption after transobturator tape placement: diagnostic pitfalls and surgical repair - a video case report.

J Minim Invasive Gynecol

Authors: Charlotte Courtois, Sandra Curinier, Aurélie Comptour, Anne Deshaies, Pauline Chauvet, Sandrine Campagne Loiseau

Affiliations

  • Department of Gynecologic Surgery, CHU Clermont-Ferrand, CHU Estaing, 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France.
  • Department of Gynecologic Surgery, CHU Clermont-Ferrand, CHU Estaing, 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France.
  • Department of Gynecological Surgery, INSERM, CIC 1405 CRECHE Unit, CHU Clermont-Ferrand, Clermont-Ferrand, France.

Abstract

OBJECTIVE

Transobturator tape (TOT) procedures are widely used for the treatment of stress urinary incontinence. Urethral complications are rare and may range from intraluminal sling exposure to urethrovaginal fistula. We report an exceptional case of distal urethral disruption without true fistula, revealed six years after TOT placement.

SETTING

Clermont Ferrand University Hospital, France. The study was approved by local Ethics Committee (IRB00013412, "CHU de Clermont Ferrand IRB #1", IRB number 2026-CF692) with compliance to the French policy of individual data protection.

PARTICIPANTS

A 70-year-old nulliparous smoker with chronic cough presented with recurrent urinary leakage of two years duration. Clinical examination showed a blind-ending urethral meatus. Urine leakage occurred through an anterior vaginal opening corresponding to the distal urethral outlet, while the sling was interposed between the urethral meatus and the displaced urethral lumen. Endoscopic evaluation confirmed a completely intact proximal urethra. These finding were consistent with distal urethral disinsertion and secondary ectopic urinary drainage through the vaginal defect.

INTERVENTIONS

The urethra was identified using four stay sutures, and the urethra was repositioned to its anatomical location following meatal dilatation. The suburethral sling was removed after dissection from the vaginal plane, with extension along both arms to the obturator fascia. The distal urethral was reapproximated to the urethral meatus using interrupted absorbable monofilament sutures.

CONCLUSION

Distal urethral disinsertion following TOT is a rare complication that may mimic urethrovaginal fistula but differs by the preservation of urethral integrity. No intraluminal urethral injury was identified, suggesting a mechanism of distal urethral disinsertion with a secondary ectopic urinary drainage rather than a true urethrovaginal fistula. The most likely mechanism is progressive urethral transection caused by chronic erosion of the sling in a patient with chronic cough, heavy smoking, and postmenopausal vaginal atrophy, contributing to impaired tissue healing. This video highlights key diagnostic features and demonstrates a reproductible surgical repair technique. Recognition of this entity is essential to guide appropriate management.

MeSH

Drainage, Fistula, Sutures, Urethra, Cough, Chronic Cough