II-202 ZDRAV VESTN 2003; 72: SUPPL II
RETROPUBIČNI HEMATOM PO OPERACIJI TVT –
PRIKAZ PRIMERA
RETROPUBIC HAEMATOMA AFTER TVT OPERATION – CASE REPORT
Vladimir Weber
Ginekološko porodniški oddelek, Splošna bolnišnica Celje, Oblakova 5, 3000 Celje
Key words: stress urinary incontinence; complications after
TVT procedure
Abstract – Background. TVT operation (tension free vaginal
tape) for treating urinary stress incontinence is an effective
in time spearing intervention, which requires careful opera-
tive and postoperative procedure.
Materials and methods. Patient, 51 years old retired lady with
mild hypertension, gave two births, one abortion, receiving
HRT and was not allergic on any medication. She was descri-
bing severe stress incontinence for more than a year, pad test
was positive. Gynecological status reveals no abnormalities,
neither by palpation, nor by vaginal ultrasound examina-
tion. Lab tests were normal at the day of admission.
Next day TVT operation under local anaesthesia was perfor-
med with no difficulties during the procedure and cystoscopy
revealed no injury of the bladder or urethra.
Two hours after operation, the patient complained on in-
creasing pain retro pubicaly, her general condition was still
stabile, gynecological examination revealed an elastic resistan-
ce retro pubicaly, which was confirmed by vaginal ultrasound.
When the red blood count decreased, we decided to perform
operative reintervention. Through supra pubic extra perito-
neal approach we explored the Retzius cavity, where we fo-
und a haematoma caused by a bleeding small retro pubic
periostal artery. We stopped the bleeding by electro coagulati-
on and evacuated the haematoma. During the procedure the
patient received transfusion of two doses of concentrated red
blood cells and was stabile.
Postoperatively our patient developed no complications, on
the second day after operation, we removed the catheter, then
spontaneous micturition was established and she left our ho-
spital continent after 8 days.
Conclusions. Also after TVT operation a careful 24-hours
postoperative survey is needed.
Ključne besede: stresna urinska inkontinenca; zapleti po
TVT
Izvleček – Izhodišča. Operacija z nenapetostnim nožničnim
trakom TVT za zdravljenje urinske inkontinence je učinkovit
in kratkotrajen poseg, ki pa zahteva natančen operativni in
pooperativni postopek.
Materiali in metode. Bolnica J.B., 51 let, upokojenka, v dru-
žinski anamnezi je mati imela raka dojke, imela je blago hi-
pertonijo, na zdravila ni bila alergična, rodila dvakrat, spla-
vila enkrat, jemala je NHT . Imela je hujše inkontinenčne te-
žave stresnega tipa več kot leto dni, pad test pozitiven. Gine-
kološki status je bil palpacijsko in ultrazvočno v redu. Labo-
ratorijski izvidi so bili na dan operacije normalni.
Dan po sprejemu je sledila operacija v lokalni anesteziji, ne-
napetostni nožnični trak smo napeljali brez težav, mehur in
uretra so bili cistoskopsko brezhibni.
Dve uri po operaciji je začela bolnica tožiti zaradi bolečin v
predelu mehurja, splošno stanje je bilo sicer v redu, pri gine-
kološkem pregledu smo tipali vaginalno levo elastično resi-
stenco, ki smo jo registrirali tudi z vaginalnim UZ. Ker se je
hemogram slabšal, smo se odločili za operativno revizijo, pri
kateri smo s suprapubičnim ekstraperitonealnim pristopom
našli za pest velik hematom v Retziusovem prostoru in krva-
vitev iz periostalne arteriole na zadnji strani ravnega kraka
sramne kosti levo. Krvavitev smo ustavili s termokavterizaci-
jo in izpraznili hematom. Bolnica je dobila med posegom
transfuzijo dveh doz koncentriranih eritrocitov in je bila ves
čas stabilna. Pooperativni potek je bil gladek, bolnica je dru-
gi dan po posegu po odstranitvi katetra normalno urinirala.
8 dan smo jo odpustili kontinentno.
Zaključki. Tudi po operaciji TVT je potreben skrben, 24-urni
nadzor.