A Case Report of an Unusual Bladder Outlet Obstruction After Midurethral Sling Placement and Review of the Literature.

Background: Tension-free mid-urethral sling procedures are next to bulking agents, fascial slings and colposuspension a possible treatment in stress urinary incontinence with high success rates up to 90%. This is an unusual and unique case of delayed presentation of a tension-free vaginal tape (TVT) complication involving the pubic bone. It shows an unusual possible cause of bladder outlet obstruction by a reactive inflammatory myofibroblastic pseudotumor. We discuss the diagnosis and management of this unique case of bladder outlet obstruction. Case presentation: We present an exclusive case of a 66-year woman with a rare cause of bladder outlet obstruction (BOO) after midurethral sling placement for recurrent stress urinary incontinence. Nine years after successful midurethral sling (MUS) insertion with relief of incontinence symptoms, the patient complained of spraying stream and prolonged micturition. Bladder outlet obstruction caused by a large retropubic myofibroblastic pseudotumor was detected by clinical examination and MRI. After removal of the mass and part of the pubic bone a plate osteosynthesis was performed. The patient received physiotherapy and local estrogen therapy. Patients’ symptoms improved reporting non-bothering intermittent incontinence episodes. The patient showed up recently and received again physiotherapy. Conclusions: Although bladder outlet obstruction after midurethral sling placement is mainly caused by an overtightened sling other factors should be considered. [ABSTRACT FROM AUTHOR]