Chung Byung-Soo, Lee Tack, Kim Jun-Sig, Lee Hun-Jae
Department of Urology, Hallym University, KyungGi-do, Korea.
Yonsei Med J. 2005 Dec 31;46(6):874-6. doi: 10.3349/ymj.2005.46.6.874.
Occult bladder injury may sometimes go unrecognized during tension-free vaginal tape (TVT) procedures. We report a case of occult intraperitoneal bladder injury that occurred during a TVT procedure. There was no sign of bladder perforation on the initial cystoscopy, which was performed just after the insertion of the trocar. Signs of general peritonitis appeared after the patient started to void the next day. A postoperative cystogram and cystoscopy showed an intraperitoneal bladder injury and a pinhead-sized ulcerative lesion in the right lateral wall of the bladder. We suspect that at the time of initial cystoscopy, the trocar passed through the submucosal area without violating the bladder mucosa. The occult bladder injury may have been caused after the initial cystoscopy by advancing the rough edge of the prolene tape during the extraction of the trocar. This report is the first description of such an occult bladder injury during a TVT procedure.
隐匿性膀胱损伤有时在无张力阴道吊带术（TVT）过程中未被识别。我们报告一例在TVT手术过程中发生的隐匿性腹膜内膀胱损伤病例。在插入套管针后立即进行的初次膀胱镜检查中没有膀胱穿孔的迹象。患者第二天开始排尿后出现了全身腹膜炎的体征。术后膀胱造影和膀胱镜检查显示腹膜内膀胱损伤以及膀胱右侧壁一个针头大小的溃疡性病变。我们怀疑在初次膀胱镜检查时，套管针穿过了黏膜下区域而未侵犯膀胱黏膜。隐匿性膀胱损伤可能是在初次膀胱镜检查后，在拔出套管针过程中推进普理灵吊带的粗糙边缘时造成的。本报告是对TVT手术过程中这种隐匿性膀胱损伤的首次描述。
