Sonographic findings in a case of voiding dysfunction secondary to the tension-free vaginal tape (TVT) procedure

The tension-free vaginal tape (TVT) procedure was introduced as a minimally invasive surgical technique for treating female stress urinary incontinence. This procedure is supposed to be associated with less postoperative voiding dysfunction because the vaginal tape, theoretically, remains tension-free. Nevertheless, significant voiding dysfunction or complete urinary retention has been reported to complicate 2.8% to 7.6% of TVT procedures. We report a case of voiding dysfunction following a TVT procedure. Two-dimensional sonography revealed the tape situated beneath the mid-urethra. The spatial orientation between the vaginal tape and the urethral structure was clearly demonstrated on three-dimensional scanning. The urethra was indented from the posterior by the vaginal tape, resulting in acute constriction of the hypoechogenic region of the urethra. Urethral dilation was performed using Hegar dilators. Thereafter, the patient's voiding difficulty improved dramatically and the residual urine volume decreased. One week later, repeat sonography showed the hypoechogenic region of the urethra to have a normal configuration with a lesser degree of urethral indentation.