Table 1: Literature on arterial injury following synthetic midurethral slings and embolization.
Case (*) | Author | Symptoms presented (hours/days) | Presenting symptoms and signs | Arterial injury | Size of hematoma | Blood transfusion | Assessment | Management | Follow-up |
---|---|---|---|---|---|---|---|---|---|
1 | Elard, et al. [5] | Two days | Anemia | Inferior vesical artery | - | Yes | CT, angiography | Embolization | Postoperative course uneventful |
2 | Zorn KC [6] | Six hours | Bradycardia Hypovolemia | Obturatorartery | 13.9 cm × 8.5 cm | Yes 4 units of packed red blood cells | Laparoscopic evaluation angiography | Embolization(coils) | Postoperativecourse uneventfulImprovement in stress incontinence |
3 | Takatera H, et al. [7] | Three hours | Lower abdominal pain, abdominal distension and nausea | - | 16 cm × 12 cm × 11 cm | No | CT, angiography | Embolization (gel foam, coils) | Postoperative course uneventful No surgical removal of hematoma |
4 | Jung, et al. [8] | One hour | Lower abdominal pain, abdominal distension and nausea. Bradycardia | Internal pudendalartery | 10 cm × 9 cm ×8 cm | No | CT, angiography | Embolization(gel foam) | Postoperative course uneventful Two years follow-up: No stress urinary incontinence Mild urge incontinence |
5 | Huffaker RK [9] | Two hours | Hypotensive Anemia, Palpable suprapubic mass | Obturatorartery + collaterals | - | Yes 2 units of packed red blood cells | Angiography | Embolization (coils +(gel foam) | Discharge on day 2 with Foley catheter. Feeling well one week postoperatively |
6 | Ku CH [10] | - | - | - | - | - | - | - | - |
7 | Krynytska I [11] | Two hours | Severe vulval pain | Obturatorartery | - | Yes 2 units of packed red blood cells | Angiography | Embolization(coils) Subsequent evacuation of hematoma, general anaesthesia (Reduce pain, infection) | Folley catheter removed on day 10 Tenderness up to six months No stress urinary incontinence, bladder overactivity or voiding dysfunction |
8 | Ko JK [12] | One day | Perineal pain, Oozing from vagina | Internal pudendalartery | 7 cm | Yes 4 units of packed red blood cells | CT, angiography | Embolization (coils + gel foam) | Discharge on day 3. Vaginal spotting and pain on day 7, edematous and fragile tissue on anterior vaginal wall. No significant bleeding. Wound completely healed at day 21. No further symptoms. |
9 | Cho EJ [13]Case A | One day | Abdominal pain Voiding difficulty | Upper vaginal branch of iliac int. | - | Yes 2 units of packed red blood cells | Laparotomy Angiography | Removal of hematoma laparotomy Unknown bleeding focus Subsequent embolization(gel foam) | Discharge on day 4 Presentation on day 12 with lower abdominal pain. Computed tomography-reduction of hematoma Improvement of stress incontinence on three months follow up |
Case B | Perioperatively | Lower abdominal pain | Inferior epigastric artery | 10 cm | Yes 8 units of packed red blood cells | CT, LaparotomyAngiography | Removal of hematoma laparotomy Unknown bleeding focus Subsequent embolization (microcoil + gel foam) | Discharge on day 5 Presentation on day 7 with lower abdominal pain. Computed tomography showed a size of residual hematoma of 7 cm. On day 13, no further symptoms |
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Case C | Intraoperatively | Intraoperative bleeding from Incision in suburethra | Anterior trunk of iliacartery | Yes 8 units of packed red blood cells + 4 fresh frozen plasma | Angiography | Embolization (gel foam) | Discharge and Folley catheter removed on day 7 without any complications. |