# An unusual intraoperative finding during tension-free vaginal tape surgery for stress urinary incontinence: a case report

## TL;DR

A 64-year-old woman had unexpected difficulty during a stress urinary incontinence surgery due to prior hernia mesh, highlighting the need for thorough surgical history and imaging.

## Contribution

Reports a rare case of technical difficulty during TVT surgery caused by prior groin mesh, emphasizing the need for preoperative imaging.

## Key findings

- Marked resistance during TVT placement was encountered due to prior left inguinal herniorrhaphy.
- The postoperative recovery was uneventful despite the intraoperative challenges.
- The case highlights the importance of preoperative imaging to identify anatomical variations.

## Abstract

Stress urinary incontinence is commonly managed with tension-free vaginal tape (TVT), a highly effective mid-urethral sling procedure. We report the case of a 64-year-old woman with prior left inguinal herniorrhaphy who presented with urodynamically confirmed stress incontinence. During retropubic TVT placement, marked resistance was encountered on the left side, requiring multiple attempts before successful passage. Her postoperative course was uneventful. This unusual technical difficulty was likely related to fibrosis or mechanical interference from a prior groin mesh. The case underscores the importance of detailed surgical history and, when indicated, preoperative imaging to anticipate anatomical variations that may complicate sling placement.