Alternative method of suprapubic assistance in operative cystoscopy.

Complications of tension-free vaginal tape (TVT) procedures have become more prevalent as the procedure has become more popular for the treatment of stress urinary incontinence. A common complication of TVT slings is bladder perforation, which is estimated to occur in 0.7-24% of treated patients. While easily treated if identified intraoperatively, unrecognized bladder perforation generally requires further surgery to correct. We propose a novel minimally invasive technique using the suture passer of the Carter-Thomason CloseSure system for suprapubic assistance during cystoscopic removal of TVT mesh from the bladder. This novel approach allows for the avoidance of an open incision or a larger accessory port placed through the bladder to assist with mesh excision.

Imaging and diagnosis of postpartum complications: sonography and other imaging modalities.

Postpartum complications can be broadly divided into 4 categories: postpartum hemorrhage, obstetrical trauma, thromboembolic complications, and puerperal infections. Postpartum hemorrhage is most commonly caused by uterine atony, abnormal placentation, or genital tract trauma. Secondary causes of hemorrhage include retained products of conception and, rarely, subinvolution of the placental implantation site. Uterine dehiscence or rupture may be occult on ultrasound examination and may be better visualized on sagittal computed tomography or magnetic resonance imaging. Obstetric trauma during prolonged vaginal or cesarean delivery may lead to fistula formation, ureteral injury, or bowel injury. Later potential complications of cesarean delivery include cesarean delivery scar ectopic, endometrial implants in the cesarean scar, and placenta accreta. Thromboembolic complications can include pulmonary embolism and deep vein thrombosis as well as ovarian vein thrombosis, the latter of which can be difficult to clinically differentiate from appendicitis in the postpartum female.