Tension-free vaginal tape手術後に後腹膜血腫を合併した腹圧性尿失禁

Retroperitoneal hematoma complicated in a patient undergoing tension-free vaginal tape for urinary incontinence

39歳，女性。腹圧性尿失禁に対しtension-free vaginal tape手術を施行。術中，左穿刺針刺入部から出血したが縫合止血し，手術は問題なく終了した。しかし，術後血圧低下と下腹部痛が出現し，CTにて骨盤腔内血腫を確認した。止血用バルーンカテーテルによる経尿道的牽引が有効であり，以後回復は良好だったが，1,000mlの輸血を要した。経腟式尿失禁手術ではレチウス腔内の操作は盲目的であり，骨盤内出血の可能性を念頭におくべきであると思われた。

A 39-year-old woman underwent tension-free vaginal tape procedure for surgical treatment of genuine stress incontinence.The operative cource was uneventful except for hemorrhage from the left needle site which was well controlled by hemostat sutures.But postoperatively,lower abdominal pain and hypotension developed.CT scan demonstrated left pelvic hematoma.Transurethral traction by hemostat balloon catheter was effective and the patient recovered well,but 1,000ml transfusion was required.Caution should be employed for intrapelvic hemorrage in the transvaginal incontinence surgerys because of their blind manipulations through the Retzius's cavity.