A 50-year-old woman undergoes a transobturator mid-urethral sling for stress urinary incontinence. Compared with a retropubic (tension-free vaginal tape) approach, which complication is characteristically more associated with the transobturator route?

• A Bladder perforation during trocar passage
• B Groin and thigh pain ✓
• C Voiding dysfunction requiring catheterisation
• D Major vascular injury

Explanation

The transobturator trocar traverses the adductor muscles and obturator region, so groin, thigh and labial pain is the complication more typical of this route. The retropubic route passes blindly behind the symphysis pubis, which explains its higher rates of bladder perforation, major vessel injury and postoperative voiding difficulty compared with the transobturator approach. Both routes have comparable subjective cure rates for uncomplicated stress incontinence with urethral hypermobility.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.