Urogynaecology / Mid-urethral tapes
Urethral injury due to the insertion of mid-urethral tapes
Yvonne had a long history of urinary incontinence, starting with the birth of her son in 1997. She underwent treatment in 1998, with urethropexy and bladder neck injection. In 2004 she presented with further urinary incontinence. In 2006 she attended theatre. A TOT procedure was planned but had to be abandoned due to a bladder perforation. She returned for the TOT procedure three months later, and subsequently reported that the incontinence was much worse. A cystoscopy revealed that mesh from the TOT was clearly visible in the urethra. A further operation removed the mesh, and she later underwent a TVT procedure which finally resolved her incontinence. Yvonne alleged that the TVT procedure was performed negligently, resulting in the TOT eroding into the urethra. PMS Expert Report concluded that the damage to the urethra was not negligent, given Yvonne's complex urogynaecological history, but that the failure to recognise the injury at the operation was. Nevertheless, causation from this negligence was minimal, due to the complications that would have resulted from discovering the injury anyway. The case was not pursued any further.
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