Urethral necrosis and proximal urethro-vaginal fistula resulting from tension-free vaginal tape.

Urethral erosion is an uncommon complication after sub-urethral sling placement using the TVT procedure. Strangulation necrosis of the entire distal urethra with a fistulous connection between proximal urethra and vagina is a devastating complication that has not been previously reported, resulting in significant morbidity and the necessity for challenging management. This is a report of a 64-year-old woman with stress urinary incontinence who underwent a TVT resulting in a large fistula between the proximal urethra and the vagina, and the necrosis of the entire urethra distal to the fistula. This problem necessitated a staged reconstruction involving three separate procedures. Initially, she underwent debridement and removal of the TVT fragments, a secondary vaginal flap urethroplasty with a labial fibro-fatty graft to restore urethral length, and a tertiary coaptive occlusive sling to restore continence.