An unusual intraoperative finding during tension-free vaginal tape surgery for stress urinary incontinence: a case report

Stress urinary incontinence is commonly managed with tension-free vaginal tape (TVT), a highly effective mid-urethral sling procedure. We report the case of a 64-year-old woman with prior left inguinal herniorrhaphy who presented with urodynamically confirmed stress incontinence. During retropubic TVT placement, marked resistance was encountered on the left side, requiring multiple attempts before successful passage. Her postoperative course was uneventful. This unusual technical difficulty was likely related to fibrosis or mechanical interference from a prior groin mesh. The case underscores the importance of detailed surgical history and, when indicated, preoperative imaging to anticipate anatomical variations that may complicate sling placement.