This case study addresses a female patient with a history of stress urinary incontinence (SUI) treated with a retropubic transvaginal tape (RP-TVT) in 2018. Approximately one year prior to the current evaluation, the patient experienced a recurrence of daytime urinary incontinence to coughing, laughing, or sneezing, alongside urgency and leakage during standing or walking. Additionally, the patient reported frequent urinary tract infections (UTIs) with typical symptoms and positive urine cultures.

The patient underwent a comprehensive evaluation, including symptomatology assessment, urinalysis, cystourethroscopy, and translabial ultrasound. The diagnostic workup aimed to elucidate the cause of urinary complaints and assess the condition of the previously placed TVT. A significant mid-urethral extrusion of the RP-TVT was confirmed, resulting in urethral extrusion and severe consequent obstruction.

Translabial ultrasound and cystourethroscopy confirmed mid-urethral extrusion of the RP-TVT, contributing to severe urethral obstruction. Uroflowmetry indicated a significantly reduced maximum flow rate (Qmax=4 ml/s). The patient's symptomatology, alongside diagnostic findings, led to a decision for surgical intervention involving vaginal suprameatal removal of the extruded RP-TVT with concomitant urethroplasty. The patient was discharged on the same day of the intervention.

The recurrence of urinary incontinence, alongside UTIs and diagnostic findings of RP-TVT urethral extrusion and stenosis, required the removal of the prosthetic sling and subsequent urethral reconstruction. This case highlights the complexity of managing complications associated with prosthetic sling procedures for SUI, emphasizing the need for individualized treatment plans and consideration of complex surgical repair that may require an alternative surgical approach. The patient was advised of the potential recurrent stress urinary incontinence, which could necessitate further urinary anti-incontinence interventions.