Delayed Vesicocutaneous Fistula 18 Years After Tension-Free Vaginal Tape: A Rare Case Report

Abstract

Background: Synthetic mid-urethral slings are widely used for female stress urinary incontinence and are generally safe. However, complications such as erosion, infection, bladder or urethral perforation, vascular or bowel injury, and postoperative voiding difficulties have been reported. Very rarely, vesicocutaneous fistulas may occur due to bladder erosion resulting from mesh-related reactions, which begin with chronic inflammation and weakening of the bladder wall, then extend to the perivesical tissues and the anterior abdominal wall, forming a fistulous tract to the skin. Case Presentation: We report a 65-year-old woman, para 4, with multiple comorbidities, including diabetes mellitus and hypertension and a history of total abdominal hysterectomy for adenomyosis 20 years earlier, who developed anterior vaginal wall prolapse and stress urinary incontinence. She underwent a tension-free vaginal tape (TVT) procedure 18 years ago. Last year, she presented with urinary leakage from her abdominal incision. Computed tomography and cystoscopy confirmed a vesicocutaneous fistula secondary to erosion of the TVT. The tape was removed, and the fistula was repaired with a layered closure of the bladder and abdominal wall. She was discharged after two days with a Foley catheter, which was removed after two weeks. Four weeks later, she presented with a recurrence of stress urinary incontinence for which we planned surgical correction later. Anterior repair and Kelly plication were performed at 6 months after removal of the tape, resulting in urinary continence. The patient was reviewed 8 weeks later and remained continent with no major complications. Conclusion: Vesicocutaneous fistula after TVT is rare but serious; chronic mesh-tissue interactions, compounded by comorbidities such as diabetes and estrogen deficiency, can lead to delayed erosion and fistula years postoperatively. This case highlights the importance of early recognition of urinary symptoms, timely surgical management, and ongoing long-term surveillance, even when initial surgery is technically successful.