It was reported to boston scientific corporation that an advantage system device was implanted into the patient during a transvaginal tape placement procedure performed on (b)(6) 2012, for the treatment of stress incontinence.No complications were observed during the procedure, and the patient was transferred to the recovery room in stable condition.The patient underwent a biopsy on (b)(6) 2022, to address a bothersome mass in her urethra resulting from a urethral diverticulum.Despite inconclusive imaging, examination in the clinic revealed purulent discharge and mass compression.The patient opted for surgical exploration to confirm the suspected diagnosis.During the examination, the doctor noticed a larger and firmer mass on the side of the urethra.This mass had shifted towards the right from its previous position in the middle.Trying to compress the mass did not reveal any functions, and there was no sign of pus in the mass or urethra.Moreover, a fistula had developed between the urethra and vagina since the last check-up.The opening of the fistula was about 1-2 cm higher than the urethral meatus, and the mucosa was highly friable.To confirm the fistula, a 19 french cystoscope was inserted into the urethra.The doctor thoroughly examined the bladder but found no abnormalities.During the pullback, it was confirmed that the patient had a urethral vaginal fistula.Moreover, the patient tolerated the procedure well.On (b)(6) 2022, the patient underwent a partial excision of the tension-free vaginal tape, urethrovaginal fistula repair with placement of martius flap, harvesting of martius labial flap from the left labia, and cystoscopy with suprapubic catheter placement due to eroded tension-free vaginal tape with urethrovaginal fistula.During the procedure, the sling was clamped on both sides, then divided in the middle and some adherent tissue was released from each side of the sling.The physician aimed to preserve some of the lateral attachment of the sling on each side to help with future continence.After that, the sling was excised on both sides, removing approximately 2 cm of it.Following that, the physician inspected the tissues of the fistula and found some not-so-healthy-looking tissue that needed to be excised.The fistula was then closed transversely by reapproximating the proximal to distal edges using continuous 4-0 monocryl.In addition, the patient tolerated the procedure well.
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