We describe a case of sudden complete urinary incontinence 20 days after pelvic floor surgery and mid-urethral sling operation.

An 81-year-old woman presented herself with disturbing stress urinary incontinence and symptomatic pelvic organ prolapse. 30 years before she had had an abdominal hysterectomy and presumably a colposuspension. To repair the symptomatic pelvic floor disorder the patient needed an anterior and posterior colporrhaphy, vaginal repair of enterocele and anterior rectocele. Additionally, a tension-free midurethral sling (retropubic tension-free vaginal tape) was implanted because of stress urinary incontinence. Seven days postoperatively she resumed the prophylactic intake of acetylsalicylic acid. The first follow-up 14 days after surgery showed a correct position of the sling and the patient was continent. 20 days later an acute vaginal vault hematoma and complete urinary incontinence occurred.

With insertion of a second sling the patient's urinary incontinence resolved. A late onset vaginal vault hematoma causing sling dislocation 20 days after surgery is extremely unusual.

The volume of the hematoma caused the dislocation of the retropubic tension-free vaginal tape, which resulted in complete urinary incontinence.

Once the retropubic tension-free vaginal tape is dislocated by hematoma, it might not be correctly placed anymore after its absorption.