An unexpected late complication of retropubic midurethral sling: vaginal obliteration

A 63-year-old postmenopausal woman presented with urgency. She had a midurethral operation for stress urinary incontinence 4 years previously. She had no sexual intercourse for 8 years. Examination revealed a short and atrophic vagina, firm adhesion of the anterior and posterior vaginal wall at the proximal 2 cm from the external urethral meatus with no vaginal passage opening (Fig. 1). No mesh extrusion was observed in the vagina. No mesh was observed in the bladder or rectum on cystoscopy and rectoscopy. Magnetic resonance images were obtained (Figs. 2 and 3). We proposed surgery to release the vaginal obliteration but she refused the procedure owing to the risk of bowel and bladder perforation, the asymp-