CASE 1: a 64 years old patient with traumatic failure of RP-TVT. In 2012 a RP-TVT was applied for SUI. The patient fell to the ground six months ago and complained again stress urinary incontinence. US show the left arm of RP-TVT collapsed and surrounded by edema (fig. 9). Pelvic floor MRI was performed three months after and the edema was resolved. The left arm still appear disrupted (fig. 10 and fig.11) , while the right arm was normal in fig.12.

CASE 2: a 70 years old patient with recurrent urinary incontinence (in 1998 osteosynthesis was performed with gamma-nail for femural neck fracture; in 2008 intraurethral Macroplastique bulking was done with subsequent left paraurethral abscess; in 2012 TO-TVT was applied).

Fig. 13 and 14: on the right side Macroplastique extends properly along the urethra (red arrow), while on the left a small residual component is seen (yellow arrow). In fig. 15 the red asterisk indicates external and internal obturator muscles, while in fig. 16 the red asterisk points out obturator fat hernia. In fig. 17 only the right arm of TO-TVT is properly seen closed to obturator muscles. In fig. 18 coronal view shows the normal right arm of TO-TVT (red asterisk), while the left arm is almost collapsed (red hexagon). As also seen in the previous images, the external and internal obturator muscles are hypothrophic and the fig. 19 the tendineous arc is deflected. This damage of supportive musculo-tendineous structures may have contributed to TO-TVT failure.  

CASE 3: a 62 years old women who undewent (2014) to an anterior elevate (MESH) for anterior prolapse. In 2012 a RP-TVT was removed because of for vaginal erosion. In this fat-sat image a large area of bone marrow edema (red arrow) is still seen at the left superior pubis ramus where the left arm of the RP-TVT were inserted (fig. 20).

In fig. 21 and in fig. 22 both arms of the anterior elevate extend from urethra and vaginal walls to the ischiatic spines (fig. 23).

CASE 4: a 46 years old patient underwent to TO-TVT for SIU in 2012 with secondary urinary retention. An attempt of loosening of the tape was done. After that the urinary incontinence recurred (2014) and an unsuccessful intraurethral injection of bulking agents was performed. Ultrasounds show deflection of the right arm of TO-TVT (fig. 24), while in fig. 25 the left arm is still appreciable at MRI. In fig. 26, fig. 27, fig. 28 and fig. 29 the tendinous arc and the levator ani muscle are scarcely noticeable (red arrows) and intraurethral bulking injection is showed (red star).