The tension-free vaginal tape (TVT) procedure is an effective treatment for stress urinary incontinence (SUI). Despite the minimally invasive nature of this procedure, serious complications can occur. Encapsulation and infection seven years after operation is a rare complication. Different imaging techniques can be used to aid diagnosis;  Computer Tomography (CT), Positron Emission Tomography (PET)  and a computed tomography (CT) scan (PET-CT), Magnetic Resonance Imaging (MRI), 2D and 4D perineal ultrasound as well as 3D vaginal ultrasound are the imaging techniques used to aid diagnosis. Out of the given modalities, the ultrasound was perceived the most accurate in diagnosis and mapping TVT. This video film shows how  pelvic floor  ultrasound was used in preoperative diagnosis and postoperative follow up of an TVT which became infected and a fistula tract opened into vagina. Computerized  Tomography (CT) Magnetic Resonans Imaging showed no fistulizing in vagina. Out of the given modalities, the 2D and 3D pelvic floor ultrasound was perceived to be the most accurate and most patient friendly for preoperative diagnosis and postoperative followup in this case.

Case: A healthy 55 years old, para 2  had been operated with retropubic  (TVT) for Mixed Urinary Incontinence 2011 with good result. She underwent robot assisted total hysterectomy and bilateral salpingo-oophorectomy 2018. Six months post-operatively debut of foul smelling, thin vaginal discharge and pelvic discomfort. CT scan and MRI did not show a fistula. She was referred to a tertiary care center with the continued clinical suspicion of vesicovaginal or urethovaginal fistula. 3 pad dye test was negative, and Urethrocystoscopy was normal. Vaginal speculum examination showed no tape erosion, but an indurated, retracted 2-3 mm opening 2 centimeter proximal from hymen in the left vaginal sulcus. Upon pressure serous fluid discharge was observed.  2D and 3D ultrasound showed fluid filled column surrounding the TVT and a fluid filled tract from the infected tape to the left vaginal sulcus. 
Positron Emission Tomography  and a computed tomography (PET CT) scan showed increased signal along the infected tape.  Culture was positive for Streptococcus agalactie. Patient went through total removal av tape through the vaginal and laparoscopic route.

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Four weeks post- operatively the patient had no vaginal discharge or discomfort. Culture from the removed tape was positive for Streptococcus contellatus and Bacteroides fragillis. Post-operative ultrasound showed no tape rest, minimal column of fluid on the right side of urethra, no fistula track opening into the left vaginal sulcus. The patient had no urinary incontinence or bladder emptying problems.

In the diagnosis of TVT complications MRI can be helpful. PET computed tomography can detect infected tapes. However 2D perineal ultrasound as well as 3D vaginal ultrasound was found more patient friendly , economical and accurate in comparison to  CT, MRI and PET CT imaging techniques in the diagnosis and post-operative follow up of this TVT complication.