The Role of Pelvic Ultrasound in Evaluating the Success of Tension-free Vaginal Tape (TVT)

Abstract

S tress urinary incontinence (SUI) is characterized by the unintentional release of urine triggered by a sudden elevation in intra-abdominal pressure, such as coughing or sneezing. [1,2] SUI significantly affects the physical and mental health as well as the quality of life of patients. [3] Incontinence occurs due to inadequate coaptation of the urethra caused by the loss of connective tissue and muscle support. The primary surgical technique recognized for treating SUI involves the insertion of a mid-urethral sling (MUS) in either the retropubic or transobturator position. In the post-surgical analysis of patients who have undergone MUS, ultrasound plays a crucial role in assessing the anatomical position of the sling, both statically and dynamically. [4] The significance of ultrasound in evaluating MUS lies in its ability to correlate the position, behavior, and symptoms during the Valsalva maneuver and post-operative complications. [5,6] Perineal ultrasound is considered the most useful imaging technique for assessing various aspects such as the Objectives: This study aims to assess the lack of response to treatment in individuals undergoing mid-urethral sling surgery for stress urinary incontinence (SUI) using ultrasound findings of the pelvic floor. Methods: The study included patients who underwent the tension-free vaginal tape (TVT) procedure for stress urinary incontinence within the period spanning from January 2016 to January 2021. The physical examination involved maintaining bladder filling at an average volume of 200-400 mL, and treatment failure was determined by the presence of SUI during the Valsalva maneuver. Results:The study comprised a total of 214 patients, where it was observed during the stress test that 32 patients (25.8%) had an unsuccessful outcome following mid-urethral sling surgery. In the unsuccessful group, the distance of the mesh-posterior urethra was lower (4.09±0.39 vs. 4.91±0.51; p<0.001), the posterior urethrovesical angle was lower when at rest, but the angle increased more significantly during the Valsalva maneuver, and the bladder neck angle was narrower (p<0.001). Conclusion:We obtained lower mean values of mesh-posterior urethral distance in unsuccessful patients compared to those found in the group of cured patients. Pelvic floor ultrasound can predict the success of TVT surgeries but there is as yet little data and there is a need to find in the near future more standard and objective parameters for the diagnosis of urinary incontinence.