The role of TVT position in relation to the pubic symphysis in eliminating the symptoms of stress urinary incontinence and urethral funneling

Abstract

The introduction of suburethral sling was a breakthrough in the treatment of stress urinary incontinence in women. The method is highly effective. However, the mechanism of action of a sling and the reasons for surgical failures are not fully understood. Aim: The aim of the study was to assess the impact of sling-pubic symphysis distance on eliminating the symptoms of stress urinary incontinence and urethral funneling. Materials and methods: The analysis included 106 patients who reported 3 to 6 months after sling placement for a follow-up visit encompassing clinical examination and standard ultrasonography. We evaluated the position of sling in relation to the pubic symphysis, urethral length, as well as urethral funneling length and width. Results: Cure criteria were met by 91 patients. Elimination of urethral funneling was achieved in 76.9% (n = 70) of cured patients. Urethral funneling was still present, yet shorter by a mean of 10.2 mm (p = 0.02) than before surgery in the remaining cured patients. There was a 32.5% reduction in the mean relative length of urethral funneling (p = 0.002). No significant differences were found in the pre- and postoperative funneling width. The tape-pubic symphysis distance was lower in cured women: 23.2 mm vs. 26.1 mm in failed women (p = 0.04). Similar observations were made for cured patients with persistent urethral funneling vs. failed patients (22.47 mm vs. 26.0 mm, p = 0.027). There were no differences between cured patients without urethral funneling and cured patients with persistent postoperative funneling (23.5 mm; 22.5 mm; p = 0.417). Conclusions: Tape position in relation to the pubic symphysis is important for the elimination of stress urinary incontinence. Sling location closer to the pubic symphysis reduces the length of urethral funneling, but has no effects on its width in cured patients with persistent postoperative funneling.

Are Transperineal Ultrasound Parameters Useful to Predict Incontinence in Patients with Single-Incision Mini-Slings?

“…Two of the most commonly used measures of MUS compression in the literature are: the pubic symphysis–tape gap [ 6 , 18 , 19 , 20 , 21 ] and the tape–urethral lumen distance [ 4 ]. Although we do not have a cut-off point to define SUI in the gap between the pubic symphysis–tape, we should mention that patients with SUI present a larger pubic symphysis–tape gap than continent patients [ 6 , 18 , 19 , 20 , 21 ]. Measurements of this gap for continent patients range from 10.9 mm to 20.3 mm, and for SUI patients from 13.3 mm to 26.1 mm [ 6 , 18 , 19 , 20 , 21 ].…”

“…Although we do not have a cut-off point to define SUI in the gap between the pubic symphysis–tape, we should mention that patients with SUI present a larger pubic symphysis–tape gap than continent patients [ 6 , 18 , 19 , 20 , 21 ]. Measurements of this gap for continent patients range from 10.9 mm to 20.3 mm, and for SUI patients from 13.3 mm to 26.1 mm [ 6 , 18 , 19 , 20 , 21 ].…”

“…The pubic symphysis–tape gap [ 6 , 18 , 19 , 20 , 21 ]: distance between the center of the sling and the lower edge of the pubic symphysis.…”

“…For the estimation of the statistical power, we relied on the study of Chantarson et al [ 6 ], using the parameter pubic symphysis–tape gap, since it is one of the most studied parameters in urethral compression in patients wearing MUS [ 6 , 18 , 19 , 20 , 21 ]. To identify a difference in the gap between the pubic symphysis–tape of 1.5 mm between asymptomatic patients (distance 10.81 ± 1.05 mm to pubis [ 6 ]) and symptomatic patients (mean distance 12.29 ± 1.25 mm [ 6 ]), with an alpha error of 5% and a power of 80%, we had to recruit 12 patients for each group.…”

Management and Follow-Up Practices of Women With Recurrent Stress Urinary Incontinence Following Transobturator Mid-urethral Synthetic Sling Procedure: A 6-Year Retrospective Monocentric University-Based Study

“…For the position of the second sling, some recent studies have revealed that the success rate of repeated suburethral sling procedures was better for slings positioned at the proximal urethra (17). Meanwhile, urodynamic stress incontinence is more likely observed in women with a greater sling-pubis gap, and sling location should be close to the symphysis pubic to reduce the length of the urethral funneling (18,19). Additionally, various parameters were always detected in the literature concerning SUI evaluation, including the distance of sling to the urethra, sling angle, and location of the sling relative to mid-urethral or bladder neck (20,21).…”