Translabial Ultrasound for Assessment of Synthetic Midurethral Sling Complications

Wermuth, Daniela Escobar; Sheridan, Alison; Oliver, Janine; Glanc, Phyllis; Khatri, Gaurav; Bagley, Anjuli R; Patel, Nayana

doi:10.1097/ruq.0000000000000545

Cited by 4 publications

(5 citation statements)

References 21 publications

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“…Studies have found that asymmetric mesh placement is more prevalent in patients who experience persistent urinary incontinence after treatment. [ 16 , 17 ] Our study observed mesh asymmetry in 77% of patients with failed mid-urethral sling surgery. Ensuring the symmetric placement of both arms of the mesh during the procedure is an important step for achieving treatment success.…”

Section: Discussionmentioning

confidence: 67%

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

Sahin

2023

Sisli Etfal

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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.

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Section: Discussionmentioning

confidence: 67%

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

Sahin

2023

Sisli Etfal

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“…In the literature, there is no unanimity in the measurement of the distance from the sling to the posterior urethral wall. Wermuth et al, in 2021 [ 17 ], in an attempt to unify these criteria, published a guide for the ultrasound assessment of suburethral slings, but continues to leave freedom for each institution to determine the extent of this parameter, some authors perform the measurement from the symphysis of the pubis [ 12 ], while others take the urethral wall as a reference. In the case of our study, we established the correct measurement as the minimum existing measurement between the edge of the sling and the posterior urethral wall and considered the cut-off point of 5 mm, according to the current literature [ 23 , 24 ], to discriminate the presence of symptomatic SUI, being the main objective of the surgery performed.…”

Section: Discussionmentioning

confidence: 99%

“…The anti-incontinence sling parameters assessable by ultrasound are [ 16 , 17 ]: Position of the sling with respect to the urethra (proximal, middle, or distal third) both at rest and in Valsalva. Distance between the sling and the posterior urethral wall is considered adequate if between 3–5 mm (in 2D transperineal).…”

Section: Introductionmentioning

confidence: 99%

Construction of a Prognostic Score for Ultrasound Evaluation of the Transobturator Sling for Stress Urinary Incontinence

Cristina

Sabonet

Rita

et al. 2022

JCM

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Currently, pelvic floor ultrasound allows us to correctly visualize the synthetic material used in stress urinary incontinence surgery. The objective of this study is the construction of a score and its correlation with the SUU clinic. During the study period, 81 patients with transobturator slings were studied using ultrasound. Through multivariate analysis, the statistically significant variables were the distance from the sling to the urethral wall (p = 0.004), the shape of the sling at rest (p = 0.003), and the symmetry of the mesh (p = 0.016). Through these variables, the construction of a score was carried out. Once the model was constructed, its internal validation was carried out to determine the discrimination capacity of patients who present clinical stress and those who do not, with an area under the curve of 0.848 (95% CI (0.72–0.97), p < 0.001). This simple score using three ultrasound variables serves to adequately and objectively discriminate patients who have successful surgery and absence of clinical effort.

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“…Ultrasound technicians received training via a formal lecture involving standardized TLUS protocol specific to MUS assessment. Translabial ultrasound was performed according to previously described standard technique 19 . All TLUS images were read independently by the previously described fellowship-trained radiologist.…”

Section: Methodsmentioning

confidence: 99%

“…Translabial ultrasound was performed according to previously described standard technique. 19 All TLUS images were read independently by the previously described fellowship-trained radiologist. Midurethral sling revision on TLUS was identified by a complete discontinuation of the hyperechoic mesh by intervening hypoechoic tissue in a segment of the MUS.…”

Section: Image Acquisition and Interpretationmentioning

confidence: 99%

Translabial Ultrasound

Clark

Wermuth

Oliver³

et al. 2022

Ultrasound Quarterly

Self Cite

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Midurethral sling (MUS) surgical procedures, in which a polypropylene synthetic mesh graft is transvaginally placed to support the urethra and manage stress urinary incontinence (SUI), is commonly performed (Urology. 2013;82(1):38-41; Radiology. 2018;289(3):728-729). Within 10 years of sling placement, about 1 in 20 women undergo subsequent surgery to revise their mesh, in which the mesh is cut or partially excised (Obstet Gynecol. 2019;133:1099-1108. Translabial ultrasound (TLUS) has been described as a sensitive technique for viewing MUS, although few studies have evaluated its ability to view surgically revised MUS (Radiology. 2018;289(3):721-727). Understanding the anatomy of the MUS is critical to urologists and urogynecologists striving to optimize management of patients presenting with lower urinary tract symptoms and history of MUS. To assess the clinical utility and reliability of TLUS as a diagnostic tool in its detection of MUS discontinuity, we conducted a retrospective analysis on patients who underwent TLUS at a tertiary care center between September 2017 and May 2020 for indication of lower urinary tract symptoms and history of MUS placement. Performance of TLUS was evaluated by comparing findings with operative or clinical records. Among the 81 women included, detection of MUS revision, which was defined as a discontinuity in sling material, had a sensitivity of 84.6% and specificity of 97.1%. Translabial ultrasound is an inexpensive, nonirradiating, and noninvasive modality that is effective at visualizing MUSs. It is a reliable identifier of previous MUS revision, in which it detects a midline discontinuity of the hyperechoic mesh with an average 10 mm gap.

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Translabial Ultrasound for Assessment of Synthetic Midurethral Sling Complications

Cited by 4 publications

References 21 publications

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

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

Construction of a Prognostic Score for Ultrasound Evaluation of the Transobturator Sling for Stress Urinary Incontinence

Translabial Ultrasound

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