Agreement between simple catheter method and 3D transperineal ultrasound for assessing urethral length measurement before stress urinary incontinence treatment

CT Three-Dimensional Visualization Model in Diagnosis and Treatment of Stress Urinary Incontinence: A Retrospective Study

OBJECTIVE

To study the clinical effect of stress urinary incontinence sling surgery based on CT 3-dimensional visualization model, and to explore the value of three-dimensional visualization model in the diagnosis and treatment of stress urinary incontinence.

METHODS

Patients with stress urinary incontinence in our center from October 2020 to March 2022 were studied retrospectively. Among them, 16 cases received preoperative 3-dimensional visualization model construction, 18 cases did not use preoperative 3-dimensional model construction. The perioperative results, the postoperative results and the correlation between some related parameters of 3-dimensional visualization model and the severity of stress urinary incontinence were analyzed.

RESULTS

Compared with traditional surgery, the operation time of 3D group is significantly shorter (P < 0.05). There was no significant difference in intraoperative blood loss, perioperative fever, bleeding, micturition, pudendal or inguinal pain and postoperative symptom improvement. The posterior vesicourethral angle measured by 3-dimensional reconstruction model was correlated with ICI-Q-SF score.

CONCLUSIONS

The construction of three-dimensional visualization model of stress urinary incontinence can be used in clinic as a safe and effective new preoperative evaluation technique, and more potential applications can be further explored.

Use of intraoperative ultrasound to improve tension-free vaginal tape-obturator placement: A pilot study

OBJECTIVE

To evaluate the use of intraoperative ultrasound (IUS) to achieve a postoperative optimal placement of the tension-free vaginal tape-obturator (TVT-O).

METHODS

A cohort study was performed among women who underwent TVT-O placement. In 25 women, ultrasound was used for the placement, and based on current evidence, the optimal intraoperative and postoperative ultrasound pattern was selected. They were compared with 25 women where IUS was not used.

RESULTS

IUS increased operative time (by 7.5 min), and in 36% (9/25) of cases it was necessary to perform some corrections based on the ultrasound findings. After 1 month, in patients of the IUS group, the tapes were more frequently placed at a distance of 3-5 mm (P = 0.01), and it was more common for it to be placed between 40% and 70% relative to the urethral length (P = 0.011). Of tapes placed with IUS, 76% (met the optimal postoperative ultrasound pattern, as opposed to only 48% placed without IUS (P = 0.041). No differences were found in the complications or the functional results at 1 month post-surgery.

CONCLUSION

The use of IUS for the placement of TVT-O allows us to position them optimally and avoid erroneous placements, although IUS increases the operative time without improving the functional results and the rate of complications.

Using clinical estimate or catheter measurement of urethral mid-point result in similar retropubic mid-urethral sling position: a randomized trial

INTRODUCTION AND HYPOTHESIS

The objective was to determine whether standardized, intraoperative urethral measurement improves retropubic mid-urethral sling (RPMUS) positioning and if the intraoperative position remains stable at 2 weeks postoperatively.

METHODS

Participants undergoing a RPMUS were randomized to mid-urethral placement as per usual surgical care (no Foley catheter measurement, no-FCM) vs urethral mid-point Foley catheter measurement (FCM). The primary outcomes were RPMUS location as determined by 2D and 3D ultrasound 2 weeks postoperatively (as percentage from urethral meatus - relative to the urethral length) and intraoperatively following the RPMUS placement.

RESULTS

Forty-four women enrolled, underwent RPMUS, and provided baseline data and intraoperative ultrasound measurements; of these, 36 (82%) had interpretable intraoperative and postoperative ultrasound measurements. Demographic data were similar in the two groups. The mean RPMUS mid-point was 57 % and 55 % in measured and controls (p = 0.685); this same measurement was relatively unchanged at 2 weeks postoperatively at 57% and 54% respectively (p = 0.538). Very much and much improvement was reported on the PGI-I by 84% and 85% of participants in the FCM and no-FCM groups respectively.

CONCLUSIONS

Intraoperative RPMUS position at 2 weeks after surgery is similar to the intraoperative position. Compared with usual surgical care, intraoperative measurement of urethral mid-point with a Foley catheter did not affect RPMUS sling position.

Assessment of the Effectiveness of the Sonofeedback Method in the Treatment of Stress Urinary Incontinence in Women-Preliminary Report

Urinary incontinence is a common problem that affects postmenopausal women. This ailment has a negative impact on many aspects of life, significantly limiting everyday functioning related to professional work, physical activity or the intimate sphere. The aim of the study was to assess the effectiveness of the sonofeedback method in reducing the severity of urinary incontinence in postmenopausal women with a urinary incontinence problem. A total of 60 patients aged 45–65 with stress urinary incontinence, confirmed by a gynecologist, were qualified for the study. All persons qualified for the study were randomly assigned to study group A (n = 20), comparative B (n = 20) and control C (n = 20). Patients from group A were treated with sonofeedback of the pelvic floor muscles. In group B, the combined electrostimulation method was used with biofeedback training. Group C was a control group in which only the measured parameters were measured at the same time interval as those carried out in groups A and B. In all patients, three times: before the therapy, after the fifth procedure and after the end of the therapy, the incidence and severity of stress urinary incontinence were assessed—Gaudenz questionnaire and the intensity of urinary incontinence—a modified 1 h pad test. The obtained results have an application value giving the possibility of using effective therapy with sonofeedback in women in whom the recommended electrostimulation method cannot be used due to health and behavioral reasons.

Sonographic assessment of compression effect on urethra following transobturator MUS

INTRODUCTION AND HYPOTHESIS

The aim of this study was to investigate the relationship between compression effect exerted by the sling on the urethra using translabial ultrasound and the prognosis of sling surgery in women for stress urinary incontinence (SUI).

METHODS

We retrospectively reviewed 151 women with SUI who had undergone either a TVT-Abbrevo (n = 81) or TVT-O (n = 70) procedure. Preoperative and 12-month postoperative assessments including sonographic data, urinary symptoms and signs were compared. Objective and subjective success rates were assessed at 12 months postoperatively.

RESULTS

Overall, 140 patients (92.7%) were objectively cured and 138 patients (91.4%) were subjectively cured of SUI 12 months after the operation with no significant differences between groups (p > 0.05). After both the TVT-Abbrevo and TVT-O procedures, the shortest distance between the tape and the urethral cavity line (TU) on straining (objective cure 4.1 mm vs. 4.5 mm, subjective cure 4.1 mm vs. 4.4 mm), the changes of the angle (∆) between the two arms of the sling (objective cure 15.8° vs. 20.8°, subjective cure 16.5° vs. 21.3°) and the gap between the sling and symphysis pubis (objective cure 9.9 mm vs. 12.1 mm, subjective cure 9.8 mm vs. 12.4 mm) were significantly smaller in the success group (p < 0.05). Analysis of ultrasound measurements in women reporting success and those reporting failure of the procedure showed the ∆TU (objective cure 1.6 mm vs. 0.9 mm, subjective cure 1.6 mm vs. 1.0 mm) and the angle on straining (objective cure 93.4° vs. 89.2°, subjective cure 94.3° vs. 88.9°) to be significantly bigger (p < 0.05). However, none of the assessed sonographic variables showed any significant differences between the TVT-Abbrevo and TVT-O groups.

CONCLUSIONS

The change in distance between the tape and urethral cavity line in the center of the urethra in the mid-sagittal plane after straining is an effective indicator of the compression effect exerted by the sling on the urethra after a mid-urethral sling (MUS) procedure and may contribute to both objective and subjective cure rates postoperatively.