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Ockrim J, Kearney R, Carolina Ochoa D, Hashim H, Van Koeveringe G, Chermansky C, Cardozo L, Wein A, Abrams P. Which parameters, related to the female urethra and pelvic floor, determine therapy selection for recurrent female stress urinary incontinence: ICI-RS 2023? Neurourol Urodyn 2024; 43:1372-1380. [PMID: 37937374 DOI: 10.1002/nau.25327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION The evidence basis for therapy selection in women who have failed primary stress urinary incontinence (SUI) surgery is limited. The ICI-RS group discussed the available data at its meeting in June 2023, particularly the anatomical characteristics as assessed using magnetic resonance imaging (MRI) and ultrasound (US) modalities, functional characteristics associated with storage and voiding urodynamic assessment, as well as the patient characteristics that might influence outcomes. This paper summarizes the evidence base that supported these discussions and offers the basis for research proposals for future groups. METHODS A literature search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was performed, and the data is presented. Research questions are based on the knowledge gaps highlighted. RESULTS Possible MRI parameters that may influence outcomes were striated urethral sphincter volume, bladder and proximal urethral funneling, pubo-urethral ligament integrity, distance of the bladder neck below the pubococcygeal line, posterior urethra-vesical angle, and bladder neck to levator ani distance. US parameters included sling distance to the urethral lumen and pubis, sling position, bladder neck mobility, and lateral arm asymmetry, twisting, or curling. Urodynamic parameters included detrusor overactivity, Valsalva leak point pressure, maximum urethral closure pressure, and bladder outlet obstruction. Important patient parameters included body mass index, age, and previous interventions. CONCLUSIONS Identifying and quantifying causative factors in patients with recurrent SUI, that allow clinicians to modify subsequent treatment choices and techniques may help reduce treatment failure and complications. Formulating algorithms is the next step in optimizing patient counseling, surgical selection, and healthcare allocation.
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Affiliation(s)
- Jeremy Ockrim
- University College London Hospital NHS Trust, University College London, London, UK
| | - Rohna Kearney
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Trust, UK
- Division of Developmental Biology & Medicine, School of Medical Sciences, University of Manchester, Manchester, UK
| | | | | | | | - Christopher Chermansky
- UPMC Magee Women's Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Alan Wein
- Desai Sethi Institute of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paul Abrams
- Division of Developmental Biology & Medicine, School of Medical Sciences, University of Manchester, Manchester, UK
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Kataoka M, Meguro S, Tanji R, Onagi A, Matsuoka K, Honda-Takinami R, Hoshi S, Hata J, Sato Y, Akaihata H, Ogawa S, Uemura M, Kojima Y. Role of puboperinealis and rectourethralis muscles as a urethral support system to maintain urinary continence after robot-assisted radical prostatectomy. Sci Rep 2023; 13:14126. [PMID: 37644075 PMCID: PMC10465550 DOI: 10.1038/s41598-023-41083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
The present study investigated the role of a urethral support system to maintain urinary continence after robot-assisted radical prostatectomy (RARP), with a focus on pelvic floor muscles, such as the puboperinealis muscle (PPM) and rectourethralis muscle (RUM). Finally, 323 patients who underwent RARP were analyzed in this study. All patients performed a one-hour pad test 1, 3, 6, 9, and 12 months after RARP to assess urinary incontinence and MRI before and 9 months after RARP to evaluate the pelvic anatomical structure. The preoperative cross-sectional area of PPM (2.21 ± 0.69 cm2) was significantly reduced by 19% after RARP (1.79 ± 0.60 cm2; p < 0.01). Positive correlations were observed between the amount of urinary leakage according to the 1-h pad test 1, 3, 6, 9, and 12 months after RARP and the change in the cross-sectional area of PPM by RARP (p < 0.01, < 0.001, < 0.001, < 0.001, and < 0.001, respectively). A positive correlation was also noted between the amount of urinary leakage 6 and 12 months after RARP and the preoperative RUM diameter (p < 0.05). The amount of urinary leakage 1, 3, 6, 9, and 12 months after RARP negatively correlated with the change in the antero-posterior diameter of the membranous urethra (MU diameter) from the static to dynamic phases during the Valsalva maneuver by cine MRI. Furthermore, the change in the MU diameter negatively correlated with the change in the cross-sectional area of PPM (p < 0.05). PPM and RUM play significant roles as a supportive mechanism to maintain urinary continence by functioning as a urethral support.
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Affiliation(s)
- Masao Kataoka
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Satoru Meguro
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Ryo Tanji
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akifumi Onagi
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kanako Matsuoka
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Ruriko Honda-Takinami
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiji Hoshi
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Junya Hata
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuichi Sato
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hidenori Akaihata
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Soichiro Ogawa
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Motohide Uemura
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yoshiyuki Kojima
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
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Ros C, Escura S, Anglès-Acedo S, Bataller E, Amat L, Sánchez E, Espuña-Pons M, Carmona F. Readjustable Sling in Women With Stress Urinary Incontinence and Hypomobile Urethra: Understanding the Mechanisms of Closure by Transperineal Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3069-3078. [PMID: 36044020 DOI: 10.1002/jum.16076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/07/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To assess the postsurgical sonographic parameters of a readjustable sling (RAS) according to urinary incontinence (UI) symptoms after surgery and compare this RAS sonographic pattern with mid-urethral slings (MUS). METHODS Observational, prospective multicenter study, including women undergoing stress urinary incontinence (SUI) surgery with RAS (Remeex®). The primary outcome was the association between UI symptoms and sonographic parameters measured by two-dimensional transperineal and high-frequency endovaginal ultrasound. We measured static parameters (bladder neck funneling, RAS position, symmetry, distance to the urethral lumen), and the movement of the sling on Valsalva. UI symptoms were measured with the postsurgical Incontinence Questionnaire-Short Form (ICIQ-UI-SF) questionnaire. We created two control groups including patients with transobturator-MUS (TOT-MUS) and retropubic-MUS (RT-MUS) to compare postsurgical sonographic parameters of RAS with MUS. RESULTS Among the 55 women with RAS included, the postoperative ICIQ-UI-SF scores were significantly higher in patients with bladder neck funneling (15.0 (3.9) vs 10.6 (6.7); P = .020) and in those with discordant movement of RAS on Valsalva (14.6 (5.7) vs 10.3 (6.7); P = .045). Compared with the 109 women with TOT-MUS and the 55 with RT-MUS, RAS was more often located in the proximal urethra and farther from the urethral lumen. CONCLUSIONS Postsurgical pelvic floor ultrasound demonstrated that in women with complex SUI and hypomobile urethra who underwent RAS (Remeex®) surgery, the presence of bladder neck funneling and discordant movement on Valsalva correlate with the persistence of UI symptoms. In these women, RAS is more often located in the proximal urethra and farther from the urethral lumen at rest in comparison with MUS.
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Affiliation(s)
- Cristina Ros
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Sílvia Escura
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Sònia Anglès-Acedo
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Eduardo Bataller
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Lluís Amat
- Pelvic Floor Unit, Hospital Sant Joan de Déu de Barcelona, University of Barcelona, Barcelona, Spain
| | - Emília Sánchez
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Montserrat Espuña-Pons
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Escura S, Ros C, Anglès-Acedo S, Bataller E, Sánchez E, Carmona F, Espuña-Pons M. Midterm postoperative results of mid-urethral slings. Role of ultrasound in explaining surgical failures. Neurourol Urodyn 2022; 41:1834-1843. [PMID: 36057980 DOI: 10.1002/nau.25032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/01/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Surgical treatment for stress urinary incontinence (SUI) with mid-urethral sling (MUS) is considered to have a high success rate. However, between 5% and 20% of MUS fail, with inadequate surgical implantation being a possible cause of SUI persistence or recurrence. Misplacement of a MUS can be determined by pelvic floor ultrasound (PF-US). The aim of this study was to investigate the role of PF-US in patients with persistent or recurrent urinary incontinence (UI) symptoms after MUS surgery for SUI with a midterm follow-up. MATERIALS AND METHODS A historical cohort study including women undergoing MUS surgery for SUI between 2013 and 2015 was designed. The primary outcome was to correlate the sonographic parameters of MUS with SUI cure (negative International Continence Society-Uniform Cough Stress Test, Incontinence Questionnaire-Short Form < 5 points and no symptoms of SUI), at 5 years postsurgery. Secondary outcomes were changes of maximum urethral closure pressure (MUCP) and symptoms of urgency urinary incontinence (UUI) at 1 and 5 years after surgery. RESULTS Eighty-seven patients (80 transobturator-MUS, 7 retropubic-MUS) were included. At 5 years all patients referred improvement of UI and objective cure of SUI was demonstrated in 81.2%. The MUS was sonographically correct in 67 (98.5%) of the 68 patients with cure of SUI. The MUS was considered incorrectly placed in only 4 (28.6%) of the 14 patients with noncured SUI. MUCP decreased from 61.9 to 48.8 cmH2 O at 5 years of follow-up (p < 0.01) and up to 53% of women had UUI symptoms after surgery, with a nonsignificant decrease compared to baseline. CONCLUSION Patients cured of SUI had sonographically correct MUS by PF-US. Less than one-third of cases of SUI persistence or recurrence after MUS surgery could be explained by a sonographically incorrect sling. Low urethral resistance and/or UUI symptoms could help to explain the remaining failures. Complete functional and anatomic studies, including urodynamics and PF-US, should be performed before deciding on the next management strategy in patients with SUI persistence or recurrence after MUS.
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Affiliation(s)
- Sílvia Escura
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Cristina Ros
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Sònia Anglès-Acedo
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Eduardo Bataller
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Emília Sánchez
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Montserrat Espuña-Pons
- Pelvic Floor Unit, ICGON, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Huang Y, Chen Z, Shen B, Shao Y, Gao J, Zhou Y, Margit F, Wei Z, Ding L. 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. Front Surg 2021; 8:710594. [PMID: 34540886 PMCID: PMC8448289 DOI: 10.3389/fsurg.2021.710594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the efficacy of management and follow-up practices in repeat retropubic mid-urethral synthetic sling (MUS) procedure after transobturator tape/tension-free vaginal tape-obturator (TOT/TVT-O) failure, and to clarify the possible etiology of recurrent stress urinary incontinence. Methods: The charts of all women patients who underwent tension-free vaginal tape (TVT) slings after previous failed transobturator MUS procedures between February 2012 and November 2018 at a single center were reviewed retrospectively. The transperineal ultrasound was performed to assess the pre-operative or post-operative urethral mobility and location of the slings. Furthermore, some essential evaluations were also made, mainly including medical history, physical examination, 1 h pad test, and urodynamic study. Finally, primary outcomes were evaluated according to the above items at 3, 6, and 12 months after the second operation, respectively. Results: Thirty-five patients were included in the primary transobturator MUS sling procedure. At the 6 months follow-up, 32 (91.42%) patients were socially continent and negative in 1 h pad test. The transperineal ultrasound measurement results revealed that the bladder neck descent (BND) values were significantly decreased after the repeat sling operation, and better urinary continence function was observed according to the post-operative urodynamic study. Multifactorial etiologies resulted in recurrent stress urinary incontinence (SUI), including poor surgical technique, inadequate sling tension when treating ISD, and inappropriate sling position. Then the detail of the surgical procedure varied with the results of pre-operative evaluations, affecting the validity of the second sling. Conclusion: Recurrent SUI has resulted from multi factors, pre-operative urodynamic study and transperineal ultrasound might be valuable tools to guide repeat sling operation and predict post-operative outcomes. A repeat TVT procedure may be regarded as a remedial measure for a failed transobturator MUS operation.
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Affiliation(s)
- Yi Huang
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China.,Department of Urology, Jiangnan University Affiliated Hospital, Wuxi, China
| | - Zhengsen Chen
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Baixin Shen
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Yunpeng Shao
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Jie Gao
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Yiduo Zhou
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Fisch Margit
- Department of Urology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Zhongqing Wei
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
| | - Liucheng Ding
- Department of Urology, Nanjing Medical University Second Affiliated Hospital, Nanjing, China
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Poutakidis G, Marsk A, Altman D, Falconer C, Morcos E. Ultrasound evaluation of anterior transvaginal mesh for pelvic organ prolapse: correlation to 5-year clinical outcomes. Int Urogynecol J 2021; 33:1907-1915. [PMID: 34185122 PMCID: PMC9270286 DOI: 10.1007/s00192-021-04889-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/26/2021] [Indexed: 01/02/2023]
Abstract
Introduction and hypothesis Vaginal prolapse mesh may effectively restore vaginal anatomy. The aim of this study was to investigate how the in vivo mesh position correlates to clinical outcomes. Methods Seventy-one women operated on using Uphold mesh for apical pelvic organ prolapse (POP-Q, C ≥ stage II) were examined 5 years after surgery by introital-perineal 2D ultrasound in a midsagittal plane at rest and Valsalva. The horizontal line and pubis symphysis were considered the reference for all measures. Ultrasound measures were statistically compared to clinical outcomes: POP-Q, Pelvic Floor Distress Inventory (PFDI-20) and subscales [Pelvic Organ Distress Inventory (PODI-6), and Urinary Distress Inventory (UDI-6)] and the VAS scale for pain. Results Original mesh length was preserved by 86% and correlated to improved pain as estimated by VAS scale (r 0.321). Valsalva was associated with a lowering of the superior and inferior mesh margins by 7.3 and 6.1 mm, respectively (p < 0.001) but a reduction of total mesh length by only 1 mm (30.2 ± 5.2 to 29.2 ± 4.7 mm, p < 0.001). Mobility of the anterior vaginal wall (bladder neck and midurethra) at Valsalva was parallel to downward movement of the mesh inferior margin (r 0.346 and 0.314) but inversely correlated to total UDI-6 (r − 0.254 and − 0.263). Mobility of the midurethra was inversely correlated to bladder emptying (PFDI-20 Question 19, r − 0.245). Conclusions Five years after surgery, preserved original length of the mesh with apical support was correlated to improved anatomical and patient-reported outcomes. Mesh support to the vaginal apex was associated with improved bladder emptying and total urinary distress outcomes but not stress urinary incontinence.
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Affiliation(s)
- Georgios Poutakidis
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, SE-176 77, Stockholm, Sweden
| | - Anna Marsk
- Department of Gynecological Ultrasound, UltraGyn, Stockholm, Sweden
| | - Daniel Altman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christian Falconer
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, SE-176 77, Stockholm, Sweden
| | - Edward Morcos
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, SE-176 77, Stockholm, Sweden. .,Department of Gynecology & Obstetrics, Karolinska Institutet, Danderyd University Hospital, SE-182 88 Danderyd, Stockholm, Sweden.
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Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:9518076. [PMID: 29568322 PMCID: PMC5820624 DOI: 10.1155/2018/9518076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 01/04/2023]
Abstract
After menopause, decreased levels of estrogen and progesterone remodel the collagen of the soft tissues thereby reducing their stiffness. Stress urinary incontinence is associated with involuntary urine leakage due to pathological movement of the pelvic organs resulting from lax suspension system, fasciae, and ligaments. This study compares the changes in the orientation and position of the female pelvic organs due to weakened fasciae, ligaments, and their combined laxity. A mixture theory weighted by respective volume fraction of elastin-collagen fibre compound (5%), adipose tissue (85%), and smooth muscle (5%) is adopted to characterize the mechanical behaviour of the fascia. The load carrying response (other than the functional response to the pelvic organs) of each fascia component, pelvic organs, muscles, and ligaments are assumed to be isotropic, hyperelastic, and incompressible. Finite element simulations are conducted during Valsalva manoeuvre with weakened tissues modelled by reduced tissue stiffness. A significant dislocation of the urethrovesical junction is observed due to weakness of the fascia (13.89 mm) compared to the ligaments (5.47 mm). The dynamics of the pelvic floor observed in this study during Valsalva manoeuvre is associated with urethral-bladder hypermobility, greater levator plate angulation, and positive Q-tip test which are observed in incontinent females.
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Wlaźlak E, Viereck V, Kociszewski J, Kuszka A, Rautenberg O, Walser C, Surkont G, Gamper M, Fehr MK. Role of intrinsic sphincter deficiency with and without urethral hypomobility on the outcome of tape insertion. Neurourol Urodyn 2017; 36:1910-1916. [PMID: 28139863 DOI: 10.1002/nau.23211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/25/2016] [Accepted: 12/10/2016] [Indexed: 11/10/2022]
Abstract
AIMS Intrinsic sphincter deficiency (ISD) is a known risk factor for therapy failure after tension-free vaginal tape (TVT) insertion. The purpose of this study was to investigate if the severity of ISD alone or other factors such as urethral mobility and tape localization influence outcomes. METHODS One hundred and nine women with urodynamically determined ISD, a TVT insertion, and a 6-month follow-up visit were included. Urethral length, mobility, and tape localization were evaluated by pelvic floor sonography. Patients were classified into three urethral mobility groups (hypomobile, normomobile, hypermobile). Surgical outcome was assessed by a combination of objective and subjective criteria. RESULTS Therapeutic success rate after TVT insertion was 81.6%. The severity of ISD did not associate with therapy failure. But urethral mobility (P < 0.0001), relative tape position (P = 0.0003), and tape-urethra distance (P < 0.0001) differed between cured and not cured patient groups. Patients with a relative tape position toward 1/2 of urethral length had a higher cure rate. Significantly different cure rates (P = 0.0003) were found for hypomobile (67%), normomobile (76%), and hypermobile (100%) urethras. For ISD patients with a hypomobile urethra, highest cure rates were obtained for tape-urethra distances between 2.5 and 3.5 mm. CONCLUSIONS The reduced cure rate for ISD patients was due to the subgroup with a hypomobile urethra. A prospective study is needed to confirm that slightly shorter tape-urethra distances and a relative tape position more toward the mid-urethra will lead to better outcomes for this patient group.
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Affiliation(s)
- Edyta Wlaźlak
- Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
| | - Volker Viereck
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Jacek Kociszewski
- Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Haspe, Hagen, Germany
| | - Andrzej Kuszka
- Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Haspe, Hagen, Germany
| | - Oliver Rautenberg
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Claudia Walser
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Grzegorz Surkont
- Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
| | - Marianne Gamper
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Mathias K Fehr
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
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Ultrasound imaging in urogynecology - state of the art 2016. MENOPAUSE REVIEW 2016; 15:123-132. [PMID: 27980522 PMCID: PMC5137478 DOI: 10.5114/pm.2016.63060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 01/03/2023]
Abstract
The role of ultrasound imaging in urogynecology is not clearly defined. Despite significant developments in visualization techniques and interpretation of images, pelvic ultrasound is still more a tool for research than for clinical practice. Structures of the lower genitourinary tract and pelvic floor can be visualized from different approaches: transperineal, introital, transvaginal, abdominal or endoanal. According to contemporary guidelines and recommendations, the role of ultrasound in urogynecology is limited to the measurement of post-void residue. However, in many instances, including planning and audit of surgical procedures, management of recurrences or complications, ultrasound may be proposed as the initial examination of choice. Ultrasound may be used for assessment of bladder neck mobility before anti-incontinence procedures. On rare occasions it is helpful in recognition of pathologies mimicking vaginal prolapse such as vaginal cyst, urethral diverticula or rectal intussusception. In patients subjected to suburethral slings, causes of surgery failure or postsurgical voiding dysfunctions can be revealed by imaging. Many reports link the location of a tape close to the bladder neck to unfavorable outcomes of sling surgery. Some postoperative complications, such as urinary retention, mesh malposition, hematoma, or urinary tract injury, can be diagnosed by ultrasound. On the other hand, the clinical value of some applications of ultrasound in urogynecology, for example measurement of the bladder wall thickness as a marker of detrusor overactivity, has not been proved.
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Moe K, Schiøtz HA, Kulseng-Hanssen S. Outcome of TVT operations in women with low maximum urethral closure pressure. Neurourol Urodyn 2016; 36:1320-1324. [PMID: 27241193 DOI: 10.1002/nau.23044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
AIMS (i) To establish whether low maximal urethral closure pressure (MUCP) is associated with a poorer prognosis after TVT-surgery, and if so to establish an MUCP cut-off value for poor outcome. (ii) To characterize the population with a low MUCP. METHODS Retrospective analysis of data from 6,646 women with stress/mixed urinary incontinence included in the Norwegian Female Incontinence Registry. Postoperative subjective (degree of satisfaction), objective (leakage on stress test) and composite cure according to preoperative MUCP were analyzed in unadjusted and adjusted analysis. Preoperative variables were compared between women having a low or normal MUCP. Non-parametric tests were used on continuous variables and χ2 tests on categorical variables. Logistic regression was used for the adjusted analysis. Level of significance: P < 0.05. RESULTS An analysis of centiles of preoperative MUCP showed that a cut-off at 20 cm H2 O did best identify women at risk of not being cured. In unadjusted analysis MUCP ≤20 cm H2 O (n = 422) was associated with objective (OR: 2.48), subjective (OR: 1.60), and composite failure (OR: 1.95) compared to MUCP >20 cm H2 O. In adjusted analysis MUCP ≤20 cm H2 O was associated with neither objective, subjective, nor composite failure. Women with MUCP <20 cm H2 O were preoperatively significantly older, had larger leakage on stress and 24 h pad test, lower mean voided volume and maximum flow rate and higher stress and urge indices. CONCLUSIONS Women with MUCP ≤20 cm H2 O have similar objective, subjective, and composite outcomes after TVT-surgery compared to women with MUCP >20 cm H2 O after adjusting for preoperative variables. Neurourol. Urodynam. 36:1320-1324, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kjartan Moe
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hjalmar A Schiøtz
- Department of Obstetrics and Gynecology, Vestfold Hospital, Tønsberg, Norway
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Ultrasound Evaluation of Midurethral Sling Position and Correlation to Physical Examination and Patient Symptoms. Female Pelvic Med Reconstr Surg 2016; 21:263-8. [PMID: 25730429 DOI: 10.1097/spv.0000000000000161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The primary objective was to evaluate the position and angle variation between 3 different midurethral slings (MUSs) using 3-dimensional ultrasound (US) technology. The secondary objective was to compare differences in findings on physical examination and symptoms of incontinence and sexual dysfunction between subjects. METHODS This was a cross-sectional study of 61 subjects who had undergone MUS placement without concomitant anterior or apical compartment prolapse surgery (21 retropubic [RP], 19 out-to-in transobturator [TOT], 21 in-to-out transobturator [TVT-O]). Subjects completed validated questionnaires (Sandvik Incontinence Severity Index, Urogenital Distress Inventory 6) and underwent a pelvic examination and standardized 2-dimensional and 3-dimensional ultrasonography evaluation. RESULTS On translabial US, the median RP sling angle was 108.2 degrees (72.6-135.9), significantly more acute than the angle of TOT and TVT-O slings (119.3 degrees [72.3-140.4, P = 0.02] and 118.5 degrees [99.0-154.7, P = 0.004]). There was no difference in the sling angles between the TOT and TVT-O slings (P = 0.86). No difference was noted in the position of the sling along the urethra (P = 0.82). The TOT sling was more often palpable (57.8%, P = 0.02) compared with the RP or TVT-O groups.Fifteen patients (4 RP, 5 TOT, 6 TVT-O) reported discomfort during intercourse that they attributed to the MUS. Three of 19 TOT subjects reported that their partner experienced pain with intercourse because of the sling. However, sexual function and urinary symptoms were not statistically different between the 3 groups. CONCLUSIONS On 3-dimensional US, RP sling angle was found to be significantly more acute than the angles of the TOT and TVT-O slings, and there was no difference between the 2 transobturator slings. The TOT sling was more often palpable on examination, but this finding did not correlate with increased pain on palpation.
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12
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Brandão S, Parente M, Mascarenhas T, da Silva ARG, Ramos I, Jorge RN. Biomechanical study on the bladder neck and urethral positions: Simulation of impairment of the pelvic ligaments. J Biomech 2015; 48:217-23. [DOI: 10.1016/j.jbiomech.2014.11.045] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 11/04/2014] [Accepted: 11/28/2014] [Indexed: 11/28/2022]
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Saaby ML, Klarskov N, Lose G. The impact of tension-free vaginal tape on the urethral closure function: mechanism of action. Neurourol Urodyn 2014; 34:50-4. [PMID: 25296187 DOI: 10.1002/nau.22513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/25/2013] [Indexed: 11/07/2022]
Abstract
AIM To investigate if the tension-free vaginal tape (TVT) works by increasing the abdominal to urethral pressure impact ratio (APIR). METHODS Twenty one women with urodynamically proven stress urinary incontinence (SUI) were assessed by ICIQ-SF, pad-weighing test, incontinence diary and Urethral Pressure Reflectometry (UPR) before and after TVT. UPR was conducted during resting and increased intra-abdominal pressure (P(Abd)) by straining. Related values of P(Abd) and urethral opening pressure (P(o)) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line was found. The slope expresses the ratio of pressure increase in the urethra compared to the pressure increase in the abdomen and was called APIR. RESULTS The urethral opening pressure at rest (P(o-rest)) was unchanged after TVT, while APIR increased in all women (from 0.7 to 1.4, P < 0.0001). CONCLUSIONS The TVT seems to strengthen the urethral closure function by increasing the APIR while P(o-rest) is unchanged regardless of the type of pre-operative dysfunction. This confirms the theory of TVT's mechanism of action being mid-urethral support.
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Affiliation(s)
- Marie-Louise Saaby
- Department of Obstetrics and Gynecology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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Viereck V, Kuszka A, Rautenberg O, Wlaźlak E, Surkont G, Hilgers R, Eberhard J, Kociszewski J. Do different vaginal tapes need different suburethral incisions? The one-half rule. Neurourol Urodyn 2014; 34:741-6. [DOI: 10.1002/nau.22658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/24/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Volker Viereck
- Department of Obstetrics and Gynecology; Cantonal Hospital Frauenfeld; Switzerland
- Department of Obstetrics and Gynecology; Georg August University Goettingen; Germany
| | - Andrzej Kuszka
- Department of Obstetrics and Gynecology; Lutheran Hospital Hagen-Haspe; Germany
| | - Oliver Rautenberg
- Department of Obstetrics and Gynecology; Cantonal Hospital Frauenfeld; Switzerland
| | - Edyta Wlaźlak
- Department of Obstetrics and Gynecology; Medical University of Lodz; Lodz Poland
| | - Grzegorz Surkont
- Department of Obstetrics and Gynecology; Medical University of Lodz; Lodz Poland
| | - Reinhard Hilgers
- Institute of Medical Statistics; Georg August University; Goettingen Germany
| | - Jakob Eberhard
- Department of Obstetrics and Gynecology; Cantonal Hospital Frauenfeld; Switzerland
| | - Jacek Kociszewski
- Department of Obstetrics and Gynecology; Lutheran Hospital Hagen-Haspe; Germany
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Rautenberg O, Kociszewski J, Welter J, Kuszka A, Eberhard J, Viereck V. Ultrasound and early tape mobilization-A practical solution for treating postoperative voiding dysfunction. Neurourol Urodyn 2013; 33:1147-51. [DOI: 10.1002/nau.22459] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 06/07/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Oliver Rautenberg
- Department of Gynecology and Obstetrics; Cantonal Hospital Frauenfeld; Frauenfeld Switzerland
| | - Jacek Kociszewski
- Department of Gynecology and Obstetrics; Lutheran Hospital Hagen-Haspe; Hagen Germany
| | - JoEllen Welter
- Department of Gynecology and Obstetrics; Cantonal Hospital Frauenfeld; Frauenfeld Switzerland
| | - Andrzej Kuszka
- Department of Gynecology and Obstetrics; Lutheran Hospital Hagen-Haspe; Hagen Germany
| | - Jakob Eberhard
- Department of Gynecology and Obstetrics; Cantonal Hospital Frauenfeld; Frauenfeld Switzerland
| | - Volker Viereck
- Department of Gynecology and Obstetrics; Cantonal Hospital Frauenfeld; Frauenfeld Switzerland
- Department of Gynecology and Obstetrics; Georg August University Goettingen; Goettingen Germany
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Stellenwert der Sonographie bei der Diagnostik von Funktionsstörungen des weiblichen Beckenbodens. Urologe A 2013; 52:533-40. [PMID: 23483273 DOI: 10.1007/s00120-013-3143-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Huang WC, Yang SH, Yang JM, Tzeng CR. Functional and morphological differences following Monarc and TVT-O procedures. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:699-705. [PMID: 22125110 DOI: 10.1002/uog.10153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/10/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore function of the lower urinary tract and morphology of tape and urethra following Monarc or TVT-O suburethral tape placement for urodynamic stress incontinence (USI). METHODS We recruited prospectively women undergoing either Monarc or TVT-O placement for USI. Before and 3 months after the procedure, participants were evaluated by a question-directed interview, the measures of Sandvik Incontinence Severity Index (SISI), Incontinence Bother Scale (IBS), Ingelman-Sundberg Score (ISS) and short forms of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), physical examination, a cough stress test and 4D ultrasound investigation. The primary outcome was participants' responses to clinical assessments and the secondary outcome was ultrasound findings. RESULTS A total of 67 women with Monarc procedures and 60 women with TVT-O procedures completed the survey both preoperatively and 3 months postoperatively. There were significant improvements in scores of SISI, IBS, ISS, UDI-6 and IIQ-7 after both Monarc and TVT-O procedures. At the 3-month follow-up, both procedures had similar success rates, SISI scores, IBS scores, ISS scores, UDI-6 scores and IIQ-7 scores, and similar incidences of postoperative voiding difficulty and overactive bladder symptoms. After Bonferroni correction, all ultrasound parameters representing tape location, tape tension and urethral mobility were similar between the two procedures. CONCLUSIONS At short-term follow-up, Monarc and TVT-O procedures are comparable in both functional outcome of the lower urinary tract and morphology on ultrasound as assessed by parameters representing tape location, tape tension and urethral mobility.
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Affiliation(s)
- W-C Huang
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
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Yang JM, Yang SH, Huang WC, Tzeng CR. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:458-465. [PMID: 21919102 DOI: 10.1002/uog.10086] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore, using 4D ultrasound, the importance of location and tension of transobturator sub- urethral tape (TOT) with respect to surgical outcome. METHODS Enrolled into the study were 56 women who had undergone TOT placement in the treatment of urodynamic stress incontinence. Tape location and tension were assessed by 4D ultrasound with the women at rest, during straining and during coughing. Ultrasound parameters representing tape location included the sagittal tape-symphysis pubis distance (sTSD), sagittal tape-symphysis pubis angle (sTSA) and tape percentile (an indication of tape position along the urethra with respect to urethral length), while those representing tape tension included urethral encroachment, sagittal tape-urethra distances at the upper end (sTUDu), center (sTUDc) and lower end (sTUDl) of the tape and axial urethral central echolucent area at the tape center (aUCEAc). RESULTS In women in whom the tape procedure had been successful, during increased intra-abdominal pressure sTSA and the incidence of urethral encroachment increased, while sTUDu, sTUDc, sTUDl and aUCEAc decreased. Compared with those reporting no stress urinary incontinence (SUI) symptoms, women who reported SUI postoperatively had lower tape percentile. Women with SUI postoperatively demonstrated no manifestation on ultrasound of urethral encroachment at rest or during increased intra-abdominal pressure. Women with postoperative overactive bladder (OAB) symptoms had shorter resting sTSD and larger resting sTSA than did women without OAB symptoms. Women reporting postoperative de novo or worsening voiding difficulty had larger resting sTSA and higher incidence of urethral encroachment at rest than did women without this difficulty. CONCLUSIONS Both tape location and tape tension are associated with surgical outcome of TOT procedures. Assessment of tape location and tension can be achieved using 4D ultrasound.
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Affiliation(s)
- J-M Yang
- Department of Obstetrics and Gynecology, Taipei Medical University and Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
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Kawasaki A, Wu JM, Amundsen CL, Weidner AC, Judd JP, Balk EM, Siddiqui NY. Do urodynamic parameters predict persistent postoperative stress incontinence after midurethral sling? A systematic review. Int Urogynecol J 2012; 23:813-22. [PMID: 22402639 DOI: 10.1007/s00192-012-1693-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS It is unclear whether preoperative urodynamic study (UDS) values are predictive of outcomes after midurethral sling. MATERIALS AND METHODS We systematically reviewed multiple databases from January 1989 to October 2011 for English-language studies correlating UDS data with postoperative outcomes after midurethral slings. We performed random effects model meta-analyses, as indicated. Relative risk (RR) ratios for the outcome of stress urinary incontinence (SUI) cure were calculated using high maximum urethral closure pressure (MUCP) and Valsalva leak point pressure (VLPP) values as the reference group. RESULTS High preoperative MUCP was associated with cure after retropubic [RR 0.67; 95% confidence interval (CI) 0.47-0.97)] and transobturator slings (RR 0.65; 95% CI 0.49-0.90). High preoperative VLPP was also associated with cure after retropubic sling (RR 0.89; 95% CI 0.82-0.96), but this relationship did not achieve statistical significance for cure after transobturator sling (RR 0.86; 95% CI 0.74-1.00). CONCLUSIONS Preoperative MUCP and VLPP values may add insight into postoperative outcomes after surgical treatment for SUI.
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Affiliation(s)
- Amie Kawasaki
- Department of Obstetrics & Gynecology, Division of Urogynecology, Duke University Medical Center, 5324 McFarland Drive, Suite 310, Durham, NC 27707, USA.
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Kociszewski J, Rautenberg O, Kuszka A, Eberhard J, Hilgers R, Viereck V. Can we place tension-free vaginal tape where it should be? The one-third rule. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:210-214. [PMID: 21793084 DOI: 10.1002/uog.10050] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The tension-free vaginal tape (TVT) insertion technique generally does not take into account individual urethral length. In this study we investigated whether preoperative sonographic measurement of individual urethral length allows for reliable TVT positioning under the midurethra, which is a critical segment for the continence mechanism. METHODS Urethral length was measured by preoperative introital ultrasonography in 102 consecutive female patients with stress urinary incontinence. TVT procedures were performed as recommended by the manufacturer. The suburethral incisions were initiated at one-third of the sonographically measured urethral length. TVT position and tape-urethra distance were followed up 6 months postoperatively. RESULTS At 6-month examination of the 102 study participants, 93.1% were cured and 6.9% showed improved continence. TVTs were found in the target range of 50-70% of the urethral length in 88.2% of the cohort. Women with the TVT in the 50-70% urethral length range and a 3-5-mm tape-longitudinal smooth muscle distance had a greater likelihood of being cured without complications (P < 0.001). CONCLUSIONS Preoperative sonographic measurement of urethral length, combined with the one-third rule, may aid in reliable midurethral TVT positioning.
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Affiliation(s)
- J Kociszewski
- Department of Gynecology and Obstetrics, Lutheran Hospital, Hagen-Haspe, Germany
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Yang JM, Yang SH, Huang WC, Tzeng CR. Reliability of a new method for assessing urethral compression following midurethral tape procedures using four-dimensional ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:210-216. [PMID: 21425199 DOI: 10.1002/uog.9003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To evaluate the intra- and interobserver reliability of a new method of assessing resting and dynamic urethral compression after midurethral tape procedures using three- and four-dimensional (3D and 4D) ultrasound. METHODS Thirty-one women who had undergone transobturator midurethral tape procedures at Cathay General Hospital were enrolled in the study and 4D ultrasound was performed pre- and postoperatively. Preoperative ultrasound assessment included measurement of the urethral central echolucent area (UCEA) in the axial plane. Postoperative ultrasound assessment included measurement of the tape-urethral distance (TUD) in the sagittal plane as well as UCEA and tape angle in the axial plane (ATA). The TUD was measured at the upper end (TUDu), central point (TUDc) and lower end (TUDl) of the tape. All pre- and postoperative ultrasound assessments were performed in women at rest, on maximum straining and during strong coughing. 4D ultrasound volume datasets were stored digitally and analyzed offline by two independent investigators blinded to clinical data and to each others' measurements. Intra- and interobserver reliability were evaluated using the intraclass correlation coefficient (ICC). RESULTS There were significant reductions in TUDc, TUDl and UCEA during increased intra-abdominal pressure. ICC values for the measurement of TUD at rest, on straining and during coughing demonstrated very good reliability. ICC values for the pre- and postoperative measurement of UCEA at rest, on straining and during coughing demonstrated good to very good reliability. ICC values for the measurement of ATA at rest, on straining and during coughing demonstrated fair to good reliability. CONCLUSIONS 4D ultrasound can be used to obtain measurements with good reliability in the assessment of urethral compression.
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Affiliation(s)
- J-M Yang
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
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Schmid C, Bloch E, Amann E, Mueller MD, Kuhn A. An adjustable sling in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape. Neurourol Urodyn 2010; 29:573-7. [PMID: 19693951 DOI: 10.1002/nau.20793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this prospective study was to evaluate the feasibility and outcome of an adjustable sling system AMI in patients with recurrent urinary stress incontinence after failed suburethral sling insertion. PATIENTS AND METHODS Twenty-five patients with recurrent urinary stress incontinence treated with an adjustable sling system AMI were analyzed for feasibility and outcome. Patients' incontinence bother was quantified using the Visual Analogue Scale (VAS) from 0 to 10. Multichannel urodynamics and pad tests were pre- and postoperatively performed. Time of adjustment, time of the surgical intervention, and clinical outcome were also recorded. RESULTS Twenty-five patients were treated with the adjustable sling system AMI. Median time of adjustment was 3 days (range 1-8) and a median follow up time of 12 months. Twenty-one out of 25 patients were continent, four patients suffered from persisting incontinence. One patient was put on clean intermittent self-catheterization (CISC). Detrusor pressure at maximum flow rate (pdet/Qmax) increased significantly as did the maximum urethral closure pressure (MUCP). Patient satisfaction improved significantly. CONCLUSION Adjustable slings in women with stress urinary incontinence might be indicated in difficult situations after surgical failure. As we present a selective group of patients these findings may not apply to other patients with recurrent stress incontinence.
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Affiliation(s)
- Corina Schmid
- Department of Gynaecology, Urogynaecology Division, University Hospital of Bern and University of Bern, Switzerland
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Tape functionality: position, change in shape, and outcome after TVT procedure--mid-term results. Int Urogynecol J 2010; 21:795-800. [PMID: 20204326 PMCID: PMC2876268 DOI: 10.1007/s00192-010-1119-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 01/26/2010] [Indexed: 10/31/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study evaluates the relevance of the tape position and change in shape (tape functionality) under in vivo conditions for mid-term outcome. METHODS Changes in the sonographic tension-free vaginal tape (TVT) position relative to the percentage urethral length and the tape-urethra distance were determined after 6 and 48 months in 41 women with stress urinary incontinence. RESULTS At 48 months, 76% (31/41) of women were cured, 17% (7/41) were improved, and 7% (3/41) were failures. Disturbed bladder voiding was present in 12% (5/41), de novo urge incontinence in 7% (3/41). The median TVT position was at 63% of urethral length. Median tape-urethra distance was 2.7 mm, ranging from 2.9 mm in continent patients without complications to 1.1 mm in those with obstructive complications. Patients with postoperative urine loss had a median distance of 3.9 mm. The tape was stretched at rest and C-shaped during straining in 15 of 41 women (37%) at 48 months (all continent). Patients with this tape functionality at 6 months were also cured at 48 months in 86% of cases (19/22), and only 14% (3/22) showed recurrent incontinence. CONCLUSIONS Mid-term data suggest an optimal outcome if the tape is positioned at least 2 mm from the urethra at the junction of the middle and distal thirds. Patients with optimal tape functionality at 6 months are likely to show mid-term therapeutic success.
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Nishibayashi M, Kobayashi K, Miki A, Okagaki R, Nagata I, Urashima M, Ishihara O. Bladder neck evaluation by perineal ultrasound before and after reconstructive surgery for pelvic organ prolapse. J Med Ultrason (2001) 2009; 36:193. [PMID: 27277439 DOI: 10.1007/s10396-009-0231-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To study the correlation between stress urinary incontinence (SUI) and the mobility and funneling of the bladder neck (BN) by observation of pre- and postoperative course by perineal ultrasound (PUS). METHODS We investigated 123 cases that underwent reconstructive surgery for pelvic organ prolapse (POP). We prospectively checked bladder neck mobility (BNM) during the Valsalva maneuver and funneling of the BN at rest by PUS. We defined the width multiplied by the depth of the funnel-like profile of the BN as the funneling index (FI). We checked BNM, FI, and the presence of SUI just before the operation, and we checked the postoperative course of BNM and SUI. RESULTS When BNM was ≥10 mm before surgery, the odds ratio for accompanying SUI was 2.68 relative to BNM <10 mm (p = 0.031). When FI was ≥150 before surgery, the odds ratio for accompanying SUI was 4.12 relative to FI <150 (p = 0.004). Although postoperative BNM values were significantly improved immediately after surgery, they gradually increased within 2 years. Among the cases with preoperative SUI, the recurrence rate was significantly higher in the patients whose FI was <150 (p = 0.019). CONCLUSIONS Our results yielded by PUS suggested that larger BNM and FI values were the causative factors of SUI. PUS may be beneficial for selecting a suitable surgical procedure for POP, and it may also be helpful for assessing surgical efficacy.
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Affiliation(s)
- Manabu Nishibayashi
- Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan.
| | - Koichi Kobayashi
- Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan
| | - Akinori Miki
- Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan
| | - Ryugo Okagaki
- Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan
| | - Ichiro Nagata
- Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan
| | - Mitsuyoshi Urashima
- Jikei Clinical Research and Development, Jikei University School of Medicine, Tokyo, Japan
| | - Osamu Ishihara
- Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan
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Martan A, Svabík K, Masata J, Koleska T, El-Haddad R, Pavlikova M. Correlation between changes in ultrasound measurements and clinical curative effect of tension-free vaginal tape-SECUR* procedure. Int Urogynecol J 2009; 20:533-9. [DOI: 10.1007/s00192-009-0823-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Accepted: 01/26/2009] [Indexed: 11/30/2022]
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Yang JM, Yang SH, Huang WC. Correlation of Morphological Alterations and Functional Impairment of the Tension-Free Vaginal Tape Obturator Procedure. J Urol 2009; 181:211-8. [PMID: 19013610 DOI: 10.1016/j.juro.2008.09.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Indexed: 11/25/2022]
Affiliation(s)
- Jenn-Ming Yang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
- Schools of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Shwu-Huey Yang
- Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Wen-Chen Huang
- Schools of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan, Republic of China
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan, Republic of China
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Yang JM, Yang SH, Huang WC. Dynamic Interaction Involved in the Tension-Free Vaginal Tape Obturator Procedure. J Urol 2008; 180:2081-7. [DOI: 10.1016/j.juro.2008.07.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Jenn-Ming Yang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei Medical University, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chen Huang
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
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28
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Kociszewski J, Rautenberg O, Perucchini D, Eberhard J, Geissbühler V, Hilgers R, Viereck V. Tape functionality: Sonographic tape characteristics and outcome after TVT incontinence surgery. Neurourol Urodyn 2008; 27:485-90. [DOI: 10.1002/nau.20556] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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29
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Cotte B, Campagne S, Botchorishvili R, Canis M, Rivoire C, Mage G. [Role of ultrasound in the evaluation of patients after laparoscopic sacropexy: preliminary study]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2008; 36:373-378. [PMID: 18424162 DOI: 10.1016/j.gyobfe.2007.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Accepted: 12/15/2007] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To evaluate results of laparoscopic sacropexy with introital and vaginal ultrasonography, that is to observe dynamic behavior of the mesh, to measure precisely its position and to conclude on the feasibility of this exam. PATIENTS AND METHODS The surgery was a laparoscopic subtotal hysterectomy and a suspension of the cervix with an anterior vesicovaginal mesh and a posterior rectovaginal mesh. These meshes are joined together and fixed on the sacrum. Ultrasound was performed in fifteen patients to see in the sagital plane the position of the mesh. The distance anterior mesh-bladder neck and the distance posterior mesh-anal sphincter were measured at rest, during straining and during retaining. The spreading out and the dynamic behavior of the mesh were studied. RESULTS The distance anterior mesh-bladder neck is 12 mm at rest, 15 mm during straining and 13 mm during retaining. The distance posterior mesh-anal sphincter is 30 mm at rest, 26 mm during straining and 31 mm during retaining. The mesh is always seen as spread out, or folded, but never strained. Video recording shows that sacropexy does not block pelvic dynamics. DISCUSSION AND CONCLUSION Ultrasound imaging appears in this study as a simple and efficient exam to study and measure prosthesis. It could be a good help for clinical examination to explain failure or complication of surgery.
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Affiliation(s)
- B Cotte
- Département de gynécologie-obstétrique, polyclinique Hôtel-Dieu, CHU de Clermont-Ferrand, boulevard Léon-Malfrey, 63000 Clermont-Ferrand, France.
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What is the relationship between the transobturator tape procedure and urethral mobility in women with SUI? ACTA ACUST UNITED AC 2008; 5:242-3. [DOI: 10.1038/ncpuro1096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 02/19/2008] [Indexed: 11/08/2022]
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31
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Bulking agents for stress urinary incontinence: Are they still indicated? CURRENT BLADDER DYSFUNCTION REPORTS 2008. [DOI: 10.1007/s11884-008-0005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Current World Literature. Curr Opin Obstet Gynecol 2007; 19:496-501. [PMID: 17885468 DOI: 10.1097/gco.0b013e3282f0ffad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Foulot H, Uzan I, Chopin N, Borghese B, Chapron C. Monarc transobturator sling system for the treatment of female urinary stress incontinence: results of a post-operative transvaginal ultrasonography. Int Urogynecol J 2006; 18:857-61. [PMID: 17120171 DOI: 10.1007/s00192-006-0244-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 10/02/2006] [Indexed: 11/29/2022]
Abstract
The aim of the study was to determine Monarc (American Medical Systems) sling position after surgical treatment of stress urinary incontinence (SUI) through the transobturator approach. A total of 54 consecutive women with SUI were evaluated post-operatively with transvaginal ultrasound. A concomitant hysterectomy was performed in ten cases and a concomitant prolapse surgery in six cases. Ultrasound measurements include urethral length, the distance between the upper edge of the sling and the bladder neck (BN-S) and the BN-S/U ratio. The mean distance between the transobturator tape and the bladder neck was found to be 12.6 +/- 3.2 mm in the group of patients who underwent the transobturator procedure alone, 13 +/- 3.1 mm in the transobturator plus hysterectomy group and 12 +/- 2.8 mm in the transobturator plus prolapse group. The superior tape margin was at the mid-urethra in 81.5% of patients and always at a distance greater than 7 mm from the bladder neck. Eight patients did not have satisfactory results after the surgery. Only in one out of these eight patients was the transobturator sling not found to be at the mid-urethra. The superior tape margin of the Monarc sling remained at the level of mid-urethra in the majority of cases. It was never located too proximally beneath the bladder neck.
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Affiliation(s)
- H Foulot
- Service de gynécologie obstétrique II et Médecine de la Reproduction (Pr Chapron), Unité de Chirurgie Gynécologique, Groupe Hospitalier Universitaire Ouest, Université René Descartes (Paris V), CHU Cochin, Paris, France
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Cartwright R, Cardozo L. Re: Role of bladder neck mobility and urethral closure pressure in predicting outcome of tension-free vaginal tape (TVT) procedure. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:743. [PMID: 17001738 DOI: 10.1002/uog.3845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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