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Yang JM, Huang WC. Ultrasound in Female Urinary Incontinence. J Med Ultrasound 2024; 32:14-20. [PMID: 38665347 PMCID: PMC11040483 DOI: 10.4103/jmu.jmu_25_23] [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: 03/11/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2024] Open
Abstract
Urinary incontinence (UI) is a common health condition that may interfere with the quality of life. A comprehensive evaluation of female UI helps with effective and safe treatments. Ultrasound has gained popularity to explore UI recently because it can collect crucial information for treatment planning and counseling. Translabial and introital approaches are commonly and reliably applied to ultrasound. The images can be obtained using two-dimensional and three-dimensional ultrasounds. Ultrasound is the only modality capable of confirming the presence or absence of a mid-urethral sling (MUS) and is able to demonstrate bulking agents as well. Although some of the ultrasound findings may only be incidental or supplementary to the patient's symptoms, ultrasound benefits for investigating the pathophysiology of UI and surgical outcomes of MUS procedures. It is anticipated that standardization in terminology, measurement techniques, and reporting can be established in the near future.
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Affiliation(s)
- Jenn-Ming Yang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chen Huang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
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Jiang C, Zhang S, Chen J, Zhang Y, Cai K, Chen W, Wu Y, Liang C. Significance of 4D US parameters for the clinical treatment of female patients with stress urinary incontinence. Front Surg 2023; 10:1126293. [PMID: 37545841 PMCID: PMC10401039 DOI: 10.3389/fsurg.2023.1126293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/19/2023] [Indexed: 08/08/2023] Open
Abstract
Background Stress urinary incontinence (SUI) that has been associated with abnormal pelvic floor muscle function or morphology is a common condition. This research aimed to study the impact of the four-dimensional (4D) pelvic floor ultrasound on the treatment of female patients with clinical diagnosis of SUI and to evaluate its clinical significance on SUI. Methods We enrolled 51 women with SUI. Before transobturator suburethral tape procedures, the patients underwent 4D pelvic floor ultrasonography. The measurements include residual urine volume, bladder detrusor thickness in resting state, the vertical distance from the bladder neck to the posterior inferior edge of pubic symphysis at rest and Valsalva movement, posterior angle of bladder urethra, and urethral rotation angle. The degree of movement of the bladder neck (the difference between the vertical distance from the bladder neck to the posterior inferior edge of the pubic symphysis under the resting state and the maximum Valsalva movement) and the formation of a funnel at the internal orifice of the urethra were calculated. Results The mean bladder detrusor thickness was 2.6 ± 0.9 mm, the vertical distance from the bladder neck to the posterior inferior edge of pubic symphysis was 27.7 ± 4.5 mm, the posterior angle of the bladder was 122.7 ± 18.9°, the vertical distance from the rectal ampulla to the posterior inferior edge of pubic symphysis was 18.5 ± 4.6 mm, and the mean area of hiatus of the levator ani muscle was 22.1 ± 6.0 cm2. The mean posterior angle of the bladder on Valsalva was 159.3 ± 23.1°, and the mean urethral rotation angle was 67.2 ± 21.4°. Conclusions The 4D pelvic floor ultrasound is a reliable method in evaluating preoperational morphological characteristics of patients with SUI. With the help of the 4D pelvic floor ultrasound, the individualized treatment regimen can be developed and, more importantly, the inappropriate surgical decision can be avoided.
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Affiliation(s)
- Changqin Jiang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Song Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Jing Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
| | - Yangyang Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Keke Cai
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Wei Chen
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Yuanyuan Wu
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- The Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
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Huang WC, Yang JM, Chen HF. Five-year clinical and imaging outcomes of primary transobturator midurethral sling procedures for uncomplicated urodynamic stress incontinence. Maturitas 2020; 138:42-50. [DOI: 10.1016/j.maturitas.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/24/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
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Huang WC, Yang SH, Yang JM. Clinical Importance and Surgical Outcomes of Green Type III Cystocele in Women With Anterior Vaginal Prolapse. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2279-2285. [PMID: 26573101 DOI: 10.7863/ultra.14.11066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/06/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To explore the clinical importance and surgical outcomes of Green type III cystocele in women with anterior vaginal prolapse. METHODS A database of 336 women with a Ba point higher than -3 cm on the Pelvic Organ Prolapse Quantification system was retrospectively reviewed. Investigated data comprised those obtained from a clinical interview, the Pelvic Organ Prolapse Quantification system, and sonography. Initially, the baseline data between women with (n = 126) and without (n = 210) Green type III cystocele on sonography were compared. Subsequently, 6-month postoperative data between women who had Green type III cystocele on sonography and underwent either anterior colporrhaphy (n = 25) or a Perigee procedure (n = 76) were compared. RESULTS Women with Green type III cystocele had symptoms of voiding dysfunction more frequently, stress urinary incontinence less frequently, and more bulging (mean ± SD, 2.7 ± 1.2 versus 1.9 ± 1.5 for women with versus without Green type III cystocele; P = .001), a greater likelihood of stage II or higher cystocele (86.5% versus 60.0% for women with versus without Green type III cystocele; P < .001), as well as more caudodorsal bladder neck and genitohiatal positions and a wider genital hiatus on sonography. Women with Green type III cystocele had a greater likelihood of stage 0 cystocele (64.0% versus 89.5% for anterior colporrhaphy versus Perigee; P< .001) and more ventral bladder neck positions after Perigee procedures. CONCLUSIONS The presence of Green type III cystocele in women with anterior vaginal prolapse is associated with more functional impairments and anatomic defects. Despite comparable functional outcomes, Perigee procedures provide better anatomic outcomes for the anterior vagina in women with Green type III cystocele than anterior colporrhaphy does in the short term.
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Affiliation(s)
- Wen-Chen Huang
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan (W.-C.H.); Department of Obstetrics and Gynecology, School of Medicine, College of Medicine (W.-C.H., J.-M.Y.), School of Nutrition and Health Sciences, College of Public Health and Nutrition (S.-H.Y.), and Department of Obstetrics and Gynecology, Shuang Ho Hospital (J-M.Y.), Taipei Medical University, Taipei, Taiwan; and School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (W.-C.H.)
| | - Shwu-Huey Yang
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan (W.-C.H.); Department of Obstetrics and Gynecology, School of Medicine, College of Medicine (W.-C.H., J.-M.Y.), School of Nutrition and Health Sciences, College of Public Health and Nutrition (S.-H.Y.), and Department of Obstetrics and Gynecology, Shuang Ho Hospital (J-M.Y.), Taipei Medical University, Taipei, Taiwan; and School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (W.-C.H.)
| | - Jenn-Ming Yang
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan (W.-C.H.); Department of Obstetrics and Gynecology, School of Medicine, College of Medicine (W.-C.H., J.-M.Y.), School of Nutrition and Health Sciences, College of Public Health and Nutrition (S.-H.Y.), and Department of Obstetrics and Gynecology, Shuang Ho Hospital (J-M.Y.), Taipei Medical University, Taipei, Taiwan; and School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (W.-C.H.).
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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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Yang JM, Yang SH, Huang WC, Tzeng CR. Matched-pair analyses of resting and dynamic morphology between Monarc and TVT-O procedures by ultrasound. Eur J Obstet Gynecol Reprod Biol 2013; 169:402-7. [PMID: 23727223 DOI: 10.1016/j.ejogrb.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/04/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine morphologic differences between Monarc and TVT-O procedures in axial and coronal planes by three- and four-dimensional (3D and 4D) ultrasound. STUDY DESIGN Retrospective chart audits and ultrasound analyses were conducted on 128 women who had undergone either Monarc or TVT-O procedures for urodynamic stress incontinence. Thirty matched pairs of the two successful procedures were randomly selected and compared. Matched variables were age, parity, body mass index, cesarean status, menopausal status, and primary surgeries. Six-month postoperative 3D and 4D ultrasound results obtained at rest, on straining, and during coughing in these 60 women were analyzed. Assessed ultrasound parameters included the axial tape urethral distance (aTUD), axial central urethral echolucent area (aUCEA), axial tape angle (aTA), and coronal tape angle (cTA), all of which were measured at three equidistant points along the tapes. Paired t-tests were used to compare differences in ultrasound parameters between women after the two procedures and a P value <0.004 was considered significant after Bonferroni correction. RESULTS At rest, women subjected to Monarc procedures had a significantly wider aTA at one-fourth of the tape and a wider cTA at one-, two-, and three-fourths of the tape than did those subjected to TVT-O procedures. There were no significant differences in other resting ultrasound parameters between these two procedures. Additionally, after both procedures women had comparable straining and coughing ultrasound manifestations as well as respective dynamic changes. CONCLUSION Despite flatter resting tape angulations in women following Monarc procedures, both Monarc and TVT-O tapes had equivalent dynamic patterns and changes assessed by 4D ultrasound.
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Affiliation(s)
- Jenn-Ming Yang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Yang JM, Yang SH, Huang WC, Tzeng CR. Reliability of a new method for assessing tension and configuration of transobturator suburethral tapes using four-dimensional ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:44-53. [PMID: 23141900 DOI: 10.1016/j.ultrasmedbio.2012.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/21/2012] [Accepted: 08/23/2012] [Indexed: 06/01/2023]
Abstract
We conducted this study to evaluate the intra- and interobserver reliability of a new method in assessing the tension and configuration of transobturator suburethral tape (TOT) at different tape points using 4-dimensional (4D) ultrasound. We randomly recruited 20 women following TOT procedures. Postoperative ultrasound datasets acquired during rest, straining, and coughing were digitally stored and analyzed offline by 2 independent and blinded investigators. The assessed parameters included axial tape-urethral distance, axial urethral central echolucent area, axial tape angle, and coronal tape angle at 5 equidistant tape points. For most parameters, the intraclass correlation coefficient and 95% confidence interval for intra- and interobserver reliability was higher than 0.70. 4D ultrasound can provide a quantitative method that meets minimal standards for reliability coefficients in assessing the tension and configuration of TOT. The reliability of the current method could be further evaluated when a whole new ultrasound examination was performed.
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Affiliation(s)
- Jenn-Ming Yang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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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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Huang WC, Yang SH, Yang JM, Tzeng CR. Impact of concomitant anterior vaginal reconstructive surgery on transobturator suburethral tape procedures. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:562-569. [PMID: 22407759 DOI: 10.1002/uog.11152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore the functional and morphological impact of concomitant anterior vaginal reconstructive surgery on outcome of transobturator suburethral tape (TOT) procedures. METHODS This was a retrospective review and analysis of data from 196 women who had undergone a TOT procedure with or without concomitant anterior vaginal reconstructive surgery during a 30-month period. Retrieved data included clinical information and ultrasound findings. Ultrasound examinations assessed the tape location and tape tension at rest, on straining and during coughing. Ultrasound parameters representing tape location comprised the sagittal tape-symphysis pubis distance, sagittal tape-symphysis pubis angle and tape percentile (an indication of tape position along the urethra with respect to urethral length); those representing tape tension included urethral encroachment, sagittal tape-urethra distances at the upper end, central point and lower end of the tape and axial urethral central echolucent area at the center of the tape. RESULTS Of the 196 women, 117 had undergone a TOT procedure without concomitant anterior vaginal surgery (Group 1), 44 had undergone TOT placement with anterior colporrhaphy (Group 2) and 35 had undergone TOT placement with a transobturator vaginal mesh procedure (Group 3). At the 3-month follow-up, functional outcomes as well as resting and dynamic ultrasound findings were similar between women following TOT procedures without (Group 1) and with (Groups 2 and 3) concomitant anterior vaginal surgery. However, a significantly higher rate of urethral encroachment at rest was noted in Group 2. CONCLUSIONS Concomitant anterior vaginal reconstructive surgery neither aggravates the functional outcome nor affects the ultrasound findings of TOT procedures.
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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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