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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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Qu P, Hai N, Lv Z, Yang J. Midurethral sling position and surgical outcome: A meta-analysis. Medicine (Baltimore) 2024; 103:e36115. [PMID: 38215115 PMCID: PMC10783216 DOI: 10.1097/md.0000000000036115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 01/14/2024] Open
Abstract
There is still ongoing debate as to whether the outcome of the sling is determined by the position of the midurethral sling. In order to evaluate the potential impact of sling position on the outcomes of retropubic and transobturator sling procedures for stress urinary incontinence, it is necessary to conduct further investigations. We conducted a comprehensive search across various electronic databases such as PubMed, EMBASE, MEDLINE. Relevant data were extracted, organized in a table format, and analyzed using RevMan software for further analysis. This review comprised a total of 9 studies. The findings indicate that patients with TVT tape placement in the midurethra exhibited a slightly higher cure rate compared to those with proximal placement. Conversely, tape placement in the midurethra was associated with a significantly higher cure rate compared to distal placement [RR = 0.84, 95% CI (0.74-0.95), P < .05]. In the case of transobturator slings, tape positioning beneath the midurethra or distal urethra yielded better outcomes compared to placement near the bladder neck [RR = 0.74, 95% CI (0.57-0.94), P = .02; RR = 0.61, 95% CI (0.39-0.96), P = .03]. Based on 2D and 3D ultrasound imaging, differences in TVT placement appear to have minimal impact on the cure rate. However, the highest rate of failure after transobturator sling surgery is closely linked to the positioning.
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Affiliation(s)
- Peng Qu
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing Chaoyang Hospital, Beijing, China
| | - Ning Hai
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing Chaoyang Hospital, Beijing, China
| | - Zhaoyang Lv
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing Chaoyang Hospital, Beijing, China
| | - Jingdong Yang
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing Chaoyang Hospital, Beijing, China
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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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Sahin F, Adan R, Emeklioglu CN, Ozdemir S, Mihmanli V. The Role of Pelvic Ultrasound in Evaluating the Success of Tension-free Vaginal Tape (TVT). SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:500-505. [PMID: 38268658 PMCID: PMC10805055 DOI: 10.14744/semb.2023.33497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 01/26/2024]
Abstract
Objectives This study aims to assess the lack of response to treatment in individuals undergoing mid-urethral sling surgery for stress urinary incontinence (SUI) using ultrasound findings of the pelvic floor. Methods The study included patients who underwent the tension-free vaginal tape (TVT) procedure for stress urinary incontinence within the period spanning from January 2016 to January 2021. The physical examination involved maintaining bladder filling at an average volume of 200-400 mL, and treatment failure was determined by the presence of SUI during the Valsalva maneuver. Results The study comprised a total of 214 patients, where it was observed during the stress test that 32 patients (25.8%) had an unsuccessful outcome following mid-urethral sling surgery. In the unsuccessful group, the distance of the mesh-posterior urethra was lower (4.09±0.39 vs. 4.91±0.51; p<0.001), the posterior urethrovesical angle was lower when at rest, but the angle increased more significantly during the Valsalva maneuver, and the bladder neck angle was narrower (p<0.001). Conclusion We obtained lower mean values of mesh-posterior urethral distance in unsuccessful patients compared to those found in the group of cured patients. Pelvic floor ultrasound can predict the success of TVT surgeries but there is as yet little data and there is a need to find in the near future more standard and objective parameters for the diagnosis of urinary incontinence.
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Affiliation(s)
- Fatih Sahin
- Department of Obstetrics and Gynecology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Ramazan Adan
- Department of Obstetrics and Gynecology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | | | - Savas Ozdemir
- Department of Obstetrics and Gynecology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Veli Mihmanli
- Department of Obstetrics and Gynecology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
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Hu Y, Zhu S, Lou Y, Zhang H, Huang T, Xie L. Efficacy of Pelvic Floor Ultrasound for Assessing Transobturator Tape Sling Procedure. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:959-965. [PMID: 37326241 DOI: 10.1097/spv.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
IMPORTANCE Complications after midurethral sling, which require a high degree of clinical suspicion for timely diagnosis, accurate evaluation, and proper intervention, are closely associated with surgical success or failure. OBJECTIVES This study aimed to evaluate the efficacy and complications of tension-free midurethral sling for stress urinary incontinence (SUI) using pelvic floor ultrasound. STUDY DESIGN This retrospective study included 152 female patients with SUI admitted to the Jinhua Central Hospital between January 2020 and December 2021 who were selected. All patients underwent midurethral transobturator tape sling procedures and were divided into success, voiding dysfunction, overactive bladder, and failure groups according to postoperative efficacy and complications. The pelvic floor ultrasound examination was performed before and after the surgery. RESULTS The posterior vesicourethral angle difference ( P < 0.01) was significantly lower after the surgery than before the surgery. The rate of bladder neck funneling ( P < 0.01) and the area of bladder neck funneling ( P < 0.01) were smaller after the surgery than before the surgery. The tape-longitudinal smooth muscle distance, the tape-symphysis pubis distance, the sling angle, and the tape-bladder neck/urethra increased successively in the voiding dysfunction, overactive bladder, success, and failure groups. CONCLUSIONS Pelvic floor ultrasound can accurately evaluate the postoperative efficacy and complications of transobturator tape sling procedures for SUI and can reasonably guide the management of complications. Therefore, it is an effective imaging method for postoperative follow-up after tension-free midurethral tape suspension.
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Affiliation(s)
- Yang Hu
- From the Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua
| | - Shuxu Zhu
- Shaoxing University Medical College, Shaoxing
| | - Yelin Lou
- Department of Ultrasonography, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua
| | - Heng Zhang
- From the Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua
| | - Ting Huang
- From the Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua
| | - Liping Xie
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, China
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Seval MM, Cetinkaya SE, Baydemir K, Varli B, Dokmeci F. Do the Ultrasonographic Measures of Midurethral Sling Location Relate With Surgical Outcomes? UROGYNECOLOGY (PHILADELPHIA, PA.) 2023:02273501-990000000-00156. [PMID: 38031319 DOI: 10.1097/spv.0000000000001434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
IMPORTANCE The proper placement of a midurethral sling (MUS) is the key factor for a successful surgical outcome. OBJECTIVE This study aimed to evaluate the relationship of perineal ultrasonographic measures of the tape location with subjective and objective outcomes after MUS surgery at midterm follow-up of women. METHODS The tape percentile (TP; total urethral length/bladder neck tape distance×100) and urethra tape distance (UTD; the shortest distance from the longitudinal smooth muscle complex of the urethra to the midpoint of the tape) were correlated with midterm surgical success. Patient satisfaction measured with the visual analog scale (VAS) was considered as the primary outcome. The presence of stress urinary incontinence on direct questioning, the Urinary Distress Inventory 6 (UDI-6) scores, findings of the cough stress test, free uroflowmetry, postvoid residual volume, and single-cycle voiding ambulatory urodynamic monitoring (AUM) were the other outcomes. RESULTS Seventy-eight women were evaluated at a mean follow-up of 4.4 ±3.3 years. Women who were highly satisfied (VAS ≥ 8) had a significantly higher TP (64.7% vs 50.8%, P < 0.001) and lower UTD (3.6 vs 4.5 mm, P = 0.018). Irritative, stress, and obstructive scores at UDI-6 increased as the tape was located closer to the bladder neck (P < 0.001, P < 0.001 and P = 0.044, respectively), and stress symptoms decreased with a tape closer to the urethra (P < 0.001). Women with detrusor overactivity at AUM were found to have a lower TP (P < 0.001). CONCLUSION The perineal ultrasonographic evaluation of tape location with UTD and TP seems to be well correlated with the women's midterm MUS surgical outcomes.
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Affiliation(s)
- Mehmet Murat Seval
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine
| | | | - Kaan Baydemir
- Department of Obstetrics and Gynecology, Lösante Children's and Adult Hospital, Ankara, Turkey
| | - Bulut Varli
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine
| | - Fulya Dokmeci
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine
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Vijay K, Kelley L, Pak T, Kuhlmann P, Patterson-Lachowicz A, Fetzer DT, Reynolds L, Carmel M, Zimmern P, Khatri G. Multimodality Imaging of Anterior Compartment Pelvic Floor Repair. Radiographics 2023; 43:e230032. [PMID: 37498784 DOI: 10.1148/rg.230032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are two common disorders that affect the anterior compartment of the pelvic floor in women. These can be treated conservatively or surgically. Among patients treated surgically, a substantial number present with pain, recurrent POP or SUI, or other conditions that warrant additional interventions. In many of these cases, imaging is key to identifying and characterizing the type of procedure performed, locating synthetic materials that may have been placed, and characterizing complications. Imaging may be particularly helpful when prior surgical records are not available or a comprehensive physical examination is not possible. US and MRI are the most commonly used modalities for such patients, although radiopaque surgical materials may be visible at voiding cystourethrography and CT. The authors summarize commonly used surgical treatment options for patients with SUI and POP, review imaging techniques for evaluation of such patients, and describe the normal imaging appearance and complications of pelvic floor surgical repair procedures in the anterior compartment of the pelvis. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Kanupriya Vijay
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Layne Kelley
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Taemee Pak
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Paige Kuhlmann
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Amber Patterson-Lachowicz
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - David T Fetzer
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Laura Reynolds
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Maude Carmel
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Philippe Zimmern
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Gaurav Khatri
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
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Gugliotta G, Schiattarella A, Giunta M, De Franciscis P, Polito S, Calagna G. Translabial ultrasound evaluation after tension-free transobturator tape technique: Outcomes based on the tape's position. Int J Gynaecol Obstet 2023; 160:214-219. [PMID: 35656763 PMCID: PMC10084178 DOI: 10.1002/ijgo.14295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/09/2022] [Accepted: 05/31/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the feasibility and accuracy of postoperative translabial ultrasound to assess the position of the tape implanted with the tension-free transobturator tape technique. METHODS We enrolled women with clinically and urodynamically proven type I or II stress urinary incontinence who were referred for transobturator tape treatment. RESULTS A total of 50 women underwent a transobturator tape procedure and were included in the analysis. We divided the patients into two study groups (group A and group B), characterized by normal and obstructed flow at least 30 days after the surgical procedure visit, respectively. We performed a translabial ultrasound evaluation to assess the suburethral localization of the sling. On the longitudinal scan, the distance between the bladder neck and the suburethral sling was >10 mm in all patients in group A (16.7 ± 1.6). On the contrary, the values in group B were ≤10 mm (5.3 ± 4.8). CONCLUSION Our findings highlight the role of a skilled sonographic operator performing translabial ultrasound as a first-line method for evaluating postoperative transobturator tape procedure and sling positioning. Moreover, translabial ultrasound could be helpful to determine a "cutoff" of the bladder neck to sling distance, as this is related to the onset of the obstruction.
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Affiliation(s)
- Giorgio Gugliotta
- Fondazione per gli Studi sulla Riproduzione Umana, Clinica Candela, Palermo, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Margherita Giunta
- Gynecology and Obstetrics Unit, "ARNAS Civico di Cristina" Hospital, Palermo, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Polito
- Gynecology and Obstetrics Unit, "Villa Sofia Cervello" Hospital, University of Palermo, Palermo, Italy
| | - Gloria Calagna
- Gynecology and Obstetrics Unit, "Villa Sofia Cervello" Hospital, University of Palermo, Palermo, Italy
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Alshiek J, Wei Q, Javadian P, Quiroz LH, Baumfeld Y, Shobeiri SA. The Correlation Between the Sonographic Course of Transobturator Slings and Sling-Related Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:125-133. [PMID: 35388919 DOI: 10.1002/jum.15982] [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: 11/23/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To determine whether transobturator slings follow a consistent path and whether there is an association between ultrasonographically visualized sling pattern or position with sling-related pain. METHODS This was a cross-sectional retrospective pilot study. We evaluated women who were presented to our clinic for pain or other urogynecologic symptoms following transobturator sling placement between 2009 and 2014. Patients had undergone a 3-dimensional endovaginal pelvic floor ultrasound, assessing minimal levator hiatus, antero-posterior diameter, left-right diameter, and the hiatal shape. The mesh patterns were categorized as seagull patterns (normal), lopsided, flat, and convoluted. RESULTS A total of 68 cases were reviewed. Fifty patients reported pain, and 18 did not. There were wide variations in the course of the slings. The sling center- minimal levator hiatus position ranged 14.8 mm below and 17.9 mm above the minimal levator hiatus. The lateral arm insertion points ranged between 17.1 mm below and 16.6 mm above the minimal levator hiatus. The right arm insertion points ranged between 9.6 mm below and 18.8 mm above the minimal levator hiatus. Thirty-five of 68 (70%) patients with pain and 13 of 18 (72.2%) without had abnormal sling patterns. The abnormal sling shape was not correlated with pain (P = 1). The levator shape trended toward a statistical significant correlation with sling shape abnormality (P = .084). CONCLUSIONS This population of women with transobturator sling complications demonstrated wide variations in anatomic paths. Neither the abnormal sling shape nor the distance of the center of the tape from the minimal levator hiatus level were correlated with pain.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, Falls Church, Virginia, USA
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Pouya Javadian
- Department of Obstetrics & Gynecology, the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Yael Baumfeld
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, Falls Church, Virginia, USA
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, INOVA Women's Hospital, Falls Church, Virginia, USA
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
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Hubka P, Masata J, Martan A, Dvorak J, Lincova M, Svabik K. Association between sonographic sling location and success of surgery for stress urinary incontinence. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022. [PMID: 36508434 DOI: 10.1002/uog.26142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine the relationship between the clinical outcome of suburethral sling surgery for stress urinary incontinence and sling location on ultrasound examination. METHODS This was a retrospective study of patients diagnosed with stress urinary incontinence who were treated with a suburethral sling by a single surgeon between January 2009 and October 2016. Four-dimensional volumes acquired on transperineal ultrasound at least 3 months postoperatively were analyzed and the gap between the sling and symphysis pubis (sling-pubis gap (SPG)) on Valsalva maneuver was measured. Continence was assessed on a cough stress test at follow-up. RESULTS A total of 378 patients were included, with a mean follow-up of 14.3 months. The success rate of sling surgery was 89.4%. The mean ± SD SPG on Valsalva maneuver was 12.0 ± 2.5 mm in women who were clinically continent at follow-up and 14.1 ± 2.8 mm in those with failed surgery (P < 0.001). CONCLUSION A shorter SPG on transperineal ultrasound imaging after suburethral sling surgery is associated with cure of stress urinary incontinence. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Hubka
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and Bulovka Hospital (FNB), Prague, Czech Republic
| | - J Masata
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague (VFN), Prague, Czech Republic
| | - A Martan
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague (VFN), Prague, Czech Republic
| | - J Dvorak
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague (VFN), Prague, Czech Republic
| | - M Lincova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and Bulovka Hospital (FNB), Prague, Czech Republic
| | - K Svabik
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague (VFN), Prague, Czech Republic
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García-Mejido JA, Blasco-Hernandez P, Fernandez-Conde C, García-Pombo S, Fernández-Palacín A, Borrero C, Sainz-Bueno JA. Are Transperineal Ultrasound Parameters Useful to Predict Incontinence in Patients with Single-Incision Mini-Slings? Tomography 2022; 8:2556-2564. [PMID: 36287812 PMCID: PMC9609347 DOI: 10.3390/tomography8050213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022] Open
Abstract
It would be logical to think that single-incision mini-slings (SIMS) should behave like the rest of the tension-free vaginal tape and, therefore, to believe that they present a similar ultrasound appearance, but there are no studies on this matter. Therefore, the main aim of our research is to determine which ultrasound parameters are associated with stress urinary incontinence (SUI) in patients carrying SIMS. A prospective observational study was carried out including 94 patients who were candidates for SUI corrective surgery with SIMS between 1 January 2021 to 31 December 2021 at the Universitary Hospital of Valme (Seville, Spain). A transperineal ultrasound evaluation was performed (six months after surgery) in order to study: the bladder neck–symphyseal distance, the posterior urethro–vesical angle, the pubic symphysis–tape gap, the tape–urethral lumen distance, the sagittal tape angle, the tape position, the concordance of movement between the tape and the urethra, and the axial tape angle. A total of 92 patients completed the study (63 asymptomatic and 29 symptomatic). Statistical differences were observed in the concordance of movement between the tape and the urethra (84.1% vs. 25.0%; p: 0.001) and in the axial tape angle at rest (139.3 ± 19.0 vs. 118.3 ± 15.4; p: 0.003) and at Valsalva (145.1 ± 20.2 vs. 159.1 ± 9.0; p: 0.034). Sagittal tape angle at rest was higher in urge urinary incontinence (UUI) patients (132.5 ± 35.7 vs. 143.3 ± 29.8; p: 0.001) and mixed urinary incontinence (MUI) patients (132.5 ± 35.7 vs. 157.8 ± 23.6; p: 0.025) compared to asymptomatic patients. In conclusion, the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to define continence in patients with SIMS.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, CP 41004 Seville, Spain
- Department of Obstetrics and Gynecology, Valme University Hospital, CP 41014 Seville, Spain
- Correspondence:
| | | | | | - Sara García-Pombo
- Department of Obstetrics and Gynecology, Valme University Hospital, CP 41014 Seville, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, CP 41004 Seville, Spain
| | - Carlota Borrero
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, CP 41004 Seville, Spain
- Department of Obstetrics and Gynecology, Valme University Hospital, CP 41014 Seville, Spain
| | - José Antonio Sainz-Bueno
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, CP 41004 Seville, Spain
- Department of Obstetrics and Gynecology, Valme University Hospital, CP 41014 Seville, Spain
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12
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Gillor M, Dietz HP. Twisting of transobturator midurethral slings: does it matter? Int Urogynecol J 2022; 33:2195-2201. [PMID: 35403884 DOI: 10.1007/s00192-022-05186-6] [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: 01/28/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We assessed rotation/twisting of transobturator midurethral slings (TOTs) and tested for associations with de novo chronic pain and voiding dysfunction. METHODS A retrospective pilot study including patients seen after Monarc™ TOT surgery at a single tertiary hospital in 2005-2016. Patients underwent an interview, clinical examination, uroflowmetry and 4D pelvic floor ultrasound. Volume datasets were analyzed blinded against all other data. Sling rotation/twisting was evaluated in volumes obtained at rest. The sling axis was measured relative to the vertical in the midline and in the most lateral parasagittal slice. Total sling rotation was calculated by summation of absolute angle differences between midline and lateral angles. "Corkscrew" rotation was noted when direction of rotation was opposite on the contra-lateral side. RESULTS The study included 215 patients. Fifty-two (24%) were excluded, leaving 163. Mean age was 57 years (28-87; SD 12), mean BMI 29.4 kg/m2 (18.3-47.4, SD 6). Follow-up was at a median of 17 months (IQR 11-27). Chronic de novo pain was reported by 15 women (9%; dyspareunia by 11 and pelvic/vaginal pain by 4). On imaging, mean total sling rotation was 144° (12-335, SD 56). In the majority (n = 103, 63%) it rotated counter-clockwise from its midline position and in 30 (18%) it rotated clockwise. "Corkscrew" rotation was noted in 30 (18%). De novo chronic pain was associated with lower BMI and vaginal sling exposure but not with sling rotation. The latter was not found to be associated with voiding dysfunction either. CONCLUSIONS Monarc™ TOTs rotate considerably throughout their course. The degree of twisting or rotation and its direction was not found to be associated with de novo postoperative chronic pain or voiding dysfunction.
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Affiliation(s)
- Moshe Gillor
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Affiliated to the Hebrew University and Hadassah School of Medicine in Jerusalem, 76100, Rehovot, Israel. .,University of Sydney, Sydney, NSW, Australia.
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13
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Pawlaczyk A, Wąż P, Matuszewski M. Comparison of retropubic tension-free vaginal tape inserted on two different height positions. Int Urogynecol J 2022; 33:931-937. [PMID: 35037974 PMCID: PMC9021049 DOI: 10.1007/s00192-021-05056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 11/23/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Surgical treatment using the mid-urethral tape has become a gold standard in the treatment of stress urinary incontinence in women. Many urogynecologists use ultrasound during the postoperative follow-up. The aim of this study was to investigate whether the position of the tape in the mid- or distal-urethra could influence the subjective assessment after surgery in 1-month control based on questionnaires of genitourinary symptoms, UDI6-SF and VAS scale. METHODS A group of 76 patients using a synthetic tension-free retropubic vaginal tape after anti-incontinence surgery was retrospectively included in this study. In a postoperative follow-up, the synthetic tape detection was performed using introital ultrasound, and its position was determined as a quotient T/U (T = distance between the external urethral orifice and the lower edge of the tape, U = urethral length). The patients were divided into two groups of 38 patients: one group with the position of the tape in the distal urethra (T/U ≤ 0.24) and the other group with the tape localised in the mid-urethra (T/U = 0.25-0.37). The correlation between the height of the tape position and the subjective assessment was evaluated in both groups of patients in the 1-month control. RESULTS No association was found between the height of the tape position in a group of patients after anti-incontinence surgery with a T/U value not exceeding 0.375 and the subjective assessment or the value of Vres. CONCLUSIONS The height of the tape position, with the T/U not exceeding 0.375, has no impact on the subjective assessment of the surgical anti-incontinence treatment in 1-month control.
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Affiliation(s)
- Anna Pawlaczyk
- Department of Urology, Medical University of Gdansk, ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland.
| | - Piotr Wąż
- Department of Nuclear Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Matuszewski
- Department of Urology, Medical University of Gdansk, ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland
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Cristina EG, Lorena SM, Rita PG, Santiago GME, Salvador JLJ. Construction of a Prognostic Score for Ultrasound Evaluation of the Transobturator Sling for Stress Urinary Incontinence. J Clin Med 2022; 11:jcm11051296. [PMID: 35268387 PMCID: PMC8910975 DOI: 10.3390/jcm11051296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Currently, pelvic floor ultrasound allows us to correctly visualize the synthetic material used in stress urinary incontinence surgery. The objective of this study is the construction of a score and its correlation with the SUU clinic. During the study period, 81 patients with transobturator slings were studied using ultrasound. Through multivariate analysis, the statistically significant variables were the distance from the sling to the urethral wall (p = 0.004), the shape of the sling at rest (p = 0.003), and the symmetry of the mesh (p = 0.016). Through these variables, the construction of a score was carried out. Once the model was constructed, its internal validation was carried out to determine the discrimination capacity of patients who present clinical stress and those who do not, with an area under the curve of 0.848 (95% CI (0.72−0.97), p < 0.001). This simple score using three ultrasound variables serves to adequately and objectively discriminate patients who have successful surgery and absence of clinical effort.
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Affiliation(s)
- Espada-Gonzalez Cristina
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Málaga, 29010 Malaga, Spain; (E.-G.C.); (G.-M.E.S.); (J.-L.J.S.)
- Department of Gynecology and Obstetrics, Quiron Salud Hospital of Malaga, 29004 Malaga, Spain
| | - Sabonet-Morente Lorena
- Department of Gynecology and Obstetrics, Regional Universitary Hospital of Malaga, 29011 Malaga, Spain
- Correspondence:
| | - Perez-Gonzalez Rita
- Statistics Department, The Institute of Biomedical Research of Málaga (IBIMA), Regional Universitary Hospital of Malaga, 29011 Malaga, Spain;
| | - Gonzalez-Mesa Ernesto Santiago
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Málaga, 29010 Malaga, Spain; (E.-G.C.); (G.-M.E.S.); (J.-L.J.S.)
- Department of Gynecology and Obstetrics, Regional Universitary Hospital of Malaga, 29011 Malaga, Spain
| | - Jimenez-Lopez Jesus Salvador
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Málaga, 29010 Malaga, Spain; (E.-G.C.); (G.-M.E.S.); (J.-L.J.S.)
- Department of Gynecology and Obstetrics, Regional Universitary Hospital of Malaga, 29011 Malaga, Spain
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15
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Ram R, Jambhekar K, Glanc P, Steiner A, Sheridan AD, Arif-Tiwari H, Palmer SL, Khatri G. Meshy business: MRI and ultrasound evaluation of pelvic floor mesh and slings. Abdom Radiol (NY) 2021; 46:1414-1442. [PMID: 31960120 DOI: 10.1007/s00261-020-02404-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pelvic floor disorders are a complex set of conditions including but not limited to stress urinary incontinence and pelvic organ prolapse that generally affect older and multiparous women. Of the several surgical options available for treatment of these conditions, synthetic mid-urethral slings for stress urinary incontinence and vaginal mesh for pelvic organ prolapse are amenable to imaging evaluation by ultrasound and magnetic resonance imaging techniques. Ultrasound can evaluate the sub- and immediate peri-urethral portions of sling due to its ability to differentiate synthetic material from native tissues with real-time imaging, while MRI is able to better depict the global pelvic floor anatomy and assess the more distant components of mesh and slings material. Given the high prevalence of pelvic floor disorders and complications after surgical repair, it is important that radiologists familiarize themselves with normal and abnormal imaging findings after these procedures. This article provides a review of the spectrum of imaging findings in patients after pelvic floor repair with synthetic mid-urethral slings and vaginal mesh.
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16
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Shek KL, Dietz HP. Ultrasound imaging of slings and meshes in urogynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:526-538. [PMID: 33206433 DOI: 10.1002/uog.23545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
Imaging is used increasingly in urogynecology. One of the main applications is in the assessment of synthetic implants. Ultrasound is particularly useful for this purpose as most such implants appear highly echogenic on ultrasound but are not visible using other imaging techniques. The worldwide success of synthetic mid-urethral slings, introduced in the late 90s, led to the subsequent introduction of transvaginal mesh in 2003-2004. Widespread use of synthetic implants for both urinary incontinence and prolapse has caused a rise in implant-related complications and increasing negative publicity and litigation, with many products removed from the market. It is not surprising that there is increasing demand for the assessment and evaluation of sling and mesh implants using imaging. This review article discusses the role of translabial/transperineal ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse. The discussion focuses on those applications of the technique that are useful for surgeons dealing with patients after mesh and/or sling placement. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K L Shek
- Liverpool Hospital, Western Sydney University, Liverpool, Australia
- Nepean Clinical School, University of Sydney, Penrith, Australia
| | - H P Dietz
- Nepean Clinical School, University of Sydney, Penrith, Australia
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17
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Bahrami S, Khatri G, Sheridan AD, Palmer SL, Lockhart ME, Arif-Tiwari H, Glanc P. Pelvic floor ultrasound: when, why, and how? Abdom Radiol (NY) 2021; 46:1395-1413. [PMID: 31529202 DOI: 10.1007/s00261-019-02216-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pelvic floor disorders are a significant medical issue, reportedly affecting nearly one in four women in the United States. Nonetheless, until the last decade, there has been relatively limited imaging research into this highly prevalent disorder. The three major imaging modalities utilized to assess pelvic floor function are ultrasound, MRI and fluoroscopy. Pelvic floor ultrasound is a rapidly emerging technique which takes advantage of the widespread availability of ultrasound, the non-invasive and relatively inexpensive approach and the incorporation of real-time imaging and software advances which permit 3-D volume imaging. Pelvic floor ultrasound provides the opportunity to optimize patient counseling and enhance pre-operative planning by providing an anatomic and functional roadmap for the referring clinician. We recommend the consideration of pelvic floor ultrasound, as described here, as an addition to the imaging armamentarium available to physicians and surgeons serving this patient population.
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Taithongchai A, Pandeva I, Sultan AH, Thakar R. Association between 3D endovaginal and 2D perineal pelvic floor ultrasound findings and symptoms in women presenting with mid-urethral sling complications. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:639-646. [PMID: 32959432 DOI: 10.1002/uog.23130] [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: 04/13/2020] [Revised: 09/05/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To present the characteristics of women attending a tertiary urogynecology pelvic floor scan clinic with mid-urethral sling (MUS) complications and examine the association between patient symptoms and findings on two-dimensional (2D) perineal and three-dimensional (3D) endovaginal ultrasound. METHODS This was a cross-sectional study of all women with MUS complications referred to a specialist pelvic floor ultrasound clinic between October 2016 and October 2018. Detailed history was obtained regarding their symptoms and time of onset. All patients underwent 2D perineal and 3D endovaginal ultrasound assessment. The association between patient symptoms and ultrasound findings was evaluated using logistic regression analysis. Only symptomatic women with a single MUS, without other pelvic floor mesh, prior mesh excision or bulking agents, were included in the regression analysis. RESULTS A total of 311 women with a history of MUS surgery were seen during the study period. Vaginal and/or non-vaginal pain was reported by 80% of patients and this was the primary presenting complaint in 59% of the patients. One-third of the patients reported symptoms starting within 4 weeks after surgery. The data of 172 patients were included in the regression analysis. MUS position within the rhabdosphincter was significantly associated with voiding dysfunction (odds ratio (OR), 10.6 (95% CI, 2.2-50.9); P = 0.003). Voiding dysfunction was highest in those with C-shaped MUS both at rest and on Valsalva maneuver (OR, 3.2 (95% CI, 1.3-7.6); P < 0.001). MUS position in the distal third of the urethra was significantly associated with a higher rate of recurrent urinary tract infection (OR, 2.9 (95% CI, 1.3-6.3); P = 0.01). CONCLUSIONS Pelvic floor ultrasound can provide insight into the position and shape of the MUS, which could explain some patient symptoms and guide management or surgical planning. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Taithongchai
- Croydon Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, London, UK
| | - I Pandeva
- Croydon Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, London, UK
| | - A H Sultan
- Croydon Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, London, UK
| | - R Thakar
- Croydon Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, London, UK
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Mahfouz W, Moussa A, Elbadry M. Adjustment of tension applied in transobturator tapes in females with intrinsic sphincteric deficiency: Two centers' prospective, comparative, randomized surgical trial. Urol Ann 2021; 13:134-141. [PMID: 34194139 PMCID: PMC8210713 DOI: 10.4103/ua.ua_73_20] [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: 05/03/2020] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Stress incontinence is the most common type of urinary incontinence in females. Recently, the gold standard treatment is mid-urethral tapes, however their efficacy is questioned in intrinsic sphincter deficiency (ISD). In our study, we try to adjust the tension applied during transobturator tapes (TOT) to evaluate its effectiveness in ISD, in order to prevent obstruction or failure and persistence of stress urinary incontinence. MATERIALS AND METHODS This study was prospectively conducted on eighty female patients having ISD, presenting at the Urology Departments in Alexandria and Minia University Hospitals. The patients were randomly assigned to two groups, with Group I including forty patients, who underwent TOT using tension-free technique, and Group II including forty patients using our new tension adjustment technique under saddle anesthesia. Patients filled the International Continence Questionnaire and Urinary Distress Inventory and did pressure flow study pre- and postoperatively. Postoperatively, the patients filled Patient Global Impression of Improvement and underwent translabial ultrasound (U/S) to estimate the distance between the tape and the urethra. RESULTS In Group I, 70% of the patients were cured with mean Valsalva leak point pressure (VLPP) of 51.43 ± 3.39 preoperatively, 20% were not improved, and 10% were improved with a mean VLPP of 44.5 ± 3.54 preoperatively, which increased to 86 ± 4.24 postoperatively. In Group II, 95% of the patients were cured with a mean VLPP of 50.74 cmH2O ± 6.56 preoperatively and 5% improved but not cured with a mean VLPP of 31 cmH2O preoperatively, which increased to 127 cmH2O at a bladder capacity of 400 ml. All patients in both groups underwent translabial U/S 6 months postoperatively. The distance between the mid-tape and the outer urethra measured by translabial US showed no significant difference between the two studied groups. CONCLUSION Performing TOT using our tensioned proposed technique in ISD seems to be effective and with low morbidity. Intraoperative adjustment of tension using Valsalva maneuver under saddle anesthesia gives better outcomes than the conventional tension-free technique. The concept of tension-free vaginal tape should be challenged.
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Affiliation(s)
- Wally Mahfouz
- Department of Urology, Alexandria University, Alexandria, Egypt
| | - Ahmed Moussa
- Department of Urology, Alexandria University, Alexandria, Egypt
| | - Mohamed Elbadry
- Urology and Nephrology Center, Minia University, Minya, Egypt
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Abstract
PURPOSE OF REVIEW After the Food and Drug Administration Public Health Notification in 2011 regarding transvaginal mesh, there has been a decline in the use of mid-urethral slings (MUS). However, they are an effective treatment option for stress urinary incontinence (SUI) with minimal complications. The management of recurrent SUI after sling continues to be debated. RECENT FINDINGS Long-term follow-up after primary MUS confirms its efficacy and safety. There remains no level 1 evidence for the best next step after a failed MUS. Preferred treatment strategies include placing a repeat MUS with more recent evidence demonstrating no difference in cure rates between transobturator tape and retropubic approach. Pubovaginal slings (PVS) and urethral bulking agents are also acceptable treatment options. A newer bulking agent, polyacrylamide hydrogel, demonstrated excellent short-term success rates in patients after a failed sling. SUMMARY MUS is an effective treatment option for SUI. Patients who develop recurrent urinary incontinence are a heterogeneous population who must be evaluated for detrusor overactivity, misplaced sling, unrecognized ISD. Patients with ISD are more likely to benefit by a PVS. Other patients with demonstrated recurrent SUI will likely do well with a repeat MUS.
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21
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Duckett J, Thakar R, Shah V, Stephenson J, Balachandran A. The Use of Imaging for Synthetic Midurethral Slings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1497-1506. [PMID: 32125008 DOI: 10.1002/jum.15254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
Ultrasound and magnetic resonance imaging can be used to image midurethral slings, which have may have complications such as pain. There is considerable misunderstanding regarding the utility of the different modalities. This article aims to review the current literature to identify the benefits and limitations of each imaging modality and identify the place that each should have for patients with midurethral sling complications. A literature search was performed, and all relevant articles were identified and reviewed. Different imaging modalities are complementary, but more research is required in this area.
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Affiliation(s)
- Jonathan Duckett
- Department of Obstetrics and Gynecology, Medway Maritime Hospital, Gillingham, Kent, England
| | - Ranee Thakar
- Croydon Urogynecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, Surrey, England
| | - Vikas Shah
- Gastrointestinal Imaging Group, Glenfield General Hospital, University Hospitals of Leicester, Leicester, England
| | - James Stephenson
- Gastrointestinal Imaging Group, Glenfield General Hospital, University Hospitals of Leicester, Leicester, England
| | - Aswini Balachandran
- Croydon Urogynecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, Surrey, England
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Serdinsek T, Martan A, Svabik K, But I, Kolek P, Masata J. Is the fixation of single incision TVT-S tape as good as that of transobturator tape? An ultrasound study of randomized trial results. Int Urogynecol J 2020; 32:141-148. [DOI: 10.1007/s00192-020-04390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
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Tan YH, Frazer MI, Hughes I, Wong V. Correlation between translabial ultrasound parameters and outcomes in retropubic mid-urethral slings: can we predict success? World J Urol 2020; 39:163-168. [PMID: 32193651 DOI: 10.1007/s00345-020-03153-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/29/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to assess the association between four-dimensional translabial ultrasound (4D-TLUS) features of the retropubic mid-urethral sling (MUS) and post-operative pelvic floor symptoms. METHODS A prospective cohort study was performed involving 100 women who had a solitary retropubic MUS (TVT Exact™) between Jan 2013 and Dec 2017 for urodynamic stress incontinence (SI) at a tertiary urogynaecological centre. All patients completed a standardised interview and had free flowmetry, prolapse evaluation and assessment for mesh exposure and tenderness. 4D-TLUS parameters measured included pelvic organ descent, levator ani status, sling-symphysis pubis (SP) gap at rest and Valsalva, angle formed by cranial and caudal ends of the sling, cranio-caudal and dorso-ventral sling-symphysis pubis distance at Valsalva. The primary outcome was treatment success as defined by patient report of cure or improvement and no objective demonstrable SI. RESULTS Eighty-nine (89%) patients reported treatment success. Two patients (2%) had mesh exposure; one was symptomatic with pain, requiring complete sling removal. There was a significant association between treatment success and a SP gap at Valsalva of 10-12 mm (p = 0.001); and independently with a SP angle at Valsalva of 45°-80° (p = 0.007). A narrower SP gap at Valsalva closer to 10 mm was associated with voiding symptoms (p = 0.036). CONCLUSION Sling-pubis gap and sling-pubis angle at Valsalva appear to be significantly associated with treatment success in retropubic MUS. There is a significant association between a narrower sling-pubis gap at Valsalva and voiding symptoms.
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Affiliation(s)
- Yu Hwee Tan
- Robina Hospital, 2 Bayberry Lane, Robina, QLD, 4226, Australia.
- Department of Urogynaecology, Varsity Lakes Day Hospital, 2 Lake Street, Varsity Lakes, QLD, 4227, Australia.
| | - Malcolm I Frazer
- Robina Hospital, 2 Bayberry Lane, Robina, QLD, 4226, Australia
- Department of Urogynaecology, Varsity Lakes Day Hospital, 2 Lake Street, Varsity Lakes, QLD, 4227, Australia
| | - Ian Hughes
- Gold Coast University Hospital, Southport, QLD, 4215, Australia
| | - Vivien Wong
- Robina Hospital, 2 Bayberry Lane, Robina, QLD, 4226, Australia
- Department of Urogynaecology, Varsity Lakes Day Hospital, 2 Lake Street, Varsity Lakes, QLD, 4227, Australia
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Giarenis I, Anding R, Chermansky C, Greenwell T, Cardozo L, Harding C. Do we have adequate data to construct a valid algorithm for management of synthetic midurethral sling complications? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S122-S131. [PMID: 32022954 DOI: 10.1002/nau.24299] [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: 11/19/2019] [Accepted: 01/14/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Synthetic midurethral sling (MUS) procedures, purported for the last two decades as the gold standard surgical treatment for stress urinary incontinence, have been in creasingly scrutinized in recent years with regard to the rate and severity of complications. METHODS During the International Consultation on Incontinence Research Society meeting held in Bristol, UK, in 2019, a multidisciplinary panel held a think tank and discussed the contemporary evidence pertaining to the classification, investigation, and treatment of MUS complications. RESULTS The current classification system of mesh-related complications was discussed, and shortcomings were identified. The lack of a standardized clinical pathway was noted, and the value of clinical investigations and surgical treatments was difficult to fully evaluate. The paucity of high-level evidence was a common factor in all discussions, and the difficulties with setting up relevant randomized-controlled trials were highlighted. CONCLUSIONS The outcome of the think-tank discussions is summarized with a set of recommendations designed to stimulate future research.
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Affiliation(s)
- Ilias Giarenis
- Department of Urogynaecology, Norfolk and Norwich Hospital, Norwich, UK
| | - Ralf Anding
- Department of Neurourology/Urology, Bonn and Neurological Rehabilitation Center "Godeshöhe" e.V., University Clinic, Friedrich Wilhelms University, Bonn, Germany
| | - Christopher Chermansky
- Department of Female Pelvic Medicine and Reconstructive Urology, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Christopher Harding
- Department of Urology, Freeman Hospital, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
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Pędraszewski P, Wlaźlak E, Wlaźlak W, Krzycka M, Pająk P, Surkont G. The role of TVT position in relation to the pubic symphysis in eliminating the symptoms of stress urinary incontinence and urethral funneling. J Ultrason 2019; 19:207-211. [PMID: 31807326 PMCID: PMC6856951 DOI: 10.15557/jou.2019.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/11/2019] [Indexed: 11/22/2022] Open
Abstract
The introduction of suburethral sling was a breakthrough in the treatment of stress urinary incontinence in women. The method is highly effective. However, the mechanism of action of a sling and the reasons for surgical failures are not fully understood. Aim: The aim of the study was to assess the impact of sling-pubic symphysis distance on eliminating the symptoms of stress urinary incontinence and urethral funneling. Materials and methods: The analysis included 106 patients who reported 3 to 6 months after sling placement for a follow-up visit encompassing clinical examination and standard ultrasonography. We evaluated the position of sling in relation to the pubic symphysis, urethral length, as well as urethral funneling length and width. Results: Cure criteria were met by 91 patients. Elimination of urethral funneling was achieved in 76.9% (n = 70) of cured patients. Urethral funneling was still present, yet shorter by a mean of 10.2 mm (p = 0.02) than before surgery in the remaining cured patients. There was a 32.5% reduction in the mean relative length of urethral funneling (p = 0.002). No significant differences were found in the pre- and postoperative funneling width. The tape-pubic symphysis distance was lower in cured women: 23.2 mm vs. 26.1 mm in failed women (p = 0.04). Similar observations were made for cured patients with persistent urethral funneling vs. failed patients (22.47 mm vs. 26.0 mm, p = 0.027). There were no differences between cured patients without urethral funneling and cured patients with persistent postoperative funneling (23.5 mm; 22.5 mm; p = 0.417). Conclusions: Tape position in relation to the pubic symphysis is important for the elimination of stress urinary incontinence. Sling location closer to the pubic symphysis reduces the length of urethral funneling, but has no effects on its width in cured patients with persistent postoperative funneling.
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Affiliation(s)
- Piotr Pędraszewski
- Department of Gynecology and Obstetrics, Provincial Integrated Hospital in Płock, Płock, Poland
| | - Edyta Wlaźlak
- First Department of Gynecology and Obstetrics, Clinic for Gynecological Surgery and Oncology, Medical University of Lodz, Lodz, Poland
| | - Wiktor Wlaźlak
- First Department of Gynecology and Obstetrics, Clinic for Gynecological Surgery and Oncology, Medical University of Lodz, Lodz, Poland
| | - Magda Krzycka
- First Department of Gynecology and Obstetrics, Clinic for Gynecological Surgery and Oncology, Medical University of Lodz, Lodz, Poland
| | - Paulina Pająk
- First Department of Gynecology and Obstetrics, Clinic for Gynecological Surgery and Oncology, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Surkont
- First Department of Gynecology and Obstetrics, Clinic for Gynecological Surgery and Oncology, Medical University of Lodz, Lodz, Poland
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Taithongchai A, Sultan AH, Wieczorek PA, Thakar R. Clinical application of 2D and 3D pelvic floor ultrasound of mid-urethral slings and vaginal wall mesh. Int Urogynecol J 2019; 30:1401-1411. [DOI: 10.1007/s00192-019-03973-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/22/2019] [Indexed: 12/22/2022]
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Pawlaczyk A, Wąż P, Matuszewski M. Introital ultrasound in the diagnosis of lower urinary tract symptoms following anti-incontinence surgery using a synthetic midurethral tape. Int Urogynecol J 2018; 30:1503-1508. [PMID: 30564870 PMCID: PMC6706474 DOI: 10.1007/s00192-018-3837-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Surgical treatment of stress urinary incontinence in women using a synthetic midurethral tape has become a standard procedure. One of the complications observed postoperatively are lower urinary tract symptoms (LUTS). The aim was to analyze the role of introital ultrasound in the identification of patients at risk for developing LUTS after surgical treatment using synthetic tape. METHODS A group of 50 patients suffering from LUTS following anti-incontinence surgery using synthetic tape was included in this study. The patients with pelvic organ prolapse and coexisting overactive bladder-wet before surgery were excluded. The control group consisted of 50 patients after the same treatment without any complications and with a good outcome. Tape visualization was performed using introital two-dimensional ultrasound. The assessment of the Tape Index (T/U) enabled us to divide the study group into the two subgroups with the tape index value of 0.375 as a borderline. The correlation between the tape position and the occurrence of LUTS was evaluated using a Chi-squared test. RESULTS In the group of patients suffering from LUTS, the tape was found to be closer to the bladder neck (the lower edge of the tape was more than 37.5% of the urethral length) and it was statistically significant (Chi-squared = 19.87, p < 0.001). CONCLUSIONS The tape position in the proximal urethra may have an impact on the postoperative occurrence of LUTS. The simple method of introital ultrasound could allow the identification of patients at risk for the development of LUTS after anti-incontinence surgery using synthetic tape.
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Affiliation(s)
- Anna Pawlaczyk
- Department of Urology, Medical University of Gdansk, Gdansk, Poland. .,Klinika Urologii UCK, ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland.
| | - Piotr Wąż
- Department of Nuclear Medicine, Medical University of Gdansk, Gdansk, Poland
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Lo TS, Chua S, Tan YL, Patrimonio MC, Pue LB. Ultrasonography and clinical outcomes following anti-incontinence procedures (Monarc vs MiniArc): A 3-year post-operative review. PLoS One 2018; 13:e0207375. [PMID: 30513097 PMCID: PMC6279016 DOI: 10.1371/journal.pone.0207375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/30/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the ultrasonographic positional changes of mid-urethral sling(MUS) tape in relation to symphysis pubis, and the different clinical outcomes among women who underwent MUS insertion with MiniArcTM or MonarcTM for the treatment of stress urinary incontinence 3 years after. Materials and methods A retrospective follow-up study on patients with clinically confirmed stress urodynamic incontinence and urodynamic stress incontinence who had undergone MiniArc or Monarc surgery. Data regarding preoperative evaluation, intraoperative complications and post-operative follow-ups were collated. Main outcome is to determine the change in position of the sling through measurement of the x- and y-axis at rest and during Valsalva maneuver using the 3D introital ultrasound. Results A total of 138 patients were evaluated, 82 belonged to Monarc and 56 to MiniArc. At 3years, objective and subjective cure rates for MiniArc and Monarc were comparable (88%, 91%; p>0.05; 83%, 89%, p>0.05 respectively). Ultrasonographic changes between MiniArc and Monarc from 6 months to 3 years, showed MiniArc to exhibit significant movement in both x- [3.0 ±0.4 mm vs. 2.2 ±0.3 mm (p = 0.02) at rest; 2.6 ±0.3 mm vs. 1.6 ±0.3 mm (p<0.001) during valsalva] and y-axis [3.5 ±0.5 mm vs. 2.0 ±0.3 mm (p<0.001) at rest; 3.3 ±0.5 mm vs. 2.9 ±0.3 mm (p = 0.037) during Valsalva]. The mobility of MiniArc was significantly more than Monarc from rest to Valsalva (1.1 ±0.4 mm vs. 0.3 ±0.3 mm, p = 0.001). Tightness of the sling assessed from the major and minor axis of the urethral core had no significant difference in both groups at rest and during Valsalva. Urethral kinking percentage and the location of the sling did not yield statistical difference. Conclusion Maintenance of continence rates of mid-urethral slings depends on the compressive effect of the sling on the urethra, urethral kinking, and sling fixation. From 6months to 3 years, MiniArc changed its position in both x- and y-axis over time, which the authors attribute to loosening of the anchoring mechanism since no clinical relevance could be sought.
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Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, Keelung, Taiwan, Republic of China
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China
- Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China
- * E-mail:
| | - Sandy Chua
- Fellow, Division of Urogynecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China
- Department of Obstetrics and Gynecology, Cebu Institute of Medicine- Cebu Velez General Hospital, Cebu City, Philippines
| | - Yiap Loong Tan
- Department of Obstetrics & Gynecology, Kuching Specialist Hospital, KPJ Healthcare, Kuching, Sarawak, Malaysia
| | - Ma. Clarissa Patrimonio
- Fellow, Division of Urogynecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China
- Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippine
| | - Leng Boi Pue
- Department of Obstetrics & Gynecology, Subang Jaya Medical Center, Ramsay Sime Darby Health Care, Selangor, Malaysia
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Benson CB, Phillips CH. Translabial US Assessment of Midurethral Slings: Providing Clarity on a Stressful Situation. Radiology 2018; 289:728-729. [PMID: 30106338 DOI: 10.1148/radiol.2018181536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carol B Benson
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Catherine H Phillips
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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Wen L, Shek KL, Subramaniam N, Friedman T, Dietz HP. Correlations between Sonographic and Urodynamic Findings after Mid Urethral Sling Surgery. J Urol 2018; 199:1571-1576. [DOI: 10.1016/j.juro.2017.12.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Lieming Wen
- Second Xiangya Hospital, Central South University, Changsha Huna, China
| | - Ka Lai Shek
- Liverpool Clinical School, Western Sydney University, Liverpool, New South Wales, Australia
- Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia
| | | | - Talia Friedman
- Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia
| | - Hans Peter Dietz
- Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia
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Nambiar AK, Bosch R, Cruz F, Lemack GE, Thiruchelvam N, Tubaro A, Bedretdinova DA, Ambühl D, Farag F, Lombardo R, Schneider MP, Burkhard FC. EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence. Eur Urol 2018; 73:596-609. [PMID: 29398262 DOI: 10.1016/j.eururo.2017.12.031] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/27/2017] [Indexed: 11/28/2022]
Abstract
CONTEXT The European Association of Urology guidelines on urinary incontinence (UI) have been updated in cyclical fashion with successive major chapters being revised each year. The sections on assessment, diagnosis, and nonsurgical treatment have been updated as of mid-2016. OBJECTIVE We present a condensed version of the full guideline on assessment and nonsurgical management of UI, with the aim of improving accessibility and increasing their dissemination. EVIDENCE ACQUISITION Our literature search was updated from the previous cut-off of July 2010 up to April 2016. Evidence synthesis was carried out by a pragmatic review of current systematic reviews and any newer subsequent high-quality studies, based on Population, Interevention, Comparator, and Outcome questions. Appraisal was conducted by an international panel of experts, working on a strictly nonprofit and voluntary basis, to develop concise evidence statements and action-based recommendations using modified Oxford and GRADE criteria. EVIDENCE SYNTHESIS The guidelines include algorithms that summarise the suggested pathway for standard, uncomplicated patients with UI and are more useable in daily practice. The full version of the guideline is available at http://uroweb.org/guideline/urinary-incontinence/. CONCLUSIONS These updated guidelines provide an evidence-based summary of the assessment and nonsurgical management of UI, together with a clear clinical algorithm and action-based recommendations. Although these guidelines are applicable to a standard patient, it must be remembered that therapy should always be tailored to individual patients' needs and circumstances. PATIENT SUMMARY Urinary incontinence is a very common condition which negatively impacts patient's quality of life. Several types of incontinence exist and since the treatments will vary, it is important that the diagnostic evaluation establishes which type is present. The diagnosis should also identify patients who need rapid referral to an appropriate specialist. These guidelines aim to provide sensible and practical evidence-based guidance on the clinical problem of urinary incontinence.
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Affiliation(s)
- Arjun K Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK.
| | - Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Francisco Cruz
- Department of Urology, Hospital São João/Faculty of Medicine of Porto, Porto, Portugal
| | - Gary E Lemack
- Department of Urology, University of Texas Southwestern Medical Centre, TX, USA
| | - Nikesh Thiruchelvam
- Urology Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Andrea Tubaro
- Department of Urology, La Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | | | - David Ambühl
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Riccardo Lombardo
- Department of Urology, La Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Marc P Schneider
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Fiona C Burkhard
- Department of Urology, University Hospital Bern, Bern, Switzerland
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Dresler MM, Kociszewski J, Wlaźlak E, Pędraszewski P, Trzeciak A, Surkont G. Repeatability and reproducibility of measurements of the suburethral tape location obtained in pelvic floor ultrasound performed with a transvaginal probe. J Ultrason 2017; 17:101-105. [PMID: 28856017 PMCID: PMC5516079 DOI: 10.15557/jou.2017.0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/08/2017] [Accepted: 02/12/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Implants used to treat patients with urogynecological conditions are well visible in US examination. The position of the suburethral tape (sling) is determined in relation to the urethra or the pubic symphysis. Aim of the study The study was aimed at assessing the accuracy of measurements determining suburethral tape location obtained in pelvic US examination performed with a transvaginal probe. Material and methods The analysis covered the results of sonographic measurements obtained according to a standardized technique in women referred for urogynecological diagnostics. Data from a total of 68 patients were used to analyse the repeatability and reproducibility of results obtained on the same day. Results The intraclass correlation coefficient for the repeatability and reproducibility of the sonographic measurements of suburethral tape location obtained with a transvaginal probe ranged from 0.6665 to 0.9911. The analysis of the measurements confirmed their consistency to be excellent or good. Conclusions Excellent and good repeatability and reproducibility of the measurements of the suburethral tape location obtained in a pelvic ultrasound performed with a transvaginal probe confirm the test’s validity and usefulness for clinical and academic purposes.
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Affiliation(s)
- Maria Magdalena Dresler
- Ultrasound Diagnostics Laboratory, Division of Operative Gynecology and Gynecologic Oncology, Gynecology and Obstetrics Department, Medical University of Łódź, Poland
| | - Jacek Kociszewski
- Frauenklinik, Evangelisches Krankenhaus Hagen-HaspeGmbH, Hagen, Germany
| | - Edyta Wlaźlak
- Ultrasound Diagnostics Laboratory, Division of Operative Gynecology and Gynecologic Oncology, Gynecology and Obstetrics Department, Medical University of Łódź, Poland
| | - Piotr Pędraszewski
- Gynecology and Obstetrics Unit, Voivodeship Hospital Complex, Płock, Poland
| | | | - Grzegorz Surkont
- Ultrasound Diagnostics Laboratory, Division of Operative Gynecology and Gynecologic Oncology, Gynecology and Obstetrics Department, Medical University of Łódź, Poland
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Takacs P, Larson K, Scott L, Cunningham TD, DeShields SC, Abuhamad A. Transperineal Sonography and Urodynamic Findings in Women With Lower Urinary Tract Symptoms After Sling Placement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:295-300. [PMID: 27925696 DOI: 10.7863/ultra.16.02076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate dynamic 2-dimensional (2D) transperineal pelvic sonographic findings and urodynamic studies in women with lower urinary tract symptoms after midurethral sling placement. METHODS Transperineal pelvic sonography and urodynamic studies were reviewed from women with a midurethral sling and lower urinary tract symptoms. The shape and sonographic dynamic change of the sling from the rest position to the maximum Valsalva maneuver and back to rest were recorded. Patients were categorized into 3 groups: group I, at rest, the sling lies parallel to the urethral lumen, and during Valsalva, the sling becomes C shaped; group 2, both at rest and during Valsalva, the sling runs parallel to the urethral lumen; and group 3, at rest, the sling is C shaped, and during Valsalva, this curved shape is maintained. For analytical purposes group 3 was compared with groups 1 and 2. Multiple logistic regressions were used to evaluate the association between transperineal pelvic sonography and urodynamic studies. RESULTS Seventy-seven women were enrolled. The detrusor pressure at the maximum flow rate was significantly higher in group 3 than groups 1 and 2 (mean ± SD, 36 ± 16 versus 19 ± 11 mm H2 O; P < .001). The odds of high detrusor pressure (>20 mm H2 O) in group 3 was approximately 12 times the odds of those in groups 1 and 2. After adjusting for other variables using a multiple logistic regression analysis, a statistically significant association between group 3 and high detrusor pressure persisted (odds ratio, 29.7; 95% confidence interval, 2.949-299.6; P = .0040) persisted. CONCLUSIONS Transperineal dynamic 2D sonography can help predict women with high-pressure voiding after midurethral sling placement and aid in the diagnosis of bladder outlet obstruction.
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Affiliation(s)
- Peter Takacs
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Kindra Larson
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Lauren Scott
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Tina D Cunningham
- Center for Health Analytics and Discovery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Sarah C DeShields
- Center for Health Analytics and Discovery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Alfred Abuhamad
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Two-Dimensional and Three-Dimensional Transperineal Ultrasound Findings in Women With High-Pressure Voiding After Midurethral Sling Placement. Female Pelvic Med Reconstr Surg 2017; 23:141-145. [DOI: 10.1097/spv.0000000000000375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tomographic Ultrasound Imaging to Control the Placement of Tension-Free Transobturator Tape in Female Urinary Stress Incontinence. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6495858. [PMID: 27610378 PMCID: PMC5004038 DOI: 10.1155/2016/6495858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 07/12/2016] [Indexed: 11/17/2022]
Abstract
Purpose. The objective was to evaluate, by means of tomographic ultrasound imaging (TUI), the reliability of a novel approach for determining the position of the implanted tension-free transobturator tape (TOT). Furthermore, we analyzed the association between the position of the tape at rest and the subjective cure in stress incontinent women. Methods. This retrospective pilot study consists of 32 stress incontinent women, who underwent TOT procedure and routine sonographic control at day 1 postoperatively and at follow-up visit. TUI was applied on the resulting 4D volumes, thereby delivering 9 axial slices with a 4 mm interslice distance starting at the meatus urethrae internus in caudal direction. The reliability of the approach was tested by two examiners. Postoperative and follow-up ultrasound parameters of uncured and cured patients were analyzed. Results. Measurements of the position of the TOT demonstrated high intraclass correlation coefficients. We found minor differences between sonographic parameters at day 1 postoperatively and at follow-up after a median period of 321 days. In cured patients, the position of the tape was measured in a more caudal position than in uncured patients. Conclusions. TUI can be a reliable method for determining the position of the tape. Further studies are needed to evaluate whether the postoperatively determined position can be used as an indicator of future subjective cure.
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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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Lo TS, Cortes EFM, Wu PY, Tan YL, Pue LB, Al-Kharabsheh A. Clinical outcomes of single-incision sling procedure (MiniArc). Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Wlaźlak E, Surkont G, Shek KL, Dietz HP. Can we predict urinary stress incontinence by using demographic, clinical, imaging and urodynamic data? Eur J Obstet Gynecol Reprod Biol 2015; 193:114-7. [PMID: 26291686 DOI: 10.1016/j.ejogrb.2015.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/05/2015] [Accepted: 07/24/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE It has been claimed that urethral hypermobility and resting urethral pressure can largely explain stress incontinence in women. In this study we tried to replicate these findings in an unselected cohort of women seen for urodynamic testing, including as many potential confounders as possible. STUDY DESIGN This study is a retrospective analysis of data obtained from 341 women. They attended for urodynamic testing due to symptoms of pelvic floor dysfunction. We excluded from the analysis women with a history of previous anti-incontinence and prolapse surgery. All patients had a standardised clinical assessment, 4D transperineal pelvic floor ultrasound and multichannel urodynamic testing. Urodynamic stress incontinence (USI) was diagnosed by multichannel urodynamic testing. Its severity was subjectively graded as mild, moderate and severe. Candidate variables were: age, BMI, symptoms of prolapse, vaginal parity, significant prolapse (compartment-specific), levator avulsion, levator hiatal area, Oxford grading, midurethral mobility, maximum urethral pressure (MUP), maximum cough pressure and maximum Valsalva pressure reached. RESULTS On binary logistic regression, the following parameters were statistically significant in predicting urodynamic stress incontinence: age (P=0.03), significant rectocele (P=0.02), max. abdominal pressure reached (negatively, P<0.0001), midurethral mobility (P=0.0004) and MUP (negatively, P<0.0001). On multivariate analysis, accounting for multiple interdependencies, the following predictors remained significant: max. abdominal pressure reached (negatively, P<0.0001), cough pressure (P=0.006), midurethral mobility (P=0.003) and MUP (negatively, P<0.0001), giving an R(2) of 0.24. CONCLUSIONS Mid-urethral mobility and MUP are the main predictors of USI. Demographic and clinical data are at best weak predictors. Our results suggest the presence of major unrecognised confounders.
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Affiliation(s)
- Edyta Wlaźlak
- Clinic of Operative and Oncologic Gynecology, Medical University of Lodz, Wilenska 37, 94029 Lodz, Poland.
| | - Grzegorz Surkont
- Clinic of Operative and Oncologic Gynecology, Medical University of Lodz, Wilenska 37, 94029 Lodz, Poland
| | - Ka L Shek
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Sydney, NSW 2750, Australia
| | - Hans P Dietz
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Sydney, NSW 2750, Australia
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Complications following Tension-Free Vaginal Tapes: Accurate Diagnosis and Complications Management. BIOMED RESEARCH INTERNATIONAL 2015; 2015:538391. [PMID: 25973423 PMCID: PMC4418011 DOI: 10.1155/2015/538391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/21/2014] [Indexed: 11/26/2022]
Abstract
The sling procedures are the gold standard for SUI treatment. They are highly effective but not free from complications. The most common adverse effect for the surgery with the implant insertion is: overactive bladder occurring de novo after the surgery, voiding dysfunctions, urine retention, and unsatisfactory treatment outcome. The most important question that arises after 20 years of sling procedures is how to manage the complications and what can be offered to complicated patients. The above review summarises the ultrasound findings in complicated cases and shows the scheme of management of the clinical problems concerning the tape location in suburethral region.
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Lo TS, Tan YL, Wu PY, Cortes EFM, Pue LB, Al-Kharabsheh A. Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs Miniarc). Eur J Obstet Gynecol Reprod Biol 2014; 182:91-7. [PMID: 25265496 DOI: 10.1016/j.ejogrb.2014.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/22/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the ultrasound morphology and its clinical outcome among women who had undergone Miniarc™ vs Monarc™ in the treatment of stress urinary incontinence (SUI). STUDY DESIGN This was a prospective study on 140 patients with USI and undergone either Miniarc or Monarc surgery. From March 2010 to December 2011, patients with clinically SUI and urodynamic stress incontinence (USI) were included in the study. Objective cure of SUI was defined as no urinary leakage on provocative filling cystometry and 1-h pad test of <2 g. Subjective cure of SUI was the negative response to UDI-6. Introital ultrasound at one-year explored the sling and bladder neck's position, mobility, sling tension, percentile of urethra where the sling was located and urethral kinking. RESULTS Postoperative data was available from 130 women. The ultrasound objective data for successful treatment post-operative follow-up was available from 119 women (46 Monarc, 73 Miniarc), the rest failed to follow-up. A bladder perforation was diagnosed in the Monarc group and 15 cases (7.1% of Monarc and 16.3% of Miniarc, p=0.082) of urinary retention was reported due to over-tensioning of the sling, majority of cases came from the Miniarc group. At rest and during Valsalva, analogous distances of the bladder neck and sling as well as the center of the urethral core were similar for both procedures. In both groups, shortest (Us) and longest diameters (Ul) of the urethral core were comparable at Valsalva which was significantly shorter and longer, respectively, compared to the values at rest. Sling position and percentage of urethral kinking were similar. Statistical analysis failed to detect any significant difference between the two groups with regards to the objective and subjective cure (p>0.05). CONCLUSIONS In conclusion, a Miniarc and Monarc exhibit similar mechanism of action with comparable subjective and objective clinical outcomes. Majority of urethral impingement was noted in the Miniarc group. A higher maximum urethral closure pressure (MUCP), longer resting Ul, and shorter resting Us suggested these observations. Postoperative ultrasonographic evaluation may give a promising future perspective for the evaluation of sling tension.
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Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung and Taipei, Medical Center, Keelung, Taiwan, ROC; Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC.
| | - Yiap Loong Tan
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, Sarawak General Hospital & Kuching Specialist Hospital (KPJ), Kuching, Sarawak, Malaysia
| | - Pei-Ying Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung and Taipei, Medical Center, Keelung, Taiwan, ROC; Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - Eileen Feliz M Cortes
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, De La Salle University Medical Center, Dasmariñas, Cavite, Philippines
| | - Leng Boi Pue
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, Hospital Serdang, Kajang, Selangor, Malaysia
| | - Ahlam Al-Kharabsheh
- Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC; Department of Obstetrics & Gynecology, King Abdullah University Hospital/University of Science & Technology, Irbid, Jordan
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Visualization of polypropylene and polyvinylidene fluoride slings in perineal ultrasound and correlation with clinical outcome. BIOMED RESEARCH INTERNATIONAL 2014; 2014:181035. [PMID: 25126545 PMCID: PMC4122004 DOI: 10.1155/2014/181035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/03/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Complications and malfunctioning after TOT can occur due to several factors, such as the material of the sling. The aim of the present study is to evaluate morphology and functionality of two types of slings (PVDF; polypropylene) in vivo using perineal ultrasound (PUS). MATERIALS In n = 47 women with TOT four criteria for PUS were taken and checked for possible differences: vertical stability of the sling position during Valsalva manoeuvre and contraction; distance "sling to urethra"; width of the sling and condition of the selvedges. RESULTS We observed an increased vertical displacement of the PP-slings, a significantly smaller variance to the extent of the displacement in PVDF-slings (P < 0.01), a significantly larger distance between sling and urethra (P < 0.001) in PVDF-slings, and a significantly smaller width of the PP-slings (P < 0.0001). CONCLUSION Significant differences were found between the slings according to the four criteria. There was no difference established between the slings in the improvement of continence and no significant influence of the parameters was found for the resulting state of continence. In future studies, PUS may help to link differences in the morphology and functionality of in vivo slings to their material properties.
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Abstract
The popularity of imaging in pelvic floor medicine continues to increase. Among the various modalities, ultrasound is superior as it is cheap, safe, easily accesible and simple, resulting in high patient compliance. It is the only technique that allows imaging of modern wide-weave polypropylene sling or mesh implants, and imaging of such implants is commonly required due to the popularity of surgical techniques that involve the placement of slings and meshes. This review article will discuss the role of translabial ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse.
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Affiliation(s)
- Ka Lai Shek
- Liverpool Hospital University of Western Sydney Liverpool New South Wales Australia
| | - Hans Peter Dietz
- Nepean Clinical School University of Sydney Sydney New South Wales Australia
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Both the middle and distal sections of the urethra may be regarded as optimal targets for 'outside-in' transobturator tape placement. World J Urol 2014; 32:1605-11. [PMID: 24531879 PMCID: PMC4236631 DOI: 10.1007/s00345-014-1261-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/04/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate whether the position of the tape under the urethra may influence ‘outside-in’ transobturator sling (TOT) outcome. Methods The study comprised 141 women who underwent TOT for clinically and urodynamically proved stress urinary incontinence. The postoperative ultrasound examination with an endovaginal biplane probe was performed before discharging the patients from hospital. The measurements obtained described the position of the tape relative to the urethra and pubic symphysis, as well as anatomical relationships in the anterior compartment. Results Ninety-six (68.1 %) patients were cured, 27 (19.1 %) significantly improved, and in 18 cases (12.7 %), the surgery failed. The tape position under the midurethra (40–70th percentile of the urethral length) or distal urethra (>70th percentile) coincided with better results (cure rate 67.1 and 82.4 %, respectively) than the location in the proximity of the bladder neck (<40th percentile) (21.4 % cured, p = 0.0015 and p < 0.001, respectively). However, the risk of failure was the lowest when the tape was located under the distal urethra. Other ultrasonographic findings were not related to treatment results. Conclusions The highest failure rate for ‘outside-in’ TOT is associated with the location of the tape under the proximal third of the urethra. Both the middle and distal sections of the urethra may be regarded as targets for transobturator tape placement.
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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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Lucas MG, Bosch RJL, Burkhard FC, Cruz F, Madden TB, Nambiar AK, Neisius A, de Ridder DJMK, Tubaro A, Turner WH, Pickard RS. [European Association of Urology guidelines on assessment and nonsurgical management of urinary incontinence]. Actas Urol Esp 2013; 37:199-213. [PMID: 23452548 DOI: 10.1016/j.acuro.2012.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/11/2012] [Indexed: 12/11/2022]
Abstract
CONTEXT The previous European Association of Urology (EAU) guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence. A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel, using a sustainable methodology. OBJECTIVE We present a short version of the full guidelines on assessment, diagnosis, and nonsurgical treatment of urinary incontinence, with the aim of increasing their dissemination. EVIDENCE ACQUISITION Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches, based on Population, Intervention, Comparator, Outcome questions. Appraisal of papers was carried out by an international panel of experts, who also collaborated on a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system. EVIDENCE SUMMARY The full version of the guidelines is available online (http://www.uroweb.org/guidelines/online-guidelines/). The guidelines include algorithms that refer the reader back to the supporting evidence, and they are more immediately useable in daily clinical practice. CONCLUSIONS These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where such evidence does not exist, they present a consensus of expert opinion.
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Affiliation(s)
- M G Lucas
- Department of Urology, Morriston Hospital, Swansea, Reino Unido.
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Kociszewski J, Viereck V. Introital ultrasound in the diagnosis of occult abscesses following a tape procedure: a case report. Arch Gynecol Obstet 2013; 288:577-9. [DOI: 10.1007/s00404-013-2792-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/06/2013] [Indexed: 02/05/2023]
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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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