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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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Zwierzchowska A, Tomasik P, Horosz E, Barcz E. Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review. J Clin Med 2024; 13:2336. [PMID: 38673609 PMCID: PMC11051119 DOI: 10.3390/jcm13082336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.
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Affiliation(s)
| | | | | | - Ewa Barcz
- Department of Gynaecology and Obstetrics, Medical Faculty Collegium Medicum, University of Cardinal Stefan Wyszynski, 01-938 Warsaw, Poland; (A.Z.); (P.T.); (E.H.)
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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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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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Abbas N, Virdee T, Basu M, Iles D, Kanitkar S, Kearney R, Khan H, Ward K, Reid F. Clinical outcomes after total excision of transobturator tape inserted for treatment of stress urinary incontinence. Neurourol Urodyn 2023; 42:785-793. [PMID: 36825383 DOI: 10.1002/nau.25155] [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: 11/22/2022] [Revised: 12/14/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Midurethral tapes (MUTs) were the most common surgical treatment for stress urinary incontinence (SUI) between 2008 and 2017. Transobturator tapes were introduced as a novel way to insert MUTs. Some women have experienced life-changing complications, and opt to undergo a total excision of transobturator tape (TETOT). There is a paucity in evidence about the outcomes of TETOT, which is a complex operation. This study aims to report clinical outcomes of all women who underwent TETOT in a specialist mesh center. METHODS All women between 2017 and 2022 who underwent TETOT in one mesh center were reviewed. Background demographics and preoperative symptoms were recorded retrospectively. Outcome data were collected using patient global impression of improvement (PGI-I) scales via telephone review and analyzed using SPSS 25. RESULTS Forty-five women underwent telephone review in May 2022, on average 27.9 months (range: 3-60) after TETOT. Mean age was 55 and body mass index (BMI): 30; 82% were postmenopausal, 20% were smokers, and 73.3% had recurrent SUI before excision. Indications for excision were infection (4%), vaginal exposure (24%), urethral perforation (9%), and chronic pain not associated with other complications (60%). Two women with recurrent SUI opted for a concomitant fascial sling; both reported a PGI of "very much improved" regarding SUI postoperatively. Only 12 women (26.5%) did not have SUI before excision; of these 9 (75%) reported new SUI postoperatively. Pain improved for 57.8%, but worsened for 24.4%. Although not statistically significant (p = 0.055), more women who underwent TETOT for pain alone reported worsening pain than those with pain with an additional complication (37% vs. 5.55%). Overall, 62.2% women felt "better" after their excision, 17.8% felt "worse." DISCUSSION After TETOT, 62% of women felt better. Improvement in pain was reported by 58%-those with chronic pain without another complication reported improvement in pain less frequently (48% vs. 72%) and worsening pain more frequently (37% vs. 6%). Existing SUI worsened in 65% of women and 75% developed new SUI. There appears to be discordance between reporting global improvement with worsening of commonly measured clinical outcomes. CONCLUSION Outcome data are important for counseling women about the risks and benefits of TETOT. Women and clinicians may have different attitudes to the possible benefits of TETOT, as evidenced by women reporting feeling better despite continuing pain or SUI. Conventional outcome measures do not adequately capture all outcomes that are important to patients.
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Affiliation(s)
- Nazish Abbas
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tonicka Virdee
- The School of Medical Sciences, University of Manchester, Manchester, UK
| | - Maya Basu
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David Iles
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Surya Kanitkar
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rohna Kearney
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Hamayun Khan
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Karen Ward
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Fiona Reid
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Huang WC, Yang JM. Comparison of two outside-in transobturator midurethral slings in the treatment of female urodynamic stress incontinence. Taiwan J Obstet Gynecol 2022; 61:1004-1008. [DOI: 10.1016/j.tjog.2022.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/23/2022] Open
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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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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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Wermuth DE, Sheridan A, Oliver J, Glanc P, Khatri G, Bagley A, Patel N. Translabial Ultrasound for Assessment of Synthetic Midurethral Sling Complications. Ultrasound Q 2021; 37:237-243. [PMID: 34478421 DOI: 10.1097/ruq.0000000000000545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Translabial ultrasound (TLUS) is an inexpensive, noninvasive imaging modality traditionally used for assessment of pelvic organ prolapse. The utility of TLUS has recently been expanded to the evaluation of synthetic midurethral slings (MUS) surgically implanted for management of stress urinary incontinence. The purpose of this article is to familiarize radiologists with translabial ultrasound technique and provide a technical protocol for TLUS execution because it can be optimized for imaging and assessment of MUS, including identification of MUS configuration and recognition of common complications. This article provides example images of transobturator and retropubic slings and their associated complications, as visualized on TLUS. Accurate imaging and assessment of MUS is helpful in the evaluation of the patient presenting with symptoms suspicious for sling-related complications and in the planning of surgical revision.
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Affiliation(s)
| | - Alison Sheridan
- Department of Radiology, University of Colorado School of Medicine
| | - Janine Oliver
- Urology & Urodynamics Clinic, University of Colorado Hospital, Aurora, CO
| | - Phyllis Glanc
- Department of Imaging, University of Toronto Sunnybrook Health Science Center, Toronto, ON
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Anjuli Bagley
- Department of Radiology, University of Colorado School of Medicine
| | - Nayana Patel
- Department of Radiology, University of Colorado School of Medicine
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Abstract
This article discusses various pelvic floor ultrasonographic modalities and the clinical applications of ultrasonography of the pelvic floor. Ultrasonography provides a detailed anatomic assessment of the muscles and surrounding organs of the pelvic floor. Different anatomic variabilities and pathologic conditions, such as prolapse, fecal incontinence, urinary symptoms, vaginal wall cysts, synthetic implanted material, and pelvic pain, are assessed with pelvic floor ultrasonography. This imaging modality is an important adjunct to the evaluation and diagnosis of pelvic floor disorders.
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Affiliation(s)
- Trang X Pham
- Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences, 800 Stanton L. Young Boulevard, Suite 2400, Oklahoma City, OK 73104, USA
| | - Lieschen H Quiroz
- Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences, 800 Stanton L. Young Boulevard, Suite 2400, Oklahoma City, OK 73104, USA.
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Liu LN, Liu XN, Liu C, Yao MY, Xu HX. Transperineal pelvic floor ultrasound for analyzing the outcomes of pelvic floor surgery for the treatment of anterior compartment prolapse: A comparative study of transvaginal mesh and native-tissue repair. Low Urin Tract Symptoms 2021; 13:456-462. [PMID: 34101374 DOI: 10.1111/luts.12392] [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: 12/27/2020] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To compare the outcomes of transvaginal mesh (TVM) and native-tissue repair (NTR) for the repair of anterior compartment prolapse. METHODS This retrospective study involved 90 patients with anterior compartment prolapse who underwent pelvic organ prolapse surgery between January 2018 and October 2020. A TVM was used to treat 53 patients and 37 underwent NTR. All patients underwent a standardized interview, clinical examination, and four-dimensional pelvic floor ultrasound (PFUS) before and after the surgery. The primary outcome was anatomic recurrence evaluated by ultrasonic parameters. The secondary outcomes were subjective recurrence and complications. RESULTS Subjective recurrence was 9.43% (5/53) for TVM and 16.22% (6/37) for NTR (P = .522). Significant recurrence of prolapse on ultrasound occurred in five patients (9.43%) after TVM and 12 (32.43%) after NTR; there was a significant difference between the TVM and NTR groups (P = .006). In the TVM group, the mesh was visible on ultrasound in each patient. The mesh exposure rate was 1.89% (1/53). The postoperative hiatal area reduction in the TVM group, compared with the NTR group, was statistically significant (5.55 ± 4.71 cm2 vs 3.09 ± 5.61 cm2 , P = .027). The incidence of de novo stress urinary incontinence was higher in the TVM group (20.75% vs 2.70%, P = .03). After surgery, there were significant differences between the two groups based on bladder descent (12.02 ± 8.64 mm vs 22.41 ± 13.95 mm, P = .000) and urethral rotation angle (25.26 ± 13.92° vs 40.27 ± 23.72°, P = .001). CONCLUSION PFUS is effective for evaluating postoperative outcomes. TVM facilitates a better anatomic cure than NTR for anterior compartment prolapse.
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Affiliation(s)
- Lin-Na Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
| | - Xiu-Ni Liu
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Chang Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
| | - Meng-Yan Yao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
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Clinical applications of pelvic floor imaging: opinion statement endorsed by the society of abdominal radiology (SAR), American Urological Association (AUA), and American Urogynecologic Society (AUGS). Abdom Radiol (NY) 2021; 46:1451-1464. [PMID: 33772614 DOI: 10.1007/s00261-021-03017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Pelvic floor dysfunction is prevalent, with multifactorial causes and variable clinical presentations. Accurate diagnosis and assessment of the involved structures commonly requires a multidisciplinary approach. Imaging is often complementary to clinical assessment, and the most commonly used modalities for pelvic floor imaging include fluoroscopic defecography, magnetic resonance defecography, and pelvic floor ultrasound. This collaboration opinion paper was developed by representatives from multiple specialties involved in care of patients with pelvic floor dysfunction (radiologists, urogynecologists, urologists, and colorectal surgeons). Here, we discuss the utility of imaging techniques in various clinical scenarios, highlighting the perspectives of referring physicians. The final draft was endorsed by the Society of Abdominal Radiology (SAR), American Urogynecologic Society (AUGS), and the American Urological Association (AUA).
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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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14
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Female pelvic medicine and reconstructive surgery challenges on behalf of the Collaborative Research in Pelvic Surgery Consortium: managing complicated cases. Int Urogynecol J 2021; 32:1373-1377. [PMID: 33580811 DOI: 10.1007/s00192-021-04702-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
This case presents the work-up and management of a patient experiencing acute kidney injury, urinary retention, and neuropathy following surgery for pelvic organ prolapse and stress urinary incontinence. Four international experts provide their evaluation of and approach to this complex case.
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15
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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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16
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Li L, Sima Y, Wang Y, Zhou J, Wang L, Chen Y. The cytotoxicity of advanced glycation end products was attenuated by UCMSCs in human vaginal wall fibroblasts by inhibition of an inflammatory response and activation of PI3K/AKT/PTEN. Biosci Trends 2020; 14:263-270. [PMID: 32493859 DOI: 10.5582/bst.2020.03125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pelvic organ prolapse (POP) occurs when the pelvic organs (bladder, bowel or uterus) herniate into the vagina, causing incontinence, voiding, and bowel and sexual dysfunction, negatively impacting upon a woman's quality of life. Intermediate intermolecular cross-links and advanced glycation cross-links increase in prolapsed tissue. Stem cells are able to participate in tissue repair due to their ability to differentiate into multiple lineages, and thus into various types of connective tissue cells, so they therefore hold great promise for treating pelvic floor dysfunction. The current study found that advanced glycation end products (AGEs) inhibited the viability and proliferation of human vaginal wall fibroblasts (VWFs), were cytotoxic to VWFs, and also induced the apoptosis of VWFs. In contrast, umbilical cord-derived mesenchymal stem cells (UCMSCs) secreted anti-inflammation cytokines to protect against the cytotoxic effects of fibroblasts induced by AGEs and attenuated the cytotoxic effect of AGE on fibroblasts by activation of the PI3K/Akt-PTEN pathway. This study demonstrated that UCMSCs inhibited the cytotoxic effect of AGE in cells from patients with POP by inducing an anti-inflammatory reaction and activating the PI3K/AKT/PTEN signaling pathway. The current results provide important insights into use of stem cells to treat POP.
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Affiliation(s)
- Lisha Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Yizhen Sima
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yan Wang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jing Zhou
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Ling Wang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Yisong Chen
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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17
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Bautrant E, Cervigni M, Moral ED, de Vicente JMG, Usandizaga R, Levesque A, Ploteau S, Riant T, Levêque C. Pain pathway and management of pain complications after surgical vaginal meshes implantation for prolapse and incontinence. J Gynecol Obstet Hum Reprod 2020; 49:101742. [PMID: 32446849 DOI: 10.1016/j.jogoh.2020.101742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Eric Bautrant
- Symposium of the 6th Congress of Convergences in Pelvic Perineal Pain, Madrid, Spain.
| | - Mauro Cervigni
- Symposium of the 6th Congress of Convergences in Pelvic Perineal Pain, Madrid, Spain
| | - Eloy Del Moral
- Symposium of the 6th Congress of Convergences in Pelvic Perineal Pain, Madrid, Spain
| | | | - Ramón Usandizaga
- Symposium of the 6th Congress of Convergences in Pelvic Perineal Pain, Madrid, Spain
| | - Amélie Levesque
- Symposium of the 6th Congress of Convergences in Pelvic Perineal Pain, Madrid, Spain
| | - Stéphane Ploteau
- Symposium of the 6th Congress of Convergences in Pelvic Perineal Pain, Madrid, Spain
| | - Thibault Riant
- Symposium of the 6th Congress of Convergences in Pelvic Perineal Pain, Madrid, Spain
| | - Christine Levêque
- Symposium of the 6th Congress of Convergences in Pelvic Perineal Pain, Madrid, Spain
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18
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Bueno Garcia Reyes P, Hashim H. Mesh complications: best practice in diagnosis and treatment. Ther Adv Urol 2020; 12:1756287220942993. [PMID: 32754226 PMCID: PMC7378717 DOI: 10.1177/1756287220942993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022] Open
Abstract
Mesh was a promising, minimally invasive, and 'gold standard' treatment for urinary stress incontinence. Time has shown that complications from these devices can happen early, or even several years, after mesh placement and can be catastrophic. Pain, erosion, voiding dysfunction, infection, recurrent UTIs [urinary tract infections (UTIs)], fistulae, organ perforation, bleeding, vaginal scarring, neuromuscular alterations, LUTS (lower urinary tract symptoms), bowel complications and even immune disorders have been linked to mesh. Various tools, such as imaging, endoscopic and functional studies, are available for diagnosis of mesh complications. Since the spectrum of complications is wide, involvement of other specialties is usually beneficial in the diagnosis and management of these complications. There is still much to learn on the accuracy and utility of diagnostic studies in each type of complication. Evidence on the best diagnostic and treatment pathways for these complications is scarce but continuously growing as information is being reported, and we continue to gain expertise in dealing with patients affected by mesh. Treatment options include conservative and medical management initially and then open or minimally invasive surgical procedure approaches. This article will describe diagnostic and treatment pathways for mesh complications.
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Affiliation(s)
| | - Hashim Hashim
- Bristol Urological Institute, Southmead
Hospital, Bristol BS10 5NB, UK
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19
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Autologous rectus fascial slings for stress urinary incontinence: can we see them on ultrasound? Int Urogynecol J 2019; 31:415-417. [PMID: 31346672 DOI: 10.1007/s00192-019-04056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
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