Translabial Ultrasound Evaluation of Pelvic Floor Structures and Mesh in the Urology Office and Intraoperative Setting

Translabial Ultrasound for Assessment of Synthetic Midurethral Sling Complications

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.

Delayed Presentation of Iliac Vein Injury: A Severe Complication at Retropubic Midurethral Sling Arm Removal

Midurethral slings are the most common treatment for female stress urinary incontinence. Perioperative vascular injuries during placement of a retropubic midurethral sling (RMUS) are uncommon but have been described. The objective of this case report is to describe a complication of delayed presentation from a vascular injury at the time of retropubic sling arm removal not previously documented in the literature. This life-threating complication should be considered and precautions should be taken at retropubic sling arm removal. Prevention is accomplished by proper visualization of pelvic vasculature and/or eliminating tension on sling before excision.