Ultrasonographic Assessment with Three-Dimensional Mode of the Urethral Compression Effect following Sling Surgery with and without Mesh Surgery

Kun-Ling Lin, Yung-Shun Juan, Shih-Hsiang Chou, Cheng-Yu Long, Kun-Ling Lin, Yung-Shun Juan, Shih-Hsiang Chou, Cheng-Yu Long

Abstract

Background: The aim of this study was to assess anatomical changes in the urethra at rest and during straining following sling surgery with and without transvaginal mesh surgery (TVM) in women with stress urinary incontinence (SUI) with or without pelvic organ prolapse (POP) using three-dimensional ultrasonography.

Methods: 76 women with SUI with or without pelvic organ prolapse after sling surgery. They underwent sling surgery alone (S group, n=36) or concomitant TVM (M group, n=40). All patients underwent urinalysis, pelvic examinations, urodynamic study, 3D perineal ultrasonography, and personal interviews before and 1 year after surgery. The urethral area was calculated from the axial plane of perineal ultrasonography by multiplying π by the long and short axes of the urethral lumen.

Results: The axial area of the middle and distal urethra during straining was significantly smaller than at rest in both groups (P<0.001). In addition, the length of the short axis of the proximal urethra was significantly shorter in those undergoing sling surgery alone during straining compared with those undergoing concomitant sling and mesh surgery (P<0.001).

Conclusions: There was a greater impact on the proximal urethra in women who underwent sling surgery alone than those who underwent sling and TVM surgery together.

Figures

Figure 1
Figure 1
Lower urinary tract on three-dimensional transperineal ultrasound imaging in a woman with tension-free vaginal transobturator tape. The top left image shows the midsagittal view (A-plane), with the tape visible as a hyperechogenic stripe just ventral (left) of the central marker dot. The top right image is a coronal view (B-plane) and the bottom left is the axial or C-plane, showing the tape as a shallow “v” (rotated 90° anticlockwise) to the left of the central marker. The bottom right image is the resulting rendered volume [12].
Figure 2
Figure 2
Ultrasound image (axial plane) of the midurethral hypoechoic core in a woman with tension-free vaginal transobturator tape, showing the measurements made for this study: the angle between the two arms of the sling (θ), the shortest (a) and longest (b) diameters of the urethral hypoechoic core and the distance between tape and urethra (TU). P, pubis symphysis [12].

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Source: PubMed

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