1346 TRANSLABIAL ULTRASONOGRAPHY OF SUBURETHRAL SLINGS IN PATIENTS WITH RECURRENT URINARY INCONTINENCE AFTER SYNTHETIC SLING PLACEMENT

Abstract

INTRODUCTION AND OBJECTIVES: Treatment for stress urinary incontinence using suburethral slings fails in 10–20% of surgeries. The underlying pathophysiology is not fully understood. In this study, we use translabial ultrasonography (US) to evaluate sling type, position, and morphology in patients after suburethral sling placement. We hypothesize that sling position and morphological changes have an impact on sling failure. METHODS: In this retrospective observational study, 51 consecutive patients were evaluated with translabial US for type, position, and morphology of suburethral slings between 2009 and 2010. Axial, coronal, and sagittal planes were obtained using a curvilinear 4-9mHz transducer. The patients were stratified, by cough test and bother scores, into patients with recurrent incontinence (n 33) and continent patients (n 18). Student’s t-test was performed for statistical evaluation comparing sling type, position, and morphology in both groups after suburethral sling procedures. RESULTS: By evaluating the sling type, translabial US revealed a similar number of patients in the incontinent and continent group treated with a transobturator (45% vs. 56%) or retropubic sling (55% vs. 44%), respectively. Comparing the position of suburethral slings in incontinent and continent patients with translabial US reveals that more patients in the incontinence group were found with slings located at the proximal urethra (48% vs. 16%, p 0.0123), less patients in the incontinence group were found with slings at the midurethra (39% vs. 67%, p 0.0323), and a similar number of patients in both groups were found with slings at the distal urethra (12% vs. 17%), respectively. Only incontinent patients presented with urethra or bladder perforation (6%). Morphologically, slings were significantly more folded in the incontinent group than in the continent population (73% vs. 6%, p 0.0016). CONCLUSIONS: In this study, we have shown that US can distinguish transobturator and retropubic slings and determine sling position. The type of sling does not seem to have an impact on recurrent UI, whereas the position, close to the bladder neck and/or folding of the sling, might be related to recurrent incontinence. Because it is the only diagnostic tool to determine the type of sling, locate the sling position, and follow up on its morphology, translabial US helps to elucidate the pathophysiology responsible for sling failure.