1355 DYNAMIC COMPRESSION OF THE URETHRA - THE ROLE OF ULTRASOUND IMAGING IN UNDERSTANDING HOW THE MALE TRANSOBTURATOR SLING WORKS

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III1 Apr 20121355 DYNAMIC COMPRESSION OF THE URETHRA - THE ROLE OF ULTRASOUND IMAGING IN UNDERSTANDING HOW THE MALE TRANSOBTURATOR SLING WORKS Lewis Chan, and Vincent Tse Lewis ChanLewis Chan Sydney, Australia More articles by this author , and Vincent TseVincent Tse Sydney, Australia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1738AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is increasing use of transobturator slings in the treatment of post-prostatectomy stress incontinence. Our previous ultrasound study demonstrated the phenomenon of ‘dynamic compression' of the urethra during Valsalva and cough in patients with AdVance slings. The aim of this study was to evaluate the concept of urethral mobility versus dynamic compression of the urethra as potential mechanisms of action of the male sling and the feasibility of using ultrasound imaging in evaluation of failed slings. METHODS Transperineal ultrasound was performed on 6 patients with mild-moderate incontinence post radical prostatectomy, 3 patients with severe incontinence, 12 patients who are continent following placement of AdVance transobturator male sling and 3 patients who have persisting or worsened incontinence following sling surgery. 2D Ultrasound examinations were conducted using a SonoSite M-Turbo ultrasound machine and C5-2 MHz transducer. Simultaneous 2-plane (X-plane) imaging of the AdVance slings was performed using a Philips IU22 ultrasound machine and matrix X6-1 MHz transducer. Patients were imaged at bladder volumes of over 150mls, at rest and on Valsalva. Imaging findings including bladder neck position, urethral mobility and position of sling relative to urethra on dynamic imaging were recorded. RESULTS All 15 Advance slings were well visualized on transperineal ultrasound. The AdVance slings were located at or above the inferior border of the pubic symphysis in patients who are continent but slings were located more distally in the perineum in patients with persisting incontinence. Dynamic compression of the urethra by the AdVance sling was demonstrated with Valsalva and cough in patients who were continent but not in the failed slings. Two of these had paradoxical distraction/opening of the urethra on Valsalva. A mild degree (<1cm) of urethral mobility was demonstrated with Valsalva in all patients and did not correlate with the degree of incontinence. Patients with severe incontinence had open bladder neck and short sphincter compared to those with mild/moderate incontinence. CONCLUSIONS Transperineal ultrasound is a good modality of imaging for assessment of synthetic male suburethral slings and may have a role in the evaluation of patients with a failed sling. Dynamic compression of the urethra by transobturator sling was demonstrated during Valsalva in patients with successful slings but not observed in failed slings suggesting that this may be a mechanism of action of the male transobturator sling. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e550 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lewis Chan Sydney, Australia More articles by this author Vincent Tse Sydney, Australia More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...