Cadaveric Assessment of Synthetic Mid-Urethral Sling Placement

Abstract

Study Objective: To prove that mid-urethral synthetic slings are visually the same against the urethra at the end of a procedure regardless of the fact that they may be placed or tensioned differently, or anchored to different muscles. To evaluate which sling placement was tensioned most correctly and was most likely at the mid-urethra.Design: We placed an obturator, retropubic, and a single incision sling in three different fresh cadavers. Afterwards, 30 physicians were allowed to visually inspect the cadavers without being aware of how the slings were placed. Each physician completed a questionnaire asking what type of sling was placed, if the sling was the right tension, and if it was located at the mid-urethra.Setting: N/APatients: N/AIntervention: Each cadaver had all possible skin incisions made. The tension for the obturator and retropubic slings were set using a 12 Hagar dilator as a spacer. The tension of the single incision sling was set so that the sling lay against the urethra such that pillowing of the periurethral tissues were observed through the pores of the sling.Measurements and Main Results: The physicians were composed of 5 urologists, 7 urogynecologist, and 18 general gynecologists. The average number of slings performed per year by each physician was 53. The findings are summarized in the table below:Tabled 1Cadaveric Mid-Urethral Sling Placement ResultsRetropubic SlingObturator SlingSingle Incision Sling% Who correctly identified sling40%43%23%% Who thought tension was just right33%47%73%% Who thought sling was at mid-urethra50%67%83% Open table in a new tab Physicians were least likely to be able to identify a single incision sling placement. The single incision sling whose tension was not set with a spacer was felt to have the most appropriate tension and was felt to most likely represent a mid-urethral placement.Conclusion: This study showed that after placement of a mid-urethral synthetic sling it is hard to tell how the sling was placed. This study also showed that most physicians felt that the sling that was tensioned the best and most likely at the mid-urethra was the single incision sling. Study Objective: To prove that mid-urethral synthetic slings are visually the same against the urethra at the end of a procedure regardless of the fact that they may be placed or tensioned differently, or anchored to different muscles. To evaluate which sling placement was tensioned most correctly and was most likely at the mid-urethra. Design: We placed an obturator, retropubic, and a single incision sling in three different fresh cadavers. Afterwards, 30 physicians were allowed to visually inspect the cadavers without being aware of how the slings were placed. Each physician completed a questionnaire asking what type of sling was placed, if the sling was the right tension, and if it was located at the mid-urethra. Setting: N/A Patients: N/A Intervention: Each cadaver had all possible skin incisions made. The tension for the obturator and retropubic slings were set using a 12 Hagar dilator as a spacer. The tension of the single incision sling was set so that the sling lay against the urethra such that pillowing of the periurethral tissues were observed through the pores of the sling. Measurements and Main Results: The physicians were composed of 5 urologists, 7 urogynecologist, and 18 general gynecologists. The average number of slings performed per year by each physician was 53. The findings are summarized in the table below: Physicians were least likely to be able to identify a single incision sling placement. The single incision sling whose tension was not set with a spacer was felt to have the most appropriate tension and was felt to most likely represent a mid-urethral placement. Conclusion: This study showed that after placement of a mid-urethral synthetic sling it is hard to tell how the sling was placed. This study also showed that most physicians felt that the sling that was tensioned the best and most likely at the mid-urethra was the single incision sling.