EP30.02: Transperineal 3D sonography: how to define a well positioned suburethral sling?

Abstract

Numerous measures have been proposed with 3D sonography to describe perineum by transperineal route. Suburethral slings used for urinary stress incontinence are easily locatable with sonography and the aim of this study is to define a well-positioned suburethral sling on sagittal, axial and coronal view of the perineum and to explain which measures are useful to assess the good position of the sling. A prospective study with a preoperative and a postoperative systematic 3D transperineal sonography in case of surgical management of urinary stress incontinence by suburethral slings has been conducted. Women also had to fill out a questionnaire before and after surgery. Correlation between symptoms and position of the sling were evaluated and useful measures were defined. This prospective study is a monocentric one and an approval of the Ethics Committee has been obtained. Out of 20 women, we first describe normal urethra with perineal sonography. Urethra is often curvilinear with a mean length of 27.3mm. On sagittal view of the perineum, position of the sling has to be defined with the distance between vesical neck and the upper edge of the strip but also by the distance between externa urethral orifice and the lower edge of the strip. Both of these distances should be greater than 8mm. On axial view, the good spreading of the sling can be assess and finally, coronal view allows differentiation between retropubic and transobturator tape but also to check the symmetry of the sling. A distance of 3mm is often observed between posterior part of the urethra and the sling when women are very satisfied. A positive correlation was observed between symptoms and position of the sling, which allow the description of the good place for the sling. Sagittal, axial and coronal view of the perineum are useful to assess the good positioning of the sling.