MP38-12 THE ROLE OF TRANSPERINEAL ULTRASOUND IN EVALUATION OF THE FAILED MALE TRANSOBTURATOR SLING – SEPARATING TECHNICAL FAILURE FROM TRUE FAILURES

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy II1 Apr 2014MP38-12 THE ROLE OF TRANSPERINEAL ULTRASOUND IN EVALUATION OF THE FAILED MALE TRANSOBTURATOR SLING – SEPARATING TECHNICAL FAILURE FROM TRUE FAILURES Lewis Chan, Vincent Tse, and Audrey Wang Lewis ChanLewis Chan More articles by this author , Vincent TseVincent Tse More articles by this author , and Audrey WangAudrey Wang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1269AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is increasing use of transobturator slings in treatment of post-prostatectomy stress urinary incontinence. Our previous ultrasound studies have 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 assess the role of transperineal ultrasound in the evaluation of patients with failed slings. METHODS Transperineal ultrasound was performed on 20 patients with unsatisfactory outcomes post AdVance transobturator sling. 16 patients had persisting incontinence post sling and 4 patients had voiding dysfunction. 2D/3D ultrasound examinations were conducted using a Philips IU22 ultrasound machine and matrix transducer. Patients were imaged at bladder volumes of over 150mls, at rest and on Valsalva. Imaging findings included bladder neck position, urethral mobility and position of sling relative to urethra on dynamic imaging. 3D datasets were analysed to assess sling position. RESULTS All 20 slings were well visualized on transperineal ultrasound. Malposition of sling was observed in 7 of 12 patients with early sling failure. 3 patients reported worsened incontinence post sling and paradoxical distraction/opening of the urethra on Valsalva was demonstrated. 2 patients had partial detachment of the central portion of the sling and 2 had distal location of the sling in the perineum. Satisfactory sling position (sub-urethral portion of sling at level of inferior border of the pubic symphysis) and dynamic compression of the urethra by sling was demonstrated in 2 patients with early failure and in all 4 patients with gradual deterioration of continence indicating true failure (significant intrinsic sphincteric deficiency). Sling position was satisfactory in all 4 patients with voiding dysfunction post sling. However indentation/kinking of the urethra was not observed in obstructed male slings unlike obstructed female slings. 3D ultrasound did not provide additional information compared to dynamic 2D imaging in assessing sling position. CONCLUSIONS Transperineal ultrasound may have a role in the evaluation of the failed male transobturator sling. Patients with early failure can be categorized into technical failure (malpositioning) and true failures. Patients with malpositioned slings and absence of dynamic compression of the urethra by sling can be considered technical failures and may be suitable for a re-do sling procedure. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e405 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Lewis Chan More articles by this author Vincent Tse More articles by this author Audrey Wang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...