MP75-07 SONOGRAPHY TAPE CHARACTERISTIC AND INCONTINENCE OUTCOME AFTER TRANS-OBTURATOR TAPE (TOT) SURGERY

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 2014MP75-07 SONOGRAPHY TAPE CHARACTERISTIC AND INCONTINENCE OUTCOME AFTER TRANS-OBTURATOR TAPE (TOT) SURGERY Manuel Di Biase, Eleonora Salvini, Michele Del Zingaro, Vittorio Bini, Amelia Pietropaolo, Elena Sarti, and Elisabetta Costantini Manuel Di BiaseManuel Di Biase More articles by this author , Eleonora SalviniEleonora Salvini More articles by this author , Michele Del ZingaroMichele Del Zingaro More articles by this author , Vittorio BiniVittorio Bini More articles by this author , Amelia PietropaoloAmelia Pietropaolo More articles by this author , Elena SartiElena Sarti More articles by this author , and Elisabetta CostantiniElisabetta Costantini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2380AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Midurethral synthetic slings (MUS) is the best procedure for the surgical treatment of stress urinary incontinence (SUI), but 5-23% of patients will have persistent or recurrent urinary incontinence after surgery. Aim of the study was to evaluate if, trans-perineal ultrasonography is able to recognize improper positioning or dislodgment of the tape or other factors that may be associated with failed surgery METHODS In November and December 2012, 67 patients who underwent TOT accepted to perform a urological evaluation and trans-perineal ultrasound scan which was performed with the woman in the supine position, with a full comfortable bladder, at rest and during Valsalva manoeuvre. We recorded the measurement above and below the longitudinal axis of the symphysis as negative and positive, respectively. Further parameters evaluated are: a) the position of the mesh along the urethra obtaining 3 different position: 1)0-40% proximal to the bladder neck 2)40-60% midurethral position 3) 60-100% distal position; b) the movement and in particular the symmetry of the lateral arms of the mesh during straining. On the basis of the incontinence outcome patients were allocated into two main categories:dry or wet (any kind or grade of leakage). Statistical analysis: X2 test for categorical data comparisons and Mann Whitney for continue data comparisons and multiple logistic regression analysis to test at the same time the relationship of various potential predictive variable with failed surgery. RESULTS At a mean follow-up of 40 months (range 24-84 months) 47/67 patients were completely dry and 20 were wet. Sling location at the distal urethral position could be related to a worst outcome as well as an asymmetry of the slings arms. Logistic regression analysis showed that age (p=0.027) and symmetry of the mesh (p=0.001) were correlated with the outcome. Also the position of the mesh was correlated with the outcome: in particular the midurethral (p=0.026) and proximal position (p=0.003). Particulary the tape placement in both, proximal and midurethral locations, reduced the risk of failure by 14 folds as compared with the tape placement in the distal third of the urethra. CONCLUSIONS A correct TOT positioning along the urethra seems to play a role in the incontinence outcome. Not only the correct mid-urethral position but also the dynamic change in tape shape during straining is important. Furthermore the modification of these parameters at long-term follow-up should be evaluated to understand if the sling tends to move in the time or if other factors could affect its position. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e875-e876 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Manuel Di Biase More articles by this author Eleonora Salvini More articles by this author Michele Del Zingaro More articles by this author Vittorio Bini More articles by this author Amelia Pietropaolo More articles by this author Elena Sarti More articles by this author Elisabetta Costantini More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...