Translabial ultrasound: a non-invasive technique for assessing \u201ctechnical errors\u201d after TOT failure

Ester Illiano,Giuseppe Carrieri,Gianluigi Califano,Vincenzo Li Marzi,Claudia Collà Ruvolo,Elisabetta Costantini,Stefano Brancorsini,Consuelo Fabi,Francesco Trama,Vito Mancini

doi:10.1007/s00192-021-04897-6

Abstract

Introduction and hypothesisThe aims of this study were to evaluate by transperineal ultrasound if there were ultrasound-detectable changes over time in the dynamic behavior of the sling in patients who underwent transobturator tape (TOT), and to evaluate if dynamic translabial ultrasonography recognized factors that may be associated with failed surgery.MethodsThis was a single-center prospective study. We included women who underwent “out-in” TOT for stress urinary incontinence (SUI). A dynamic translabial ultrasound was performed 6 months post-surgery and again at the last visit. The objective cure for SUI was defined as the absence of urine leakage during the stress test. We evaluated the bladder neck mobility at rest and during Valsalva; the position of the mesh along the urethra; the concordance of urethral movement with the sling during Valsalva; the symmetry of the lateral arms of the sling during straining; and the presence or absence of bladder neck funneling.ResultsFrom December 2012 to February 2016, 80 consecutive patients were included. Six months after surgery, incontinent women compared with continent women had the sling in a proximal or distal position, that moved discordantly with the urethra (p < 0.0001), with asymmetry arm and bladder neck funneling (p < 0.0001). Continent patients had a significant improvement of urethrocele grade both at rest (p = 0.036) and during Valsalva (p = 0.045).ConclusionsTechnical and positioning errors can lead to the failure of anti-incontinence surgical treatment. Translabial ultrasound allows the correct positioning of the sling to be evaluated and any errors that need to be analyzed in order to then solve the failure.

Highlights

Introduction and hypothesisThe aims of this study were to evaluate by transperineal ultrasound if there were ultrasounddetectable changes over time in the dynamic behavior of the sling in patients who underwent transobturator tape (TOT), and to evaluate if dynamic translabial ultrasonography recognized factors that may be associated with failed surgery
The preoperative evaluation included a medical history, a clinical examination using the POP-Q classification [13], a standardized cough stress test (CST) performed in the standing position at a bladder volume of 300 ml, a urodynamic study according to International Continence Society (ICS) criteria, and a dynamic translabial ultrasound
These analyses showed that asymmetric sling arms, a distal and proximal sling position, the distal movement of the urethrovesical junction and the discordant urethral movement from the sling were risk factors for the failure of TOT

Summary

Introduction

Introduction and hypothesisThe aims of this study were to evaluate by transperineal ultrasound if there were ultrasounddetectable changes over time in the dynamic behavior of the sling in patients who underwent transobturator tape (TOT), and to evaluate if dynamic translabial ultrasonography recognized factors that may be associated with failed surgery. When abdominal pressure increases owing to a cough, sneeze, or other physical stress, the pelvic floor muscles contract. Contraction of these muscles results in mid-urethral closure as the pubococcygeus muscle stretches the distal vagina and the proximal urethra stretches around a competent pubourethral ligament [3]. Failure of this urethral closure mechanism may contribute to the pathophysiology of stress urinary incontinence (SUI) [4]. Ulmsten and Petros introduced the mid-urethral sling (MUS) as a surgical replacement for a defective pubourethral ligament [5, 6].

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