You have accessJournal of UrologyUrodynmaics/Incontinence/Female Urology: Incontinence, Evaluation & Therapy (I)1 Apr 2013563 TRANSLABIAL ULTRASOUND (TLUS) DETECTION IN URETHRAL MESH SLING REVISION: FACTORS ASSOCIATED WITH THE NEED FOR INTERPOSITIONAL TISSUE FLAP OR URETHRAL RECONSTRUCTION Forrest Jellison, Leah Nakamura, Lisa Rogo-Gupta, Denise Chow, Chad Baxter, Ja-Hong Kim, Larissa Rodriguez, and Shlomo Raz Forrest JellisonForrest Jellison Los Angeles, CA More articles by this author , Leah NakamuraLeah Nakamura Los Angeles, CA More articles by this author , Lisa Rogo-GuptaLisa Rogo-Gupta Los Angeles, CA More articles by this author , Denise ChowDenise Chow Los Angeles, CA More articles by this author , Chad BaxterChad Baxter Los Angeles, CA More articles by this author , Ja-Hong KimJa-Hong Kim Los Angeles, CA More articles by this author , Larissa RodriguezLarissa Rodriguez Los Angeles, CA More articles by this author , and Shlomo RazShlomo Raz Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1959AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The objective of this study is to detect and localize urethral sling mesh by TLUS and to determine preoperative factors predictive of an interpostional tissue flap or urethral construction (UC). METHODS Patients who underwent excision of transvaginal mesh between 7/2005 to 7/2012 were retrospectively reviewed. Women that had only urethral mesh sling revision and pre-operative TLUS were included for analysis. Demographics, pre-operative, TLUS findings, and operative findings were compared. RESULTS A total of 43 (mean age 58 +/− 17, BMI 26 +/− 3.58, postmenopausal 32%) women underwent urethral mesh sling revision and pre-operative TLUS. UC or interpositional flap of tissue was performed in 44% (19) with a local flap (periurethral fascia, perivesical fat) in 68%, and a martius flap in 32%. TLUS was able to detect mesh in all patients. TLUS sensitivity and specificity was (74%, 100%) for reconstruction when mesh was within 1 mm of the lumen of bladder or urethra. TLUS findings of mesh within 1 mm of the urethral or bladder was predictive of urethral or bladder flap during reconstruction in 93% and was significant compared to those not requiring reconstruction, p<0.01. 63% (12) of patients requiring reconstruction were not identified on pre-operative cystoscopy of which 66% (8) were found to be within 1 mm of the urethra or the bladder lumen on ultrasound. TLUS findings of mesh folding or mesh location (proximal to distal) were not predictive of reconstruction. There was a higher rate of pre-operative stress and mixed incontinence (66% vs 48%, p=0.01) and subsequent surgical procedures for stress incontinence (63% vs 43%, p=0.03) in the reconstructive group. Significant risks for urethral reconstruction was age greater than 65 (p<0.01), BMI >25 (p<0.01), and parity > 3 (p.02).There was no significant difference in reconstruction operative times (105 +/− 25 vs 82 +/− 17, p=0.08), EBL (165 +/− 70 vs 177 +/− 171, p=74), or complications (5% vs 4%) compared to those who did not undergo reconstruction. CONCLUSIONS TLUS was able to detect and localize urethral sling mesh and may predict those who would need an interpositional flap or UC at the time of surgery. This technique may allow the surgeon to pre-operatively identify and council the patient about the need for reconstruction. This information needs to be applied prospectively to determine if indeed sling location within 1 mm of urethral lumen predicts need for UC or interpositional tissue flap. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e231 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Forrest Jellison Los Angeles, CA More articles by this author Leah Nakamura Los Angeles, CA More articles by this author Lisa Rogo-Gupta Los Angeles, CA More articles by this author Denise Chow Los Angeles, CA More articles by this author Chad Baxter Los Angeles, CA More articles by this author Ja-Hong Kim Los Angeles, CA More articles by this author Larissa Rodriguez Los Angeles, CA More articles by this author Shlomo Raz Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...