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Early transperineal ultrasound to predict success rates in women undergoing mid-urethral sling surgery
IUGA Academy. Andreoli F. Jun 30, 2018; 213000
Topic: Stress Incontinence
Dr. Felipe Andreoli
Dr. Felipe Andreoli

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Early transperineal ultrasound to predict success rates in women undergoing mid-urethral sling surgery

Andreoli, F1; Alvarez, J1; Rondini, C1; Urzúa, MJ1; Storme, O1; Monroy, M1; Stern, J1; Maldonado, AD1

1: Hospital Padre Hurtado, Santiago, Chile

Introduction: It is estimated that nearly a third of women will suffer from urinary incontinence. Women who fail to respond to conservative measures usually undergo a mid-urethral sling, and even though success rate are over 85%, some women will continue to persist with stress incontinence.

Objetive: The aim of the study was to analyze which transperineal ultrasound measurement could predict failure of a mid-urethral sling.

Methods: A prospective study was conducted at a single tertiary center between May 2017 and December 2017. Women with stress urinary incontinence or mixed urinary incontinence who were scheduled to undergo a mid-urethral sling procedure were invited to participate. Women who were scheduled for a repeat MUS, pubo-vaginal sling or who could not consent were excluded. Following the procedure women underwent a Transperineal Ultrasound assessment at 24 hrs, one month and three months following surgery. Measurements included the relationship between the sling and the urethra: Distance between bladder neck and sling and its relationship with urethral length; distance between sling and the longitudinal smooth muscle (Tape-MLL) at rest and Valsalva. Other ultrasound measurements included the relationship between sling and pubis (SP-Gap) at rest and Valsalva as well as sling shape and behavior during valsalva. In addition, during follow-up women were assessed with Patient global improvement index (PGI-I), and VAS score. Succesful sling placement was considered as a negative cough-test at three months follow-up. Subjective outcomes were the patient VAS scores and PGI-I. To estimate the predictive value of the continuous variables at ultrasound, a binary logistic regression analysis was performed with a significance level of 5%.

Results: During the study period seventy-seven women were invited to participate. Sixty-nine women agreed to participate. Of the 69 patients 62 had a negative cough test at three-month follow-up. Fifty-three women out of 69 (76.7%) had a VAS over 80% and 85% of patient declared being PGI-I: “Much better” or above. There was no significant difference in demographic characteristics among women who failed or had a successful MUS. In order to analyze which sling location segment had the best Negative Predictive Value (NPV), we compared different centile groups, determining that segment between 50-70% achieved a 100%. The logistic regression analysis showed that only Tape-MLL at rest (Exp(B) 2,329; p=0,016) and SP-Gap at Valsalva (Exp(B) 1,605; p=0,011) could predict significantly women who will have a positive cough test. The other ultrasound measurements did not have a significant predictive value.

Conclusions: Transperineal Ultrasound is a useful tool to better understand sling placement and its relationship to the urethra. However only the relationship between sling-urethra and sling-symphysis pubis can predict in a best way success after surgery.

TABLE : Baseline Demographics and Characteristics of Study Participants (n=69)

All n=69

Continent n=62

Incontinent n=7

p

Age (years)

56,1±11,8

56,1±12,4

56±4,7

0,936

Parity

3,1±1,5

3,0±1,3

4,4±2,8

0,241

Vaginal Deliveries

2,5±1,8

2,3±1,6

4,2±2,9

0,134

C-section

0,52±1,0

0,5±1,0

0,1±0,3

0,046

Forceps

0,1±0,3

0,1±0,3

0

0,42

BMI (Kg/m2)

30,6±4,7

30,6±4,8

30,8±4,1

0,94

Type of Sling : TO

48 (69,6%)

44 (71%)

4 (57,1%)

0,451

RP

21 (30,4%)

18 (29%)

3 (42,9%)

0,451

* Data presented as n (%), mean (±SD)?

REFERENCES:

  1. Neurourology and Urodynamics 27: 485-490 (2008)
  2. Int Urogynecol J (2010) 21:795-800
  3. Am J Obstet Gynecol 144:408, 1982

Disclosure:

Work supported by industry: no.

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