Can we predict the results of single-incision sling insertion with translabial ultrasound?

Abstract

Objectives: To describe the translabial ultrasound findings in patients with stress urinary incontinence (SUI) who underwent single-incision sling (SIS) insertion and to determine the correlation between these findings and results after surgery.

Study design: Retrospective and analytical study of patients with SUI who underwent SIS. Translabial ultrasound was performed 12 months after surgery. Success was assessed using the cough test. Satisfaction was assessed using the Treatment Benefit Scale (TBS). The presence of de novo urgency and de novo voiding dysfunction were assessed by anamnesis and questionnaires.

Main outcome measures: Objective resolution of incontinence, patient satisfaction, de novo urgency and voiding dysfunction.

Results: 111 patients were analyzed. Among the patients with resolution of SUI (92 patients, 82,9 %), 93,5 % (86 patients) had the mesh in the middle third of the urethra, reducing to 78,9 % (15 patients) in patients with SUI unresolved (p = 0,04). In the group of SUI cured, 78,3 % of these patients showed a mean reduction of 17,4 ± 20 % of mesh-pubis distance in Valsalva compared with rest and in the group of SUI unresolved this distance showed an increase of 1,6 ± 16 % (p = 0,02). Mesh-urethral lumen distance was significantly shorter in patients who experienced de novo voiding dysfunction compared with patients without voiding dysfunction (4(3-4,9)mm vs 5(4-7)mm, p = 0,03). The prevalence of voiding dysfunction was 19 % (13 patients) when the mesh-urethral lumen distance was <5 mm, reducing to 2 % (1 patient) in patients with a larger distance (p = 0,01). Urgency was not correlated with any of the variables evaluated.

Conclusions: Translabial ultrasound findings after SIS are correlated to objective resolution of SUI and de novo voiding dysfunction.