Imaging of sub-urethral slings: State of the art.

Abstract

Objectives: The mid-urethral synthetic sling (MUS) is a widely used surgical intervention for stress urinary incontinence (SUI). This study aims to evaluate the complexities of diagnosing and managing complications related to MUS through various imaging techniques.

Methods: This study reviews the application of different imaging modalities in patients presenting with recurrent or new symptoms following MUS surgery. The focus is on comparing the effectiveness of US and MRI in identifying the position and potential complications of pelvic slings. The use of voiding cystourethrography and CT is also discussed, although these techniques are less frequently employed due to their limited ability to directly depict mid-urethral slings.

Results: US was found to be more effective in depicting mid-urethral slings within the urethrovaginal space, while MRI excelled in visualizing the sling arms in the retropubic space and obturator foramen. MRI was also superior in identifying infectious complications. However, both US and MRI faced challenges in distinguishing scarring from the slings and mesh.

Conclusions: Effective diagnosis and management of MUS complications require a comprehensive understanding of the strengths and limitations of various imaging modalities. US and MRI are the primary tools, with MRI being particularly useful for detecting infectious complications and visualizing sling arms in specific anatomical regions.