Postoperative transperineal ultrasound parameters in women with intrinsic sphincteric deficiency underwent midurethral sling for stress urinary incontinence

Ultrasound (US) is an excellent tool for imaging the upper urinary tract, as it is completely non-invasive and gives anatomical information independent of renal function US is frequently used for assessing female urinary incontinence and prolapse and, in skilled hands, it may provide useful functional and morphological information about the perineum Quantitative variables of female lower urinary tract US may highlight the importance of perineal US in improving our knowledge about pelvic statics and dynamics Transperineal ultrasound (TP-US) may be used in the outcome assessment after incontinence surgery throughout : elevation and distortion of the bladder neck and placement and mobility of the mid-urethra tape. Purpose: to evaluate postoperative TP-US parameters in female patients with stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD), who underwent either a retropubic tension-free vaginal tape (TVT) or a transobturator suburethral sling (TVT-O) Materials and methods: 62 women with SUI and ISD, 18 cases treated using a TVT, 44 cases treated using a TVT-O, pre- and 3-month postoperative TP-US was performed in all cases in gynaecologic position, under Valsalva manoeuvre and during maximal pelvic floor muscle contraction (Kegel). For each patient a Q-tip test was performed. The TP-US parameters used were: alpha-angle (pubourethral angle), beta-angle (urethra-vesical angle) and distance between the bladder neck and the tape. Results: see the table. TVT TVT-O p value • alpha angle (°) rest Valsalva Kegel 16.9 37.7 11.5 20.3 43.1 8.9 p=0.02 • beta angle (°) rest Valsalva Kegel 138.1 131.5 150.4 131 130.8 135.2 p=0.02 • Distance between the bladder neck and the tape (mm) 21.3 17.4 p=0.01 At multivariate analysis the distance between the bladder neck and the tape was the only statistically significant parameter. Discussion: Our preliminary data might suggest a different pathophysiological mechanism underlying the two employed tension free procedures which could justify different success rates and complication rates in women with SUI and ISD undergone these surgical interventions Conclusion: TP-US may represent a valid tool able to give useful information on tension-free suburethral slings used in the treatment of female SUI in order to better understand slings pathophysiological mechanisms, opening new paths to the improvement of SUI research outcomes