Changes in the MRI morphology of the stress continence control system after TVT (tension-free vaginal tape) insertion

Tunn, Ralf; Schuettoff, St. A.; Gauruder-Burmester, A.; Beyersdorff, Dirk

doi:10.1016/j.ejogrb.2006.03.010

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…On the other hand, it has been demonstrated that TVT plasty is equally successful in treating all six types of stress urinary incontinence [2]. This success not only contradicts the original concept of midurethral stabilization and replacement of the pubourethral ligaments but also the observation, at least based on magnetic resonance imaging criteria, that the lateral defect is not repaired by TVT insertion [3].A second group is equally adamant that primary cesarean section should be performed in women with a TVT because this is what has always been recommended for deliveries after incontinence surgery. Well, let us just say that the literature on this subject is rather meager [4-6], and the scientific discussion is not very deep.…”

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Childbearing after TVT: how I have my baby when I have a TVT

Tunn

2006

Int Urogynecol J

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About 1 million tension-free vaginal tape (TVT) procedures, according to Ulmsten et al. [1], have been performed worldwide, and the total number of interventions is estimated to be about twice that figure if the tension-free tapes from other manufacturers are included. Compared to other surgical techniques used to treat urinary incontinence, TVT plasty is minimally invasive and has excellent longterm results with only few complications. Hence, it is only too understandable that women of reproductive age also favor this therapeutic option. Even if a woman convinces her gynecologist when discussing therapeutic options that she is absolutely positive that her family planning is complete, situations can change, and then we are in a fix.There are those who say that women should not become pregnant after TVT insertion, and that all women of childbearing age should be treated by colposuspension, which has been effectively used for over 45 years in this age group, where lateral defects seem to be the main etiologic factor underlying the development of stress urinary incontinence. Proponents of this approach rely on their vast clinical experience, but hard scientific evidence is lacking. On the one hand, there is no prospective clinical data demonstrating that colposuspension is superior to the TVT procedure in women with stress urinary incontinence and a lateral defect. On the other hand, it has been demonstrated that TVT plasty is equally successful in treating all six types of stress urinary incontinence [2]. This success not only contradicts the original concept of midurethral stabilization and replacement of the pubourethral ligaments but also the observation, at least based on magnetic resonance imaging criteria, that the lateral defect is not repaired by TVT insertion [3].A second group is equally adamant that primary cesarean section should be performed in women with a TVT because this is what has always been recommended for deliveries after incontinence surgery. Well, let us just say that the literature on this subject is rather meager [4-6], and the scientific discussion is not very deep. One important fact should not be forgotten: The rate of cesarean sections is on the rise, and many countries allow elective cesareans since its safety has dramatically improved and is now on par with spontaneous delivery. Just think of breech delivery. Not so long ago, it was a skilled and highly competent obstetrician who mastered vaginal delivery, whereas today, we are liable to be sued for malpractice if we do not perform primary cesarean section.When two people quarrel, a third rejoices, and if he comes from a research background, he will search the medical database. Unfortunately, he is out of luck because only a handful of case reports turn up. Some early reports describe successful cesarean sections after TVT with preservation of continence [7], while other braver souls report the first successful spontaneous deliveries with maintained continence [8], well, at least, for a couple of weeks after delivery. Why so pessimist...

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Childbearing after TVT: how I have my baby when I have a TVT

Tunn

2006

Int Urogynecol J

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“…However, complications including mesh exposure, sling failure, voiding dysfunction, dyspareunia, recurrent urinary tract infection (UTI), and de novo overactive bladder (OAB) can occur in a small group of patients (<10%) [4,5]. Sling position may play a role in predicting outcomes and complications associated with surgery [6][7][8][9][10][11][12][13]. Imaging techniques can provide assistance in evaluation of sling position [7].…”

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confidence: 99%

Ultrasound Evaluation of Mid-Urethral Sling Position: A Potential Predictor of Outcomes and Adverse Effects

Ayati

Ghanbari

Bastani

et al. 2022

Gynecol Obstet Invest

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Objective: To evaluate mid-urethral sling (MUS) position and its association with postoperative outcomes and complications. Design: This was a prospective cohort study. 92 women who underwent MUS procedure with a median follow-up period of 11 months (interquartile range 5 to 24 months) were recruited. Participants/Materials, Setting, Methods: Two-dimensional trans-labial ultrasound (TLUS) with an endovaginal probe was used to visualize the urethral length (UL), sling distance to the bladder neck (BN) and to the urethra longitudinal smooth muscle (LSM). Results: Mean sling-LSM, UL and sling-BN distances were 5.97±2.04 mm, 28.66±3.19 mm, and 18.85±4.46 mm, respectively. Sling position relative to BN (proximal vs. middle vs. distal) was not associated with surgery outcomes and complications; however, mean sling-LSM in patients with exposure (4.3%) was significantly higher compared to those who did not experience exposure (8.80±1.9 mm vs. 5.8±2.0 mm, P=0.048). Moreover, the mean sling-LSM distance was associated with patient satisfaction (5.87±2.0 mm in satisfied patients with VAS>6 vs. 6.29± 2.1 mm in unsatisfied patients, p value= 0.043). Likewise, Patients who had worsened or showed de novo overactive bladder (OAB) symptoms (8.8%) had significantly higher mean sling-LSM distance compared to patients with improved OAB symptoms (6.52 ± 2.0 mm vs. 5.37 ± 1.9 mm, P=0.007). Mean sling-LSM distance was lower in patients with recurrent urinary tract infection (UTI), voiding dysfunction, and improved stress urinary incontinence whereas patients with dyspareunia after surgery had higher mean sling-LSM distance; however, these differences were not statistically significant. Limitations: Both trans-obturator and retropubic procedures with or without concomitant prolapse surgery were assessed. Heterogeneity of the study population and performing pelvic floor ultrasound by a single urogynecologist were the limitations of the current study. Conclusions: Ultrasound visualization of MUS is feasible and has the potential to predict outcomes and complications. High sling-LSM distance was associated with exposure and low sling-LSM distance with increased satisfaction rate, probability of voiding dysfunction and recurrent UTI.

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“…However, others have noted that visualization of the periurethral portion of the sling is poor or nonexistent . Since slings appear hypointense on MRI, postoperative changes that decrease the signal intensity of surrounding tissue can obscure the sling …”

Section: Introductionmentioning

confidence: 99%

“…10 Since slings appear hypointense on MRI, postoperative changes that decrease the signal intensity of surrounding tissue can obscure the sling. 11 One limitation of TUS is dependence on technician proficiency as well as reliance on radiologic interpretation of images. As with any imaging study, it is advantageous for a urologist to be able to interpret the images alone without having to wait for a radiologist's interpretation and to correlate them instantly to clinical findings.…”

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