Clinical and ultrasonographic correlations following three surgical anti-incontinence procedures (TOT, TVT and TVT-O)

Abstract

The aim of this study was to compare ultrasonographic findings on tape position, angulation and mobility following three surgical anti-incontinence procedures (trans-obturator tape (TOT), tension-free vaginal tape (TVT), tension-free vaginal tape obturator (TVT-O)) and to correlate these data with clinical signs of cures and failures and de novo voiding disorders. In this prospective study, vesicourethral static and dynamic analysis of 81 patients (30 TOT, 28 TVT, 23 TVT-O) were evaluated using introital ultrasonography. Width, position and appearance of the tape were similar in all three groups, i.e. like a "V" at rest, round angulation on Valsalva and closed angulation at maximum retaining. Moreover, closer angulation on Valsalva was associated with voiding disorders. Closer angulation at retaining was associated with de novo urge incontinence. Larger angulation of the tape at rest appeared to be significantly associated with recurrent stress incontinence. Ultrasonography could a be useful tool assessing anti-incontinence procedures and investigating post-operative voiding disorders.

Matched-pair analyses of resting and dynamic morphology between Monarc and TVT-O procedures by ultrasound

“…Chene et al have compared the vesicourethral dynamics and explored the correlations between surgical outcomes and axial tape angulations by ultrasound after TOT and RPT procedures [12]. They observed a wider straining axial tape angle, a manifestation suggesting mechanical compression of the urethra by the tape [12]. They also reported the associations between a wider resting tape angulation and recurrent SUI, narrower squeezing tape angulation and de novo urgency incontinence, and narrower straining tape angulation and postoperative voiding disorders [12].…”

“…They observed a wider straining axial tape angle, a manifestation suggesting mechanical compression of the urethra by the tape [12]. They also reported the associations between a wider resting tape angulation and recurrent SUI, narrower squeezing tape angulation and de novo urgency incontinence, and narrower straining tape angulation and postoperative voiding disorders [12]. The data are represented with number (percentage) and analyzed with Yates corrected Chi-square test.…”

“…Ultrasound comparisons limited to a single tape point without taking account of tape configuration and width may be one of the reasons. Chene et al have compared the vesicourethral dynamics and explored the correlations between surgical outcomes and axial tape angulations by ultrasound after TOT and RPT procedures [12]. They observed a wider straining axial tape angle, a manifestation suggesting mechanical compression of the urethra by the tape [12].…”

Transvulvar ultrasound of urethrovesical junction and proximal urethra as prognostic markers of burch procedure outcome

“…The importance of the urethrovesical junction (UVJ) and proximal urethra (PU) mobility in the maintenance of female urinary continence has already been established [4,[6][7][8][9][10][11] . However, the urodynamic evaluation determines only indirectly the UVJ and PU mobility, differently from what can be clearly demonstrated in real time imaging by ultrasound [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] .…”

“…The ultrasonographic examination of the UVJ and PU has been increasingly used in the preoperative evaluation and postoperative follow-up of patients with SUI, to document the UVJ and PU positioning before and after the elected surgical treatment [4][5][6][7][8][9][10][11][12][13][17][18][19] . At least one study suggested that the positioning of the UVJ and PU in the postoperative period is a good marker for treatment prognosis (whether a surgical procedure for SUI correction had been successful or not) [14] .…”