Sonographic evaluation of anatomic results after the pubovaginal sling procedure for stress urinary incontinence.

Abstract

Objective. To investigate the anatomic changes after the pubovaginal sling procedure in women with stress urinary incontinence by transrectal sonography. Methods. This study enrolled 56 women with varying types of stress urinary incontinence who were treated with the pubovaginal sling procedure using self-fashioned polypropylene mesh. The suburethral sling was fixed without tension and was placed at the position between the bladder neck and the proximal urethra. The patients were investigated preoperatively and postoperatively by transrectal sonography of the bladder and urethra. Results. At a median follow-up of 24 months (range, 6-39 months), 48 patients (85.7%) were cured, 6 (10.7%) had improved, and 2 (3.6%) had treatment failures. Transrectal sonography revealed a wellsuspended bladder neck and proximal urethra in all patients who were cured. As measured by changes of the axis of the pubovesical ligament, the position of the bladder neck was elevated by a mean of 29.6 ± 21.5°in the resting condition and 47.4 ± 27.7°in the straining condition. An incompetent bladder neck and proximal urethra were noted in 8 patients who had stress urinary incontinence after surgery. The incidence of opening of the bladder neck was 84.6% in 13 patients with de novo urgency or urge incontinence, whereas only 2 (4.7%) of 43 patients who did not have postoperative urgency had opening of the neck (P = .000). Conclusion. Transrectal sonography provides useful information about anatomic changes after the pubovaginal sling procedure. Bladder neck incompetence after surgery was closely related to postoperative urgency or urge incontinence.

Positioning of a Suburethral Sling at the Bladder Neck Is Associated With a Higher Recurrence Rate of Stress Urinary Incontinence

“…The possible pathogenesis of de novo urge symptoms includes bladder outlet obstruction and damage to bladder autonomic innervation by the sling procedure 23 . In addition, bladder neck incompetence on transrectal sonography is reportedly closely related to postoperative urgency or urge incontinence 19 . In this study, bladder neck incompetence on transrectal sonography was significantly higher in the distal urethra group but was not significantly associated with de novo urge symptoms.…”

Prepubic and thigh abscess after successive placement of two suburethral slings

“…Because of the high mortality of this inflammatory disease, early diagnosis is essential to initiate adequate surgical and medical treatment. At the present time, MRI cannot identify synthetic slings, although translabial ultrasonography can identify it [10,11] since the polypropylene slings are highly echogenic and easily identified posterior to the urethra. However, nor MRI or ultrasound can identify synthetic sling in obturator foramen.…”

Long-Term Surgical Results of Pubovaginal Sling Procedure Using Polypropylene Mesh in the Treatment of Stress Urinary Incontinence

“…In patients with type 3 SUI, the sling was not fi xed and was placed with mild tension in order to produce more urethral resistance. Previous sonographic investigation using the pubovaginal sling procedure of this study demonstrated a thick endopelvic fascia lying between the sling and the urethra [15] . This endopelvic fascia buffer helps prevent the development of bladder outlet obstruction; however, it might also result in inadequate compression of the urethra by the sling.…”