The Evaluation of the Effect of Suburethral Transobturator Sling on the Urethra Using Ultrasound Examination

Abstract

Background Despite the use of suburethral tapes for many years, the mechanism of their action and the reasons for their failures have not been thoroughly understood. Objectives The aim of this study was to analyze the impact of the TOT tape on changes in urethral mobility depending on its location. Additionally, the urethral funneling was evaluated. Material and methods 57 patients with SUI symptoms had TOT implanted. Ultrasound examinations were performed before and 3–6 months after surgery, among others, urethral length, suburethral tape location, bladder neck mobility, and urethral funneling were evaluated. Results 77.2% of patients were cured, while 22.8% were not cured. After tape insertion, a reduction in bladder neck mobility parameters was observed in the group of patients with preoperative hypermobile urethras, regardless of the therapeutic outcome. The average distance of the tape from the hypoechoic area of the urethra was smaller in cured patients, while the relative tape position did not differ significantly between cured and not cured women. Before surgery, all patients had a long urethral funneling. Postoperatively, all non‑cured patients had a long funneling, while in cured patients, no long urethral funneling was observed. Conclusions The TOT suburethral tape reduced urethral mobility to a similar extent in cured and not cured women. The effect on UM was noticeable in patients with preoperative hypermobile urethrae. The obtained TOT tape locations did not affect the degree of UM reduction. Patients in whom the TOT tape was located closer to the hypoechoic zone of the urethra had a greater chance of effective elimination of SUI symptoms. It was confirmed that the assessment of the urethral funneling during PFS ‑TV may be useful for confirming SUI and for assessing the effects of SUI treatment after suburethral tape implantation.