The Use of Imaging for Synthetic Midurethral Slings

Abstract

Ultrasound and magnetic resonance imaging can be used to image midurethral slings, which have may have complications such as pain. There is considerable misunderstanding regarding the utility of the different modalities. This article aims to review the current literature to identify the benefits and limitations of each imaging modality and identify the place that each should have for patients with midurethral sling complications. A literature search was performed, and all relevant articles were identified and reviewed. Different imaging modalities are complementary, but more research is required in this area.

Construction of a Prognostic Score for Ultrasound Evaluation of the Transobturator Sling for Stress Urinary Incontinence

“…In the case of our study, we established the correct measurement as the minimum existing measurement between the edge of the sling and the posterior urethral wall and considered the cut-off point of 5 mm, according to the current literature [ 23 , 24 ], to discriminate the presence of symptomatic SUI, being the main objective of the surgery performed. In the case of slings very close to the urethral lumen, if there is consensus in the literature of their relationship with urge symptoms [ 25 ], these symptoms must be considered, and an ultrasound study was completed in search of these findings.…”

“…Kociszewski et al [ 23 ], established an ultrasound classification according to the behavior of the sling according to its shape and considered that those that have a curved shape maintained at rest and in Valsalva to be related to greater complication and unsatisfactory surgery [ 24 , 25 ]. In our case, the correlation in Valsalva was not statistically significant, and therefore it was not included in the score.…”

“…The position of the resting sling in the urethral path was also a statistically significant result ( p = 0.04) in our study. The fact of performing a bivariate study (proximal versus non-proximal) may not be the most appropriate, since slings very far from the middle third are also related to the failure of the surgery [ 23 , 25 ]. The concordance of the movement of the sling with the urethra when performing Valsalva was also statistically significant ( p = 0.04).…”

“…The concordance of the movement of the sling with the urethra when performing Valsalva was also statistically significant ( p = 0.04). Like other studies, we also consider it to be a useful parameter when the sling remains fixed at the middle position of the urethra [ 16 , 25 ]. These last ultrasound parameters (resting mesh position and urethral concordance) were not included in our score since they were not statistically significant.…”

Translabial Ultrasound

“…Magnetic resonance imaging (MRI) has also recently been developed as a potential alternative imaging modality, in which some literature suggests that MRI is superior to ultrasound for depiction of the MUS arms in the retropubic space and obturator foramen; however, ultrasound identifies MUS better in the urethrovaginal space. 20 Furthermore, compared with ultrasound, MRI is less accessible and is much more costly. 14,20,21 When patient TLUS imaging findings were compared with their records, TLUS identification of sling revision resulted in a high sensitivity of 95.6% and specificity of 84.6%.…”