Skip to main content

Advertisement

SpringerLink
Log in

Meshy business: MRI and ultrasound evaluation of pelvic floor mesh and slings

  • Special Section: The pelvic floor
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Pelvic floor disorders are a complex set of conditions including but not limited to stress urinary incontinence and pelvic organ prolapse that generally affect older and multiparous women. Of the several surgical options available for treatment of these conditions, synthetic mid-urethral slings for stress urinary incontinence and vaginal mesh for pelvic organ prolapse are amenable to imaging evaluation by ultrasound and magnetic resonance imaging techniques. Ultrasound can evaluate the sub- and immediate peri-urethral portions of sling due to its ability to differentiate synthetic material from native tissues with real-time imaging, while MRI is able to better depict the global pelvic floor anatomy and assess the more distant components of mesh and slings material. Given the high prevalence of pelvic floor disorders and complications after surgical repair, it is important that radiologists familiarize themselves with normal and abnormal imaging findings after these procedures. This article provides a review of the spectrum of imaging findings in patients after pelvic floor repair with synthetic mid-urethral slings and vaginal mesh.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25
Fig. 26
Fig. 27
Fig. 28
Fig. 29
Fig. 30

Similar content being viewed by others

References

  1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89 (4):501-506. doi:10.1016/s0029-7844(97)00058-6

    Article  CAS  PubMed  Google Scholar 

  2. Lavelle RS, Christie AL, Alhalabi F, Zimmern PE (2016) Risk of Prolapse Recurrence after Native Tissue Anterior Vaginal Suspension Procedure with Intermediate to Long-Term Followup. J Urol 195 (4 Pt 1):1014-1020. doi:10.1016/j.juro.2015.10.138

    Article  PubMed  Google Scholar 

  3. Sountoulidis. “Stress urinary incontinence.”https://www.ics.org/committees/standardisation/terminologydiscussions/sui

  4. Osman NI, Li Marzi V, Cornu JN, Drake MJ (2016) Evaluation and Classification of Stress Urinary Incontinence: Current Concepts and Future Directions. Eur Urol Focus 2 (3):238-244. doi:10.1016/j.euf.2016.05.006

    Article  PubMed  Google Scholar 

  5. Macura KJ, Thompson RE, Bluemke DA, Genadry R (2015) Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency. World J Radiol 7 (11):394-404. doi:10.4329/wjr.v7.i11.394

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bayrak O, Osborn D, Reynolds WS, Dmochowski RR (2014) Pubovaginal sling materials and their outcomes. Turk J Urol 40 (4):233-239. doi:10.5152/tud.2014.57778

    Article  PubMed  PubMed Central  Google Scholar 

  7. Novara G, Artibani W, Barber MD, Chapple CR, Costantini E, Ficarra V, Hilton P, Nilsson CG, Waltregny D (2010) Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol 58 (2):218-238. doi:10.1016/j.eururo.2010.04.022

    Article  PubMed  Google Scholar 

  8. Cosson M, Debodinance P, Boukerrou M, Chauvet MP, Lobry P, Crepin G, Ego A (2003) Mechanical properties of synthetic implants used in the repair of prolapse and urinary incontinence in women: which is the ideal material? Int Urogynecol J Pelvic Floor Dysfunct 14 (3):169-178; discussion 178. https://doi.org/10.1007/s00192-003-1066-z

  9. Naumann G, Albrich S, Skala C, Laterza R, Kölbl H (2012) Single-incision slings (SIS)—a new option for the surgical treatment of female stress urinary incontinence. Geburtshilfe Frauenheilkd 72(2):125–131

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Rapp DE, Govier FE, Kobashi KC (2009) Outcomes following mid-urethral sling placement in patients with intrinsic sphincteric deficiency: comparison of sparc and monarc slings. Int Braz J Urol: Off J Braz Soc Urol 35(1):68–75

    Article  Google Scholar 

  11. Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA (2017) Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 7:Cd006375. https://doi.org/10.1002/14651858.cd006375.pub4

  12. Bahrami S, Khatri G, Sheridan AD, Palmer SL, Lockhart ME, Arif-Tiwari H, Glanc P (2019) Pelvic floor ultrasound: when, why, and how? Abdom Radiol (NY). doi:10.1007/s00261-019-02216-8

    Article  Google Scholar 

  13. Khatri G, Carmel ME, Bailey AA, Foreman MR, Brewington CC, Zimmern PE, Pedrosa I (2016) Postoperative Imaging after Surgical Repair for Pelvic Floor Dysfunction. Radiographics 36 (4):1233-1256. doi:10.1148/rg.2016150215

    Article  PubMed  Google Scholar 

  14. Aguilar VC, White AB, Rogers RG (2017) Updates on the diagnostic tools for evaluation of pelvic floor disorders. Curr Opin Obstet Gynecol 29 (6):458-464. doi:10.1097/gco.0000000000000415

    Article  PubMed  Google Scholar 

  15. Kociszewski J, Fabian G, Grothey S, Kuszka A, Zwierzchowska A, Majkusiak W, Barcz E (2017) Are complications of stress urinary incontinence surgery procedures associated with the position of the sling? Int J Urol 24 (2):145-150. doi:10.1111/iju.13262

    Article  PubMed  Google Scholar 

  16. Dresler MM, Kociszewski J, Wlazlak E, Pedraszewski P, Trzeciak A, Surkont G (2017) Repeatability and reproducibility of measurements of the suburethral tape location obtained in pelvic floor ultrasound performed with a transvaginal probe. J Ultrason 17 (69):101-105. doi:10.15557/JoU.2017.0014

    Article  PubMed  PubMed Central  Google Scholar 

  17. Graf CM, Kupec T, Stickeler E, Goecke TW, Meinhold-Heerlein I, Najjari L (2016) Tomographic Ultrasound Imaging to Control the Placement of Tension-Free Transobturator Tape in Female Urinary Stress Incontinence. Biomed Res Int 2016:6495858. doi:10.1155/2016/6495858

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tamma A, Bjelic-Radisic V, Holbfer S, Trutnovsky G, Tamussino K, Aigmuller T, Ulrich D (2019) Sonographic sling position and cure rate 10-years after TVT- O procedure. PLoS One 14 (1):e0209668. doi:10.1371/journal.pone.0209668

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Rautenberg O, Kociszewski J, Welter J, Kuszka A, Eberhard J, Viereck V (2014) Ultrasound and early tape mobilization–a practical solution for treating postoperative voiding dysfunction. Neurourol Urodyn 33 (7):1147-1151. doi:10.1002/nau.22459

    Article  PubMed  Google Scholar 

  20. Kociszewski J, Rautenberg O, Perucchini D, Eberhard J, Geissbuhler V, Hilgers R, Viereck V (2008) Tape functionality: sonographic tape characteristics and outcome after TVT incontinence surgery. Neurourol Urodyn 27 (6):485-490. doi:10.1002/nau.20556

    Article  PubMed  Google Scholar 

  21. Flock F, Kohorst F, Kreienberg R, Reich A (2011) Ultrasound assessment of tension-free vaginal tape (TVT). Ultraschall Med 32 Suppl 1:S35-40. doi:10.1055/s-0029-1245798

    Article  PubMed  Google Scholar 

  22. Chantarasorn V, Shek KL, Dietz HP (2011) Sonographic appearance of transobturator slings: implications for function and dysfunction. Int Urogynecol J 22 (4):493-498. doi:10.1007/s00192-010-1306-y

    Article  PubMed  Google Scholar 

  23. Takacs P, Larson K, Scott L, Cunningham TD, DeShields SC, Abuhamad A (2017) Transperineal Sonography and Urodynamic Findings in Women With Lower Urinary Tract Symptoms After Sling Placement. J Ultrasound Med 36 (2):295-300. doi:10.7863/ultra.16.02076

    Article  PubMed  Google Scholar 

  24. Chan L, Tse V (2018) Pelvic floor ultrasound in the diagnosis of sling complications. World J Urol 36 (5):753-759. doi:10.1007/s00345-018-2253-3

    Article  PubMed  Google Scholar 

  25. Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, Dwyer PL, Fatton B, Kocjancic E, Lee J, Maher C, Petri E, Rizk DE, Sand PK, Schaer GN, Webb R (2011) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Neurourol Urodyn 30 (1):2-12. doi:10.1002/nau.21036

    Article  PubMed  Google Scholar 

  26. Viragh KA, Cohen SA, Shen L, Kurzbard-Roach N, Raz S, Raman SS (2018) Translabial US: Preoperative Detection of Midurethral Sling Erosion in Stress Urinary Incontinence. Radiology 289 (3):721-727. doi:10.1148/radiol.2018180786

    Article  PubMed  Google Scholar 

  27. Chapple CR, Cruz F, Deffieux X, Milani AL, Arlandis S, Artibani W, Bauer RM, Burkhard F, Cardozo L, Castro-Diaz D, Cornu JN, Deprest J, Gunnemann A, Gyhagen M, Heesakkers J, Koelbl H, MacNeil S, Naumann G, Roovers JWR, Salvatore S, Sievert KD, Tarcan T, Van der Aa F, Montorsi F, Wirth M, Abdel-Fattah M (2017) Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence. Eur Urol 72 (3):424-431. doi:10.1016/j.eururo.2017.03.048

    Article  PubMed  Google Scholar 

  28. Siddiqui NY, Grimes CL, Casiano ER, Abed HT, Jeppson PC, Olivera CK, Sanses TV, Steinberg AC, South MM, Balk EM, Sung VW (2015) Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis. Obstet Gynecol 125 (1):44-55. doi:10.1097/aog.0000000000000570

    Article  PubMed  PubMed Central  Google Scholar 

  29. Costantini E, Mearini L, Lazzeri M, Bini V, Nunzi E, di Biase M, Porena M (2016) Laparoscopic Versus Abdominal Sacrocolpopexy: A Randomized, Controlled Trial. J Urol 196 (1):159-165. doi:10.1016/j.juro.2015.12.089

    Article  PubMed  Google Scholar 

  30. Obstetrical and Gynecological Devices; Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair; Final order (2016). Fed Regist 81 (2):353-361

  31. “Urogynecologic Surgical Mesh Implants | FDA.” <https://www.fda.gov/medical-devices/implants-and-prosthetics/urogynecologic-surgical-mesh-implants>.

  32. Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev (4):Cd004014. https://doi.org/10.1002/14651858.cd004014.pub5

  33. Denson L, Shobeiri SA (2014) Three-dimensional endovaginal sonography of synthetic implanted materials in the female pelvic floor. J Ultrasound Med 33 (3):521-529. doi:10.7863/ultra.33.3.521

    Article  PubMed  Google Scholar 

  34. Api M, Kayatas S, Boza A (2015) Spondylodiscitis following sacral colpopexy procedure: is it an infection or graft rejection? Eur J Obstet Gynecol Reprod Biol 194:43-48. doi:10.1016/j.ejogrb.2015.08.003

    Article  PubMed  Google Scholar 

  35. Schofield ML, Higgs P, Hawnaur JM (2005) MRI findings following laparoscopic sacrocolpopexy. Clin Radiol 60 (3):333-339. doi:10.1016/j.crad.2004.06.028

    Article  CAS  PubMed  Google Scholar 

  36. Heinonen P, Aaltonen R, Joronen K, Ala-Nissila S (2016) Long-term outcome after transvaginal mesh repair of pelvic organ prolapse. Int Urogynecol J 27 (7):1069-1074. doi:10.1007/s00192-015-2939-7

    Article  PubMed  Google Scholar 

  37. Lee RK, Mottrie A, Payne CK, Waltregny D (2014) A review of the current status of laparoscopic and robot-assisted sacrocolpopexy for pelvic organ prolapse. Eur Urol 65 (6):1128-1137. doi:10.1016/j.eururo.2013.12.064

    Article  PubMed  Google Scholar 

  38. van Geelen JM, Dwyer PL (2013) Where to for pelvic organ prolapse treatment after the FDA pronouncements? A systematic review of the recent literature. Int Urogynecol J 24 (5):707-718. doi:10.1007/s00192-012-2025-3

    Article  PubMed  Google Scholar 

  39. Staack A, Vitale J, Ragavendra N, Rodriguez LV (2014) Translabial ultrasonography for evaluation of synthetic mesh in the vagina. Urology 83 (1):68-74. doi:10.1016/j.urology.2013.09.004

    Article  PubMed  Google Scholar 

  40. Tunn R, Picot A, Marschke J, Gauruder-Burmester A (2007) Sonomorphological evaluation of polypropylene mesh implants after vaginal mesh repair in women with cystocele or rectocele. Ultrasound Obstet Gynecol 29 (4):449-452. doi:10.1002/uog.3962

    Article  CAS  PubMed  Google Scholar 

  41. Svabik K, Martan A, Masata J, El-Haddad R, Hubka P, Pavlikova M (2011) Ultrasound appearances after mesh implantation–evidence of mesh contraction or folding? Int Urogynecol J 22 (5):529-533. doi:10.1007/s00192-010-1308-9

    Article  PubMed  Google Scholar 

  42. Feiner B, Maher C (2010) Vaginal mesh contraction: definition, clinical presentation, and management. Obstet Gynecol 115 (2 Pt 1):325-330. doi:10.1097/AOG.0b013e3181cbca4d

    Article  PubMed  Google Scholar 

  43. BJ, Elliott DS (2019) Synthetic Midurethral Slings: Roles, Outcomes, and Complications. Urol Clin North Am 46 (1):17-30. doi:10.1016/j.ucl.2018.08.013

    Article  PubMed  Google Scholar 

  44. Shek KL, Dietz HP (2014) Imaging of slings and meshes. Australas J Ultrasound Med 17 (2):61-71. doi:10.1002/j.2205-0140.2014.tb00108.x

    Article  PubMed  Google Scholar 

  45. Khatri G, de Leon AD, Lockhart ME (2017) MR Imaging of the Pelvic Floor. Magn Reson Imaging Clin N Am 25 (3):457-480. doi:10.1016/j.mric.2017.03.003

    Article  PubMed  Google Scholar 

  46. Kanmaniraja D, Arif-Tiwari H, Palmer SL, Kamath A, Lewis SC, Flusberg M, Kobi M, Lockhart ME, Chernyak V (2019) MR defecography review. Abdom Radiol (NY). doi:10.1007/s00261-019-02228-4

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Erin Moore for the medical illustrations: Erin Moore, M.A. Sr. Graphic Designer/Medical Illustrator, Department of Radiology, 5323 Harry Hines Blvd., Dallas, Texas 75390-8896.

Author information

Authors and Affiliations

  1. University of Arkansas for Medical Sciences, 4301, W. Markham Street, Little Rock, AR, USA

    Roopa Ram & Kedar Jambhekar

  2. Department of Medical Imaging, Body Division, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Rm MG160, Toronto, Canada

    Phyllis Glanc

  3. Mount Sinai South Nassau, Oceanside, USA

    Ari Steiner

  4. Department of Radiology, University of Colorado, Colorado, USA

    Alison D. Sheridan

  5. South Campus Hospital, University of Arizona College of Medicine, Tucson, USA

    Hina Arif-Tiwari

  6. Keck School of Medicine, University of Southern California, Los Angeles, USA

    Suzanne L. Palmer

  7. Department of Radiology, UT South Western Medical Center, Dallas, USA

    Gaurav Khatri

Authors
  1. Roopa Ram
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kedar Jambhekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Phyllis Glanc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ari Steiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alison D. Sheridan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hina Arif-Tiwari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Suzanne L. Palmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gaurav Khatri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roopa Ram.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 13731 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ram, R., Jambhekar, K., Glanc, P. et al. Meshy business: MRI and ultrasound evaluation of pelvic floor mesh and slings. Abdom Radiol 46, 1414–1442 (2021). https://doi.org/10.1007/s00261-020-02404-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02404-x

Keywords

Search

Navigation