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Pelvic floor ultrasound in the diagnosis of sling complications

Abstract

Purpose

The mid-urethral synthetic sling (MUS) procedure has become the standard of care for treatment of female stress urinary incontinence. However, a small number of patients will have complications following MUS including failure, obstructive voiding, sling erosion, or chronic pain. This paper discusses the role of 2D and 3D ultrasound imaging in the evaluation of the female patient with complications following placement of a synthetic mid-urethral sling.

Results

The MUS is easily visualized as an echogenic structure on ultrasound and can be imaged by transperineal, transvaginal and introital approaches. Ultrasound allows dynamic assessment of the sling and can assist in the diagnosis of sling failure, obstruction, erosion and mesh related pain.

Conclusions

Pelvic floor ultrasound has an emerging role in the assessment of complications following MUS surgery. 3D ultrasound can assist the clinician in assessment of the complex patient with multiple slings or meshes in situ.

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Author information

LC: project development, data collection, and manuscript writing. VT: data collection and manuscript editing.

Correspondence to Lewis Chan.

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Conflict of interest

The authors have no potential conflicts of interest to disclose.

Human participants or animals rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (AVI 7937 kb) Video 1 Transperineal 2D ultrasound of MUS imaged in para-sagittal plane showing dynamic compression of the mid-urethra by sling during coughing

Supplementary material 2 (AVI 23449 kb) Video 2 Transperineal ultrasound of patient with MUS who reported recurrence of urinary incontinence following heavy physical exercise at 3-weeks post surgery. Note lack of dynamic compression of the urethra suggesting that the sling may have become loose after exercise

Supplementary material 3 (AVI 21818 kb) Video 3 Transperineal ultrasound (imaged in sitting position) of patient with voiding dysfunction following pubovaginal fascial sling demonstrating marked angulation of proximal urethra/ bladder neck by sling during Valsalva

Supplementary material 4 (AVI 78750 kb) Video 4 Transvaginal ultrasound in patient with pelvic pain, previous MUS, and mesh repair of rectocele. Pain was reproduced by gentle pressure of transducer on MUS but not on posterior mesh—this patient subsequently underwent excision of sling with resolution of pain

Supplementary material 1 (AVI 7937 kb) Video 1 Transperineal 2D ultrasound of MUS imaged in para-sagittal plane showing dynamic compression of the mid-urethra by sling during coughing

Supplementary material 2 (AVI 23449 kb) Video 2 Transperineal ultrasound of patient with MUS who reported recurrence of urinary incontinence following heavy physical exercise at 3-weeks post surgery. Note lack of dynamic compression of the urethra suggesting that the sling may have become loose after exercise

Supplementary material 3 (AVI 21818 kb) Video 3 Transperineal ultrasound (imaged in sitting position) of patient with voiding dysfunction following pubovaginal fascial sling demonstrating marked angulation of proximal urethra/ bladder neck by sling during Valsalva

Supplementary material 4 (AVI 78750 kb) Video 4 Transvaginal ultrasound in patient with pelvic pain, previous MUS, and mesh repair of rectocele. Pain was reproduced by gentle pressure of transducer on MUS but not on posterior mesh—this patient subsequently underwent excision of sling with resolution of pain

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Cite this article

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

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Keywords

  • Mid-urethral sling
  • Ultrasound
  • Mesh complications