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.
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.
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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The authors have no potential conflicts of interest to disclose.
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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 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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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
- Mid-urethral sling
- Mesh complications