title: Three-dimensional ultrasonographic assessment of compression effect on urethra following tension-free vaginal tape and transobturator tape procedures.
abstract: OBJECTIVE
  To compare the anatomical difference using three-dimensional (3D) ultrasound between the urethra at rest and during straining, in women who have undergone a tension-free vaginal tape (TVT) or TVT-obturator tape (TVT-O) procedure for stress urinary incontinence (SUI).
  
  
  METHODS
  We reviewed retrospectively 48 women with SUI who had undergone either a TVT (n = 24) or a TVT-O (n = 24) procedure. All women underwent urinalysis, pelvic examination, pad test, 3D perineal ultrasonography and personal interview about urinary symptoms within 1 year after surgery.
  
  
  RESULTS
  After both TVT and TVT-O procedures, the area and longest and shortest diameters of the hypoechoic core of the mid-urethra were significantly smaller during straining than during resting (P < 0.01). The distance between tape and urethra was similarly smaller during straining in both groups. Analysis of ultrasound measurements in women reporting success (n = 40) and those reporting failure (n = 8) of the procedure showed the area and longest and shortest diameters of the hypoechoic core of the mid-urethra to be significantly smaller during straining than during resting in both groups (P < 0.01). However, the shortest diameter of the proximal and distal urethra during straining were significantly smaller only in the successful group (P < 0.01).
  
  
  CONCLUSIONS
  There are differences in urethral morphology during straining compared with during resting in women with TVT and those with TVT-O, regardless of tape procedure. A urethral compression effect of slings may have an important role in the continence mechanism.
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: K-L
authors.initials: KL
authors.lastname: Lin
authors.forename: Y-S
authors.initials: YS
authors.lastname: Juan
authors.forename: T-S
authors.initials: TS
authors.lastname: Lo
authors.forename: C-M
authors.initials: CM
authors.lastname: Liu
authors.forename: E-M
authors.initials: EM
authors.lastname: Tsai
authors.forename: C-Y
authors.initials: CY
authors.lastname: Long
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics