title: Matched-pair analyses of resting and dynamic morphology between Monarc and TVT-O procedures by ultrasound.
abstract: OBJECTIVE
  To determine morphologic differences between Monarc and TVT-O procedures in axial and coronal planes by three- and four-dimensional (3D and 4D) ultrasound.
  
  
  METHODS
  Retrospective chart audits and ultrasound analyses were conducted on 128 women who had undergone either Monarc or TVT-O procedures for urodynamic stress incontinence. Thirty matched pairs of the two successful procedures were randomly selected and compared. Matched variables were age, parity, body mass index, cesarean status, menopausal status, and primary surgeries. Six-month postoperative 3D and 4D ultrasound results obtained at rest, on straining, and during coughing in these 60 women were analyzed. Assessed ultrasound parameters included the axial tape urethral distance (aTUD), axial central urethral echolucent area (aUCEA), axial tape angle (aTA), and coronal tape angle (cTA), all of which were measured at three equidistant points along the tapes. Paired t-tests were used to compare differences in ultrasound parameters between women after the two procedures and a P value <0.004 was considered significant after Bonferroni correction.
  
  
  RESULTS
  At rest, women subjected to Monarc procedures had a significantly wider aTA at one-fourth of the tape and a wider cTA at one-, two-, and three-fourths of the tape than did those subjected to TVT-O procedures. There were no significant differences in other resting ultrasound parameters between these two procedures. Additionally, after both procedures women had comparable straining and coughing ultrasound manifestations as well as respective dynamic changes.
  
  
  CONCLUSIONS
  Despite flatter resting tape angulations in women following Monarc procedures, both Monarc and TVT-O tapes had equivalent dynamic patterns and changes assessed by 4D ultrasound.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jenn-Ming
authors.initials: JM
authors.lastname: Yang
authors.forename: Shwu-Huey
authors.initials: SH
authors.lastname: Yang
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Huang
authors.forename: Chii-Ruey
authors.initials: CR
authors.lastname: Tzeng
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D012189:Retrospective Studies; D053825:Suburethral Slings; D014463:Ultrasonography; D014550:Urinary Incontinence, Stress / Q000601:surgery*
keywords: Introital ultrasound; Tape angulation; Tape tension; Three-/four-dimensional ultrasound; Transobturator suburethral tape