title: Three-dimensional transperineal ultrasound for imaging mesh implants following sacrocolpopexy.
abstract: OBJECTIVE
  To characterize, using three-dimensional (3D) transperineal ultrasound, the appearance, position and dimensions of mesh implants following minimally invasive abdominal sacrocolpopexy.
  
  
  METHODS
  In women who underwent sacrocolpopexy, mesh was evaluated at rest and on maximal Valsalva, on all 3D orthogonal planes and rendered views. Mesh dimensions were obtained by 3D processing in the midsagittal and coronal planes (anterior, posterior and sacral arm) and were analyzed offline, the operator blinded to clinical data.
  
  
  RESULTS
  Overall, 62 women, mean age 58.4 (range, 42-79) years were evaluated at a median of 9 (range, 1-26) months following surgery. The anterior arm of the mesh was caudal to the lowermost point of descent of the anterior compartment in 56 (90.3%) women, was equally positioned in five (8.1%) and was cranial in one. The posterior arm was caudal in 44 (71%) women, was equally positioned in 16 (25.8%) and was cranial in two (3.2%). The Y connection and the sacral arm of the mesh could not be adequately seen because of physical limitations of ultrasound (lower resolution at greater depth), large recurrent rectoceles, echogenic stools or folding of mesh remnants. Folding of the mesh was seen in 46 (74.2%) women, folding of the anterior arm in five (8.1%) and folding of the posterior arm in 23 (37.1%). Folding occurred caudally in 26 (41.9%) women, proximally in 11 (17.7%) and in both areas in nine (14.5%). There were no erosions.
  
  
  CONCLUSIONS
  Mesh visualization following minimally invasive abdominal sacrocolpopexy procedures using transperineal 3D/four-dimensional (4D) ultrasound is feasible. Studies are needed to evaluate the correlation between ultrasound measures and prolapse recurrence or mesh erosion.
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: V H
authors.initials: VH
authors.lastname: Eisenberg
authors.forename: M
authors.initials: M
authors.lastname: Steinberg
authors.forename: Z
authors.initials: Z
authors.lastname: Weiner
authors.forename: M
authors.initials: M
authors.lastname: Alcalay
authors.forename: J
authors.initials: J
authors.lastname: Itskovitz-Eldor
authors.forename: E
authors.initials: E
authors.lastname: Schiff
authors.forename: L
authors.initials: L
authors.lastname: Lowenstein
mesh_terms: D000328:Adult; D000368:Aged; D052858:Cystocele / Q000000981:diagnostic imaging* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging* / Q000601:surgery; D010502:Perineum / Q000000981:diagnostic imaging; D012008:Recurrence; D013526:Surgical Mesh; D013536:Suture Techniques; D014463:Ultrasonography; D014596:Uterine Prolapse / Q000000981:diagnostic imaging* / Q000601:surgery; D014636:Valsalva Maneuver
keywords: 3D transperineal ultrasound; cystocele; mesh; mesh folding; pelvic organ prolapse; sacrocolpopexy