Ultrasound Evaluation of Midurethral Sling Position and Correlation to Physical Examination and Patient Symptoms.
OBJECTIVE
The primary objective was to evaluate the position and angle variation between 3 different midurethral slings (MUSs) using 3-dimensional ultrasound (US) technology. The secondary objective was to compare differences in findings on physical examination and symptoms of incontinence and sexual dysfunction between subjects.


METHODS
This was a cross-sectional study of 61 subjects who had undergone MUS placement without concomitant anterior or apical compartment prolapse surgery (21 retropubic [RP], 19 out-to-in transobturator [TOT], 21 in-to-out transobturator [TVT-O]). Subjects completed validated questionnaires (Sandvik Incontinence Severity Index, Urogenital Distress Inventory 6) and underwent a pelvic examination and standardized 2-dimensional and 3-dimensional ultrasonography evaluation.


RESULTS
On translabial US, the median RP sling angle was 108.2 degrees (72.6-135.9), significantly more acute than the angle of TOT and TVT-O slings (119.3 degrees [72.3-140.4, P = 0.02] and 118.5 degrees [99.0-154.7, P = 0.004]). There was no difference in the sling angles between the TOT and TVT-O slings (P = 0.86). No difference was noted in the position of the sling along the urethra (P = 0.82). The TOT sling was more often palpable (57.8%, P = 0.02) compared with the RP or TVT-O groups.Fifteen patients (4 RP, 5 TOT, 6 TVT-O) reported discomfort during intercourse that they attributed to the MUS. Three of 19 TOT subjects reported that their partner experienced pain with intercourse because of the sling. However, sexual function and urinary symptoms were not statistically different between the 3 groups.


CONCLUSIONS
On 3-dimensional US, RP sling angle was found to be significantly more acute than the angles of the TOT and TVT-O slings, and there was no difference between the 2 transobturator slings. The TOT sling was more often palpable on examination, but this finding did not correlate with increased pain on palpation.
From the *Female Pelvic Medicine and Reconstructive Pelvic Surgery, Obstetrics and Gynecology, Women's Health Institute, and †Female Pelvic Medicine and Reconstructive Pelvic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH.
Elena
E
Tunitsky-Bitton
Cecile A
CA
Unger
Matthew D
MD
Barber
Howard B
HB
Goldman
Mark D
MD
Walters
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004414:Dyspareunia / Q000209:etiology*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008875:Middle Aged; D010808:Physical Examination; D010865:Pilot Projects; D053825:Suburethral Slings / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology*