title: Dynamic assessment of sling function on transperineal ultrasound: does it correlate with outcomes 1 year following surgery?
abstract: OBJECTIVE
  To correlate dynamic assessment of sling function using 2D and 3D transperineal ultrasound with outcomes following transobturator sling surgery.
  
  
  METHODS
  This is an unmatched case-control study of 100 patients who underwent transobturator sling surgery at our center between 2009 and 2012. Group A (n = 50) patients had successful outcomes and group B (n = 50) patients had suboptimal outcomes 1 year following surgery. The patients underwent 2D dynamic and 3D transperineal ultrasound. The two groups were compared with regard to the deformability of the sling on Valsalva, the concordance of urethral movement with the sling, and location of the sling.
  
  
  RESULTS
  When compared with group B, group A had a significantly greater number of patients in whom the sling deformed at Valsalva (flat at rest, curving into a c-shape at Valsalva), the urethral movement was concordant with the sling and the sling had a midurethral location (p < 0.0001). In all 17 patients in group B in whom the urethra moved in a concordant manner with the sling (34%), the sling did not deform on Valsalva maneuver and was located proximally. In all 15 patients in group A in whom the sling remained either flat or curved (30%), the urethra moved concordant with the sling and the sling was in midurethral location.
  
  
  CONCLUSIONS
  On 2D and 3D transperineal ultrasound, the best outcomes following transobturator sling surgery are associated with concordance of urethral movement with the sling, midurethral location, and deformability of the sling on dynamic assessment.
authors.affiliation: Center for Urogynecology and Pelvic Health (C.U.P), New Delhi, India. aparnahegde@cupindia.org.|Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL, USA. aparnahegde@cupindia.org.
authors.forename: Aparna
authors.identifier: http://orcid.org/0000-0002-5050-1060
authors.initials: A
authors.lastname: Hegde
authors.affiliation: Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Mayte
authors.initials: M
authors.lastname: Nogueiras
authors.affiliation: Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Vivian C
authors.initials: VC
authors.lastname: Aguilar
authors.affiliation: Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: G Willy
authors.initials: GW
authors.lastname: Davila
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009068:Movement; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D014521:Urethra / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014636:Valsalva Maneuver / Q000502:physiology
keywords: Dynamic assessment; Outcomes; Sling function; Sling surgery; Ultrasound