Pelvic Floor 3D USG Three Years After Mid-urethral Slings ( TVT-R, TVT-O, TVT-S)
Condition: Urinary Incontinence; Postoperative Period
MeSH terms: Urinary Incontinence
Study type: Observational

Summary: 
      Compare through 3D USG the tape spatial orientation, in three different techniques of
      insertion of mid-urethral synthetic sling, correlating USG findings to postoperative results
      in an average of three years follow-up.

      Methods: This is a transversal study of a cohort women surgically treated for stress urinary
      incontinence by retropubic sling (TVT-R), transobturator sling (TVT-O) or single-incision
      sling (TVT-S). The clinical and USG evaluation were performed at the same medical visit, from
      April 2013 to June 2014, .
    

Detailed description: 
      Introduction: The three dimensional ultrasonography (3D USG) provides a clear spatial
      orientation of polypropylene tape and can help clarify the pathogenesis of bladder
      dysfunction after a TVT procedure. Thus, the USG in urogynecology postoperative has shown an
      increasing role in monitoring surgically treated patients and specially in complications such
      as urinary retention and urinary disorders.

      Objective: Compare through 3D USG the tape spatial orientation, in three different techniques
      of insertion of mid-urethral synthetic sling, correlating USG findings to postoperative
      results in an average of three years follow-up.

      Methods: This is a transversal study of a cohort of women surgically treated for stress
      urinary incontinence by retropubic sling (TVT-R), transobturator sling (TVT-O) or
      single-incision sling (TVT-S). The surgeries occurred from May 2009 to December 2011. Were
      eligible for the study 158 patients. The clinical and USG evaluation were performed at the
      same medical visit, from April 2013 to June 2014, after local ethics committee approval and
      signature of informed consent. The objective cure rates were evaluated by negative pad-test
      and stress test. The subjective cure rate and urgency symptoms were accessed by
      questionnaires. The subjective cure was defined as absence of reports of stress urinary
      leakage.

      The USG evaluation was performed using General Electric Voluson 730 expert systems with 8 - 4
      Mhz volume transducers with an 85-degree acquisition angle. The exams were performed with
      patient in supine position with hip flexed and using slightly abduced, after voiding. The US
      transducer was placed on the perineum in the midsagittal position and volumes were obtained
      at rest, at maximum Valsalva, and perineal contraction. Moved mode rendering for OMNINI View
      plan as previous described.The volumes datasets were analyzed offline by of the authors. They
      were blinded and the average values were considered.

      The urethral length and the location of the sling, measured by the distance between bladder
      neck and the tape (CF), were assessed in midsagittal plane. The tape angle in relation to the
      urethra were assessed in OMINI VIEW plan.

      Statistical analysis was performed using student t, ANOVA and Tukey-test. P value of <0.05
      was considered statistically significant.
    

Intervention name(s): 3D pelvic floor ultrasound
Intervention type(s): Other
Intervention description(s): Pelvic Floor 3D Ultrasound Clinical evaluation with pad-test, stress test and questionnaires of symptoms and quality of life
Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Women who underwent stress urinary incontinence surgery with synthetic midurethral sling,
        by different approaches ( TVT, TVT-O and TVT-Secur) in a period of 2 to 4 years before
        clinical and 3D USG evaluation
      
Keywords: 3D Pelvic floor USG; Mid-Urethral Sling; TVT; TVT-O; TVT-S