The Role of Pelvic Ultrasound in Evaluating the Success of Tension-free Vaginal Tape (TVT)

Objectives: This study aims to assess the lack of response to treatment in individuals undergoing mid-urethral sling surgery for stress urinary incontinence (SUI) using ultrasound findings of the pelvic floor.
Methods: The study included patients who underwent the tension-free vaginal tape (TVT) procedure for stress urinary incontinence within the period spanning from January 2016 to January 2021. The physical examination involved maintaining bladder filling at an average volume of 200–400 mL, and treatment failure was determined by the presence of SUI during the Valsalva maneuver.
Results: The study comprised a total of 214 patients, where it was observed during the stress test that 32 patients (25.8%) had an unsuccessful outcome following mid-urethral sling surgery. In the unsuccessful group, the distance of the mesh-posterior urethra was lower (4.09±0.39 vs. 4.91±0.51; p<0.001), the posterior urethrovesical angle was lower when at rest, but the angle increased more significantly during the Valsalva maneuver, and the bladder neck angle was narrower (p<0.001).
Conclusion: We obtained lower mean values of mesh-posterior urethral distance in unsuccessful patients compared to those found in the group of cured patients. Pelvic floor ultrasound can predict the success of TVT surgeries but there is as yet little data and there is a need to find in the near future more standard and objective parameters for the diagnosis of urinary incontinence.

Tension-free Vaginal Tape (TVT) Operasyonunun Baþarýsýnýn Deðerlendirilmesinde Pelvik Ultrasonun Rolü

Amaç: Bu çalýþma, stres üriner inkontinans (SÜÝ) nedeniyle mid-üretral aský ameliyatý geçiren bireylerde pelvik tabanýn ultrason bulgularýný kullanarak tedaviye yanýt eksikliðini deðerlendirmeyi amaçlamaktadýr.
Metot: Çalýþmaya Ocak 2016-Ocak 2021 tarihleri arasýnda stres tipte inkontinans nedeniyle Tension-free Vaginal Tape (TVT) iþlemi uygulanan hastalar dahil edildi ve tedavi baþarýsýzlýðý, mesane hacmi 200-400 ml dolu haldeyken; Valsalva manevrasý sýrasýnda stres üriner inkontinansýn varlýðý ile belirlendi.
Bulgular: Çalýþmaya toplam 214 hasta dahil edildi. Mid-üretral aský ameliyatý sonrasý 32 hastada (%25.8) stress testi pozitifliði ile baþarýsýz sonuç alýndýðý gözlemlenmiþtir. Baþarýsýz grupta mesh ile posterior üretra arasýndaki mesafe anlamlý olarak daha kýsaydý (4,09±0,39'a karþý 4,91±0,51; p<0,001), posterior üretrovezikal açý istirahatte daha düþüktü, ancak Valsalva manevrasý sýrasýnda açý daha arttý ve mesane boynu açýsý daha dardý (p<0.001).
Sonuç: Baþarýsýz hastalarda mesh-posteriour üretral mesafe ortalama deðerleri iyileþen hasta grubunda bulunanlara göre daha düþük elde ettik. Pelvik taban ultrasonu, TVT ameliyatlarýnýn baþarýsýný tahmin edebilir, ancak henüz çok az veri vardýr ve yakýn gelecekte idrar kaçýrma tanýsý için daha standart ve objektif parametreler bulmaya ihtiyaç vardýr. (SETB-2023-06-106)