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Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
A magnetic resonance imaging-based study of retropubic haematoma after sling procedures: preliminary findings
Subhasis K Giri1, Fintan Wallis, John Drumm
1Department of Urology, University Hospital, Limerick, Ireland.
Objective:
To determine, using magnetic resonance imaging (MRI), the incidence of retropubic haematoma and any associated clinically significant effects after a xenograft (porcine dermis) sling (XS) or the tension-free vaginal tape (TVT) procedure.
Patients And Methods:
Between October 2003 and March 2004, 24 consecutive patients presenting with stress urinary incontinence (SUI) were enrolled in this prospective study; 12 each underwent an XS or TVT procedure. A vaginal balloon pack was used for only 3 h after XS and not after TVT. All patients had pelvic MRI 6-8 h after surgery. The primary outcome measure was the incidence and distribution of retropubic haematoma after each sling technique. Secondary outcome measures included the interval to the first three spontaneous voids, the bladder emptying efficiency of the first three voids, a visual analogue scale pain score at 24 h after surgery, and the short-term (6-month) cure rate for SUI.
Results:
Overall, six (25%) patients (four XS and two TVT) developed a retropubic haematoma. Most commonly, they spread along the right paravesico-urethral space between the right half of the levator ani and the bladder neck. Patients with large haematomas took significantly longer to void (median 14.5 vs 6.0 h, P = 0.048). There was no difference in pain score in patients with or with no haematoma. None of the patients had clinically detectable haematomas in the suprapubic wound. All six patients with haematomas were cured or improved at the 6-month follow-up.
Conclusions:
MRI is a useful noninvasive method for detecting retropubic haematomas soon after surgery. There was a surprisingly high incidence of retropubic haematomas, especially after the XS procedure. Retropubic haematomas may influence postoperative voiding efficiency.
Insights
Magnetic resonance imaging (MRI) revealed a 25% incidence of retropubic hematomas after sling procedures for stress urinary incontinence (SUI). These hematomas, particularly after the xenograft sling (XS), impacted voiding efficiency but not pain levels.
Area of Science:
- Urogynecology
- Medical Imaging
- Surgical Outcomes
Background:
- Stress urinary incontinence (SUI) is a common condition affecting women.
- Surgical interventions like xenograft sling (XS) and tension-free vaginal tape (TVT) are used to treat SUI.
- Postoperative complications, such as retropubic hematoma, can impact patient recovery and outcomes.
Purpose of the Study:
- To determine the incidence of retropubic hematoma using magnetic resonance imaging (MRI) after XS and TVT procedures.
- To assess the clinical significance of these hematomas on postoperative voiding, pain, and SUI cure rates.
Main Methods:
- A prospective study involving 24 patients with SUI undergoing either XS or TVT.
- Pelvic MRI was performed 6-8 hours post-surgery to detect retropubic hematomas.
- Secondary outcomes included voiding interval, bladder emptying efficiency, pain scores, and 6-month SUI cure rates.
Main Results:
- Six patients (25%) developed retropubic hematomas (four XS, two TVT).
- Hematomas primarily occurred in the paravesico-urethral space.
- Patients with larger hematomas experienced significantly longer voiding times (median 14.5 vs 6.0 hours).
- No difference in pain scores was observed between patients with or without hematomas.
Conclusions:
- MRI is effective for noninvasive detection of early postoperative retropubic hematomas.
- A high incidence of retropubic hematomas was observed, particularly after the XS procedure.
- Retropubic hematomas may negatively influence postoperative voiding efficiency in SUI patients.
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