Correlation of introital ultrasound with LUTS after sling surgery

This study aims to assess the role of the introital ultrasound in the evaluation of patients with low urinary tract symptoms after sling surgery for incontinence.

From 2000 till 2007, a total of 31 patients underwent sub-urethral tape placement for stress urinary incontinence and developed thereafter lower urinary tract symptoms. The urological evaluation consisted of a detailed medical history, a urogynecologic examination, a complete urodynamic exam, a measurement of the post-void residue, and an introital ultrasound. All patients filled up the MHU (Mesure du Handicap Urinaire) questionnaire. These patients had a transvaginal tape lysis under local anesthesia. We correlated the ultrasound findings with postoperative clinical success and failure.

Thirty-one patients with low urinary tract symptoms (LUTS) secondary to sling placement underwent a tape lysis. Median age was 63.1 +/- 10.9 years, and the median time between the anti-incontinence surgery and the tape lysis was 21.5 +/- 16.2 months. Seven patients had only obstructive symptoms, 15 patients had obstructive and overactive bladder symptoms, and nine patients had overactive bladder symptoms. Introital ultrasound revealed an abnormality of the tape in 26 patients. Ten patients had a position abnormality, five patients had a urethral distortion by the tape, and 11 patients had the previous two abnormalities. After tape lysis, the obstructive symptoms disappeared in 19 out of 22 patients (86%), and the overactive bladder symptoms disappeared in 16 out of 24 patients (66%). In case of ultrasound anomaly, the tape lysis was efficient in 23 out of 26 patients (89%), while in the absence of ultrasound anomaly (five patients) the tape lysis was not useful in treating LUTS in all patients.

Ultrasonography is a useful tool in investigating postoperative lower urinary tract symptoms and in the selection of patients who will benefit from tape lysis.