Sonographic appearance of transobturator slings: implications for function and dysfunction.

Area of Science:

• Urology
• Pelvic Floor Surgery
• Medical Imaging

Background:

• Suburethral slings, like the Monarc system, are used to treat female stress urinary incontinence.
• Postoperative symptoms such as stress incontinence (SI) and urge incontinence (UI) can persist despite surgical intervention.
• Ultrasonography offers a non-invasive method to visualize sling placement and pelvic floor anatomy.

Purpose of the Study:

• To investigate the relationship between the ultrasonic characteristics of the Monarc suburethral sling and the occurrence of postoperative bladder symptoms.
• To assess if sling positioning visualized on ultrasound correlates with patient-reported stress and urge incontinence at follow-up.

Main Methods:

• A prospective clinical audit involved 98 patients who underwent Monarc suburethral sling placement.
• Pelvic floor ultrasound was used to measure the gap between the sling and symphysis pubis, sling angles at rest and Valsalva, and urethral proximity.
• Patient-reported symptoms of stress incontinence and urge incontinence were recorded at an average follow-up of 11 months.

Main Results:

• A significantly wider gap between the symphysis pubis and the Monarc sling was observed in patients reporting postoperative stress incontinence (P = 0.032).
• Similarly, a wider gap was significantly associated with the presence of urge incontinence (P = 0.006).
• No other assessed ultrasonic parameters showed significant association with postoperative symptoms.

Conclusions:

• A narrower gap between the transobturator sling tape and the symphysis pubis, as seen on ultrasound, is associated with successful cure of both stress and urge incontinence.
• Tighter placement of the Monarc sling appears to be beneficial for achieving symptom resolution in patients with urinary incontinence.