Preoperative Ultrasound Predictors of Treatment Failure after 24 Months of Transobturator Midurethral Sling

To evaluate the role of pelvic floor ultrasound (PF-US) in predicting persistent urinary incontinence after tension-free vaginal obturator tape (TVT-O) placement surgery and to identify prognostic ultrasound parameters.

We performed a retrospective analysis of 74 patients who underwent TVT-O placement for stress urinary incontinence (UI) or stress-predominant mixed UI. Preoperative assessment included clinical evaluation, urinary diary, validated questionnaires, and PF-US to measure bladder neck mobility and descent, presence of urethral funneling, urethral length, and bladder wall thickness (BWT). Surgical success was defined as resolution of incontinence at 24 months postoperatively.

At 24 months, 19% of patients presented with persistent incontinence. Preoperative factors associated with surgical failure were age, body mass index, BWT at dome, anterior wall and average BWT, urethral length and urethral funneling. In multivariate logistic regression analysis, only preoperative ultrasound findings were associated with UI persistence, including the presence of urethral funneling, a BWT greater than 7 mm at the dome of the bladder, and a urethral length longer than 45 mm.

Preoperative ultrasound is a valuable tool to predict functional outcomes of TVT-O surgery. Preoperative assessment of urethral funneling, BWT at dome and urethral length may help identify patients at higher risk of surgical failure with persistent incontinence. Integration of ultrasound into routine evaluation could improve patient selection and surgical planning.