3D ultrasound mesh position and long-term outcomes after TVT surgery

This study evaluated the long-term outcomes after tension-free vaginal tape (TVT) surgery and examined whether 3D transvaginal ultrasound (US) mesh position parameters (providing multiplanar visualization and improved measurement reproducibility compared with 2D imaging) are associated with urinary symptoms and quality-of-life changes in women with stress urinary incontinence (SUI). We hypothesized that mesh position would correlate with long-term patient-reported outcomes.

In this retrospective cohort, 30 women underwent TVT surgery for SUI between 2012 and 2014 at a tertiary referral center. In 2024, at a median follow-up of 11 years (interquartile range [IQR] 10-12), all patients had clinical evaluation, completed the Urinary Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and Overactive Bladder Questionnaire Short Form (OAB-q SF), and underwent 3D transvaginal US to measure total urethral length, mesh-to-bladder neck distance, mesh-to-midurethra ratio, and minimal mesh-to-urethral lumen distance. Preoperative and follow-up scores were compared using paired t-tests or Wilcoxon signed-rank tests. Correlations between mesh parameters and score changes were analyzed with Spearman's correlation.

Long-term treatment success was achieved in all patients, with negative postoperative stress tests and no retreatment. UDI-6, IIQ-7, and OAB-q SF scores improved significantly from baseline (p < 0.001 for all). No mesh erosion occurred. De novo overactive bladder (OAB) developed in six patients (20%). No strong correlations were found between mesh parameters and score changes (all |ρ| < 0.30).

TVT surgery provided excellent long-term outcomes with sustained symptom and quality-of-life improvement. Mesh position measured by 3D US at long-term follow-up was not strongly associated with patient-reported outcomes.