Intraoperative Ultrasound Guided Sling Adjustment During Transobturator Sling Placement: A Preliminary Pilot Report...

To describe a qualitative intraoperative ultrasound protocol for transobturator mid-urethral sling adjustment and assess technical feasibility.

This retrospective pilot series included 58 consecutive women with urodynamically confirmed stress urinary incontinence or stress-predominant mixed urinary incontinence undergoing outside-in transobturator sling placement. Sagittal and axial images guided gentle traction for a visible tape-urethra gap and tension release for urethral encroachment. Sling-arm oscillation supplemented assessment when acoustic shadowing limited visualization. Feasibility measures included visualization, adjustment frequency, final sonographic findings, scanning duration, and intraoperative complications. Clinical outcomes were summarized using available cases.

The tape was visualized in all 58 procedures and adjusted in 26 (44.8%). No final residual gap or encroachment was observed. Median scanning duration was 3 min 45 s (interquartile range, 3-4 min); no intraoperative complications were recorded. All 58 women provided baseline and 3-month questionnaire data. Mean six-item Urogenital Distress Inventory scores decreased from 68.3 ± 17.2 to 20.0 ± 6.7; seven-item Incontinence Impact Questionnaire scores decreased from 75.4 ± 10.5 to 18.2 ± 6.7. At 36 months, 20/58 women (34.5%) had outcome data. All 20 met the objective stress continence criterion (exact two-sided 95% confidence interval, 83.2%-100%); none met the objective voiding dysfunction criterion (exact two-sided 95% confidence interval, 0%-16.8%). These findings concern only the retained subgroup.

The protocol was technically feasible in this single-surgeon, single-center series. Reproducibility, workflow burden, and clinical benefit require prospective evaluation.