Pelvic floor ultrasound in the diagnosis of sling complications
- 411 Downloads
The mid-urethral synthetic sling (MUS) procedure has become the standard of care for treatment of female stress urinary incontinence. However, a small number of patients will have complications following MUS including failure, obstructive voiding, sling erosion, or chronic pain. This paper discusses the role of 2D and 3D ultrasound imaging in the evaluation of the female patient with complications following placement of a synthetic mid-urethral sling.
The MUS is easily visualized as an echogenic structure on ultrasound and can be imaged by transperineal, transvaginal and introital approaches. Ultrasound allows dynamic assessment of the sling and can assist in the diagnosis of sling failure, obstruction, erosion and mesh related pain.
Pelvic floor ultrasound has an emerging role in the assessment of complications following MUS surgery. 3D ultrasound can assist the clinician in assessment of the complex patient with multiple slings or meshes in situ.
KeywordsMid-urethral sling Ultrasound Mesh complications
LC: project development, data collection, and manuscript writing. VT: data collection and manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors have no potential conflicts of interest to disclose.
Human participants or animals rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Supplementary material 1 (AVI 7937 kb) Video 1 Transperineal 2D ultrasound of MUS imaged in para-sagittal plane showing dynamic compression of the mid-urethra by sling during coughing
Supplementary material 2 (AVI 23449 kb) Video 2 Transperineal ultrasound of patient with MUS who reported recurrence of urinary incontinence following heavy physical exercise at 3-weeks post surgery. Note lack of dynamic compression of the urethra suggesting that the sling may have become loose after exercise
Supplementary material 3 (AVI 21818 kb) Video 3 Transperineal ultrasound (imaged in sitting position) of patient with voiding dysfunction following pubovaginal fascial sling demonstrating marked angulation of proximal urethra/ bladder neck by sling during Valsalva
Supplementary material 4 (AVI 78750 kb) Video 4 Transvaginal ultrasound in patient with pelvic pain, previous MUS, and mesh repair of rectocele. Pain was reproduced by gentle pressure of transducer on MUS but not on posterior mesh—this patient subsequently underwent excision of sling with resolution of pain
- 1.Fusco F, Abdel-Fattah M, Chapple CR, Creta M, La Falce S, Waltregny D et al (2017) Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol 72(4):567–591CrossRefPubMedGoogle Scholar