ULTRASONOGRAPHIC EVALUATION OFURETHRAL ANGLE AND BLADDER NECK MOBILITY AFTER SINGLE INCISIONMINI-SLING
W. HSIEH1, C. LIANG2, Y. LIN 3;
1Department ofGynecology & Obstetrics, Chang Gung Mem. Hosp. institution,Taoyuan County, Taiwan, 2Obstetrics and Gynecology, ChangGung Mem. Hosp., Linkou Med. Cente, Taoyuan, Taiwan, 3Obstetricsand gynecology, Chang Gung Mem. Hosp., Tao-Yuan, Taiwan.
Introduction: From prior study,we already know that SIMS surgery has similar subjective cure rate totension-free vaginal tape(TVT). However, postoperative incontinenceseverity is greater in SIMS than in TVT. It may be related to thedesign of SIMS, less trauma and poor fixed instability. Greaterangular closure provided by TVT may more effectively prevent urinefrom entering the upper posterior urethra, therefore, decreasepostoperative urgency and urge incontinence. We suppose that betterfixation of single incision mini-sling causes greater urethral anglewhen Valsalva, which result in better treatment outcome afterSIMS.
Objective: To investigate the predictors ofpersistence or resolution of lower urinary tract symptoms(LUTS) inwomen following single incision mini-sling(SIMS) surgery forurodynamic stress incontinence(USI).
Methods: Patients withurodynamic stress incontinence undergoing SIMS between October, 2015and September, 2016 in a tertiary hospital were recruited. Allpatients underwent evaluation including a structured urogynecologicalquestionnaire, pelvic examination using the POP-quantificationsystem, pelvic ultrasound, and urodynamic testing before and 6 monthsafter surgery. Patient demographics, ultrasonographic findings, andurodynamic findings were analyzed. To test the possible role ofurethral angle in maintaining LUTS women.
Results: Of 57patients who underwent SIMS, 20 (35.1%) had postoperative urgency.All patient had subjective cure for USI. Ultrasound analysis showedgood repeatability and is not influenced by vesical volume. The betaangle is between the proximal part and the distal part of urethra.Beta angle and urethrovesical mobility are inversely proportional.Urethral angle identifies postoperative urgency better thanurethrovesical mobility (sensitivity 92% vs 81%).
Conclusions:Better fixation of single incision mini-sling contributes to greaterurethral angle when Valsalva and better treatment outcome.Measurement of the urethral angle can provide useful additionalinformation for adjusting the tightness of sling duringanti-incontinence surgery.
References: 1.Evaluation andSurgery for Stress Urinary Incontinence: A FIGO Working GroupReport2.Sling surgery for stress urinary incontinence in women: Asystematic review and meta-analysis.