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124 - CORRELATION BETWEEN SLING SURGERY OUTCOME AND ULTRASOUND MEASUREMENTS OF SLING POSITION

124

CORRELATION BETWEEN SLING SURGERYOUTCOME AND ULTRASOUND MEASUREMENTS OF SLING POSITION

P. HUBKA1, J. MASATA2, A. MARTAN 3, K. SVABIK 4;
1Dpt.Obstetrics and Gynecology, 1st Faculty of Med. and Gen. Univ. Hos,Prague, Czech Republic, 2Obstet. Gynecol. Dpt., GUH andCharles Univ.,, Prague, Czech Republic, 3Dpt. of Obstet.and Gynecol., 1st Faculty of Med., Prague, Czech Republic, 4CharlesUniv. in Prague, Gen. Univ. H, Prague, Czech Republic.

Introduction: Stress urinaryincontinence is usually treated by various types of a tension-freevaginal tape. All slings are hyperechogenic and ultrasound scan (US)is a simple non-invasive exam that shows the position of the sling.During US examination, the position of the sling can be measuredrelative to some landmark such as symphysis (1) or urethra (2). Thosedistances are believed to display tightness of the sling and explainthe success or failure of the surgery.
Objective: This is aretrospective US study of a group of 394 patients diagnosed withurodynamic stress incontinence (USI) and treated with a tension-freevaginal tape. We hypothesise that the Success group (no leakage afterthe sling surgery) and the Failure group (persistency of USI afterthe sling surgery) will differ in the position of the sling. In otherwords, that gaps between the sling and the symphysis (sling-symphysisgap) or between the sling and the urethra (sling-urethra gap) willdiffer.
Methods: We retrospectively analysed 4D US volumesof all patients diagnosed with USI and subsequently provided with asling insertion between January 2009 and October 2016 by the singlesurgeon (394 in total). We included each patient with at least onefollow-up at three months or more (386 patients out of original 394).We measured the sling-urethra gap (shortest distance between thesling and the hypoechogenic urethral lumen) on Valsalva and thesling-symphysis gap (shortest distance between the sling and theinferoposterior symphyseal margin) at rest and on Valsalva asdescribed in previous works. The dynamic change of thesling-symphysis gap is the difference of value at rest and atValsalva.
Results: This study comprises 386 patients(Success N=344, Failure N=42), with mean follow-up 14.3 month, withoverall success rate 89.11%. The sling use was as following:transobturator inside-out TVT-O (N=123) and TVT Abbrevo (N=128);retropubic TVT Exact (N=68) and Advantage Fit (N=33); other types(N=34). We found differences (p ˂0.0001) between Success and Failuregroup in the sling-symphysis gap at Valsalva: average 12.1mm (SD2.5mm) at Success and average 14.1mm (SD 2.7mm) at Failure. Similardifferences (p ˂ 0.001) were found in the sling-urethra gaps atValsalva: average 3mm (SD 1.1mm) at Success and average 3.6mm (SD1.2mm) at Failure. Both measurement methods showed a moderatecorrelation (r = 0.362, p ˂ .001).

We also analysed the dynamic change(difference of the sling-symphysis gap at rest and at Valsalva),finding no difference (p 0.09) between Success and Failure group:mean 2.8 mm (SD 2.7mm) at Success and mean 2.1 mm (SD 2.5mm) atFailure.
Conclusions: The success or failure of the slingprocedure seems to be dependent already on the position of the tapeas dynamic change of the sling-symphysis gap did not differ betweenSuccess and Failure group. Both measurements of the sling-symphysisgap and the sling-urethra gap showed difference between continent andincontinent women after the sling insertion and they moderatelycorrelate.
References: (1) Ultrasound Obstet Gynecol23:267-71 (2) Int Urogynecol J Pelvic Floor Dysfunct 21:795-800