Dynamic assessment of sling function on transperineal ultrasound: does it correlate with outcomes 1 year following surgery?
INTRODUCTION AND HYPOTHESIS
To correlate dynamic assessment of sling function using 2D and 3D transperineal ultrasound with outcomes following transobturator sling surgery.


METHODS
This is an unmatched case-control study of 100 patients who underwent transobturator sling surgery at our center between 2009 and 2012. Group A (n = 50) patients had successful outcomes and group B (n = 50) patients had suboptimal outcomes 1 year following surgery. The patients underwent 2D dynamic and 3D transperineal ultrasound. The two groups were compared with regard to the deformability of the sling on Valsalva, the concordance of urethral movement with the sling, and location of the sling.


RESULTS
When compared with group B, group A had a significantly greater number of patients in whom the sling deformed at Valsalva (flat at rest, curving into a c-shape at Valsalva), the urethral movement was concordant with the sling and the sling had a midurethral location (p < 0.0001). In all 17 patients in group B in whom the urethra moved in a concordant manner with the sling (34%), the sling did not deform on Valsalva maneuver and was located proximally. In all 15 patients in group A in whom the sling remained either flat or curved (30%), the urethra moved concordant with the sling and the sling was in midurethral location.


CONCLUSIONS
On 2D and 3D transperineal ultrasound, the best outcomes following transobturator sling surgery are associated with concordance of urethral movement with the sling, midurethral location, and deformability of the sling on dynamic assessment.
['Hegde|Aparna|A|http://orcid.org/0000-0002-5050-1060', 'Nogueiras|Mayte|M|', 'Aguilar|Vivian C|VC|', 'Davila|G Willy|GW|']
D000368:Aged D016022:Case-Control Studies D005260:Female D006801:Humans D008875:Middle Aged D009068:Movement D011183:Postoperative Complications D053825:Suburethral Slings D016896:Treatment Outcome D014463:Ultrasonography D014521:Urethra D014550:Urinary Incontinence, Stress D014636:Valsalva Maneuver
Dynamic assessment Sling function Ultrasound Outcomes Sling surgery