It is a prospective, multicenter (2 centers), non-randomized, uncontrolled study. The study involved 31 patients from the outpatient clinic of these two centers, with adequate indication for examination and surgery. These patients were selected according to the inclusion and exclusion criteria, being composed only of incontinent patients and divided into two different groups: Group 1 - Mild / moderate incontinence (Pad test <400g / 24h); Group 2- Severe incontinence (Pad test> 400g / 24h). These patients were submitted to transobturator sling procedure with DynaMesh®-PRM in the period from August 2014 to August 2018.
All of them presented negative uroculture, 24h Pad test, urodynamic evaluation, ICIQ-SF quality of life questionnaire and urethrocystoscopy (if necessary). Perineal Ultrasonography was performed in the preoperative period of 21 patients and in the period of three to six months postoperatively of transobturator sling of 30 patients. The examination was performed with the patient in the supine position, with the legs slightly abducted, similar to the Litotomy. The transducer was positioned with slight pressure in the perineal region (between the scrotum and the anus), in sagittal orientation, to obtain images of the pubic symphysis, bladder, bladder neck and urethra.
During preoperative and postoperative examination, hypermobility of the proximal urethra, as well as voluntary contraction of the pelvic floor, were evaluated during Valsalva maneuver, perineal contraction and rest. We also evaluated the distance between de the urethra from pubis and the urethral angle. Positioning of the bladder neck was performed at rest, during Valsalva maneuver and during contraction of the pelvic floor. The measurements were made by means of xy coordinate system, as the reference point the pubis. The X axis was drawn by a line at the upper border of the pubic symphysis. The Y axis was drawn perpendicular to the X axis at the upper border of the pubic symphysis. For exact positioning of the bladder neck, the most proximal and superior point of the urethral wall was used, in the immediate vicinity of the transition with the bladder. The movement of the bladder neck was calculated by the following formula: √ (x2 - x1) ² + (y1- y2) ², where x1 and y1 represent the coordinates at rest. (FIGURE 1)
After data collection, ultrasonographic patterns were compared in men in the preoperative and postoperative periods of the transobturator sling in 21 patients and in the postoperative period in 30 patients. The significance criterion adopted was the level of 5%. Statistical analysis was performed using statistical software SAS® System, version 6.11 (SAS Institute, Inc., Cary, North Carolina).