Hypothesis / aims of study
This is the firt time perineal ultrasound pre andimmediate post-operative is reported. Stress urinary incontinence (SUI) in mainly caused by urethral hypermpbility, due to alteratios of the supporting elements of the uretha, i.e., pubourthral ligament (PUL) and urethropelvic ligameny (UPL) or hammock.
As far as we know, this is the first study comparing ultrasound anatomic findings in the pre and immediate post-operative preriod shadding some light on the pathophysiology of the management of SUI.
The aim of this study is to identify the anatomical alteration and to offer a mor personalized approch for each patient.
Study design, materials and methods
A total of 20 patients presenting SUI were enrolled in this study after sining the informed consent.
all patients underwen a work-up for SUI, including transperineal ultrasound, using thr midray device with convex probe and frequency from 1.2 to 6 Mhz and the ICIQ-SF questionnaire.
Fourteen patients underwent the Threads plus system, that consist in the placemet of polycaprolactone threads horizontally to teinforce the UPL and verically at the vaginal suci pre and retropubic to reinforce the PUL (fig.1).
Two patients underwnt plication of the pubourethral and urethropelvic ligament using 3--0 polyester sutereson each side of the midurethra (fig.2).
Four patients underwent midurethral slings, 1 retropubic Ophira mini sling and 3 horizontal retropubic TOT.
All slings we adjustes using the 8x4 adjustment method.
Results
Anatomical changes evidence were found in all patients, mainly the reduction of the urethra mobility, mean 4.9 to 3.1 mm.
All patients undergone PUL plication and threads plus system presented elevation of the waginal sulci, so that due to its appearence the coined the term "the Batman sign", (fig3).
tImprovement in all the ultrasound parameter was achieved in all patients.
Te distance between the tape and urethra varies from 3 to 5mm, ideal as we expected using the 8x4 adjistment.
The urethra inclination angle (PUL) was improved in all aptiend the underwent slings as well as the urethrovesical angle (Hammock) to a lesser extent, maybe to low degree cystocele.
Interpretation of results
Our findings demosntrated the anatomic modification induced by the different techniques to treat SUI.
Perienal ultrasoud allows for the immediate identification of dysfunctional slings and shows clearly the anatomic improvement induded by differents thecniques. Incresing the vaginal sulci is an evidence of the improvement of the urethral support, as well as the urethra mobility and the the urethral angles due to the reinformenct of the respetives ligaments.
Because perineal ultrasoun allos for the identification of the predominat lesion, it also allows for a more individualized approch to me managemt of patients with SUI.