Sonographic tape characteristics and outcome after tape anti-incontinence surgery: a cross-sectional study

Abstract

Background: Ultrasound (US) is an easy-to-perform imaging modality that allows in vivo evaluation of the tension free-vaginal tape obturator (TVT-O).
Aim: To investigate the position and shape of TVT-O using US, in order to correlate the findings to outcome.
Methods: Our cross-sectional study is based on the data obtained from 46 women with stress urinary incontinence (SUI) who underwent TVT-O insertion at a tertiary hospital between January 2015 and December 2016. These patients underwent a postoperative examination in 2020 (5 years after TVT-O). Patients who had undergone reoperation were excluded. The main outcome parameters were patient’s symptoms, US measurements and dynamic changes in TVT-O shape at rest and during straining. A descriptive and comparative (bi- and multivariant) statistical analysis was performed by Stata v14.0.
Results: At five years, 76% (35/46) were continent, 17.4% (8/46) improved and 6.5% (3/46) were failures. The tape was stretched at rest and C-shaped during straining in 27 (58.7%) patients; 92.6% (25/27) of these women were continent after surgery. An unchanged tape shape was associated with a more failures. Patients with a stretched tape at rest and during straining failed in 57.7% and patients with a permanent curved shape in 42.3%. SUI was most accurately predicted using a multiple linear regression model based on the independent variables: age, bladder wall thickness, distance of the tape from the bladder neck and study groups according to Kociszewski criteria.
Conclusions: Outcome was best in women in whom US demonstrated the elastic sling to lie parallel to the urethra at rest and assumed a transient C-shape during straining. However, other US measures could predict patient satisfaction or subjective cure/improvement.