Determination of bladder neck position by intraoperative introital ultrasound in colposuspension: outcome at 6-month follow-up.

OBJECTIVE

To determine whether open colposuspension modified by intraoperative ultrasound to prevent overcorrection is a safe and effective procedure.

METHODS

Ninety women operated on for urodynamically proven genuine stress urinary incontinence underwent intraoperative introital ultrasound in a prospective observational clinical study. The positions of the bladder neck and proximal urethra were assessed by determining the parameters height (H), distance (D) and the urethrovesical angle (beta) perioperatively and for up to 6 months postoperatively. Colposuspension of the bladder neck was performed with a vertical height correction, DeltaH (resting H(intraop) - resting H(preop)) of 1 to 10 mm. Bladder neck positions were determined on an individual basis by introital ultrasound before, during and after surgery.

RESULTS

Surgical elevation of the bladder neck (median height correction, DeltaH 4 mm) resulted in a median intraoperative elevation of 9 mm (6 months: 8 mm). All postoperative measurements showed a significant reduction of the median linear movement of the bladder neck during straining (P < 0.0001). Anti-incontinence surgery resulted in a significant reduction of funneling and hypermobility 6 months after surgery (P < 0.0001). At 6-month follow-up, 94% (85/90) of the women were continent. Evaluation immediately after surgery showed voiding difficulties and urge symptoms in 9% (8/90) of the patients each and de novo urge incontinence in 1% (1/90).

CONCLUSIONS

Intraoperative introital ultrasound can help to optimize the colposuspension procedure. Ultrasonographic measurement of height H allows for objectively assessing the surgical procedure and can reduce postoperative complications by preventing excessive correction.