Two-Dimensional and Three-Dimensional Transperineal Ultrasound Findings in Women With High-Pressure Voiding After Midurethral Sling Placement.

OBJECTIVES

The aim of this study was to evaluate dynamic two-dimensional (2D) and 3D transperineal pelvic ultrasound findings with urodynamic studies in women with lower urinary tract symptoms after midurethral sling placement.

METHODS

On 2D images, the sling position, and on 3D imaging the sling angle, urethral diameter, urethral height, and urethral cross sectional area were recorded with and without Valsalva. Patients were categorized into 3 groups based on 2D imaging: group 1-at rest, the sling lies parallel to the urethral lumen, and during Valsalva, the sling becomes C shaped; group 2-both at rest and during Valsalva, the sling runs parallel to the urethral lumen; group 3-at rest, the sling is C shaped, and during Valsalva, this curved shape is maintained. For analytical purposes, G3 was compared with G1+2. Multiple logistic regressions were used to evaluate the association between transperineal pelvic ultrasound and urodynamic study.

RESULTS

Univariate analyses to examine the relationships between high-pressure voiding, and each variable revealed that Valsalva sling angle, G3 versus G1+2, and sling position as percentage of the urethral length yielded significant findings (odds ratio, 95% confidence interval, P value for each, respectively: 1.037, 1.001-1.074, 0.04; 11.67, 2.116-64.31, 0.004; and 0.952, 0.911-0.994, 0.02). When including G3 versus G1+2, Valsalva sling angle, and percentage into the regression model, we concluded that there was only statistically significant association between groups and high-pressure voiding (odds ratio, 6.85; 95% confidence interval, 1.12-42.04; P = 0.03).

CONCLUSIONS

Transperineal ultrasound can help to predict women with high-pressure voiding after midurethral sling and thus may aid in the diagnosis of partial bladder outlet obstruction.