Ghanbari Zinat, Ayati Elnaz, Bastani Parvin, Pourali Leila, Amini Erfan
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran.
Research Center for Evidence-based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Gynecol Obstet Invest. 2022;87(6):344-351. doi: 10.1159/000526506. Epub 2022 Aug 15.
The aim of this study was to evaluate mid-urethral sling (MUS) position and its association with postoperative outcomes and complications.
This was a prospective cohort study. Ninety-two women who underwent MUS procedure with a median follow-up period of 11 months (interquartile range 5-24 months) were recruited.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Two-dimensional trans-labial ultrasound with an endovaginal probe was used to visualize the urethral length (UL), sling distance to the bladder neck (BN) and to the urethra longitudinal smooth muscle (LSM).
Mean sling-LSM, UL, and sling-BN distances were 5.97 ± 2.04 mm, 28.66 ± 3.19 mm, and 18.85 ± 4.46 mm, respectively. Sling position relative to BN (proximal vs. middle vs. distal) was not associated with surgery outcomes and complications; however, mean sling-LSM in patients with exposure (4.3%) was significantly higher compared to those who did not experience exposure (8.80 ± 1.9 mm vs. 5.8 ± 2.0 mm, p = 0.048). Moreover, the mean sling-LSM distance was associated with patient satisfaction (5.87 ± 2.0 mm in satisfied patients with VAS > 6 vs. 6.29 ± 2.1 mm in unsatisfied patients, p value = 0.043). Likewise, patients who had worsened or showed de novo overactive bladder (OAB) symptoms (8.8%) had significantly higher mean sling-LSM distance compared to patients with improved OAB symptoms (6.52 ± 2.0 mm vs. 5.37 ± 1.9 mm, p = 0.007). Mean sling-LSM distance was lower in patients with recurrent urinary tract infection (UTI), voiding dysfunction, and improved stress urinary incontinence, whereas patients with dyspareunia after surgery had higher mean sling-LSM distance; however, these differences were not statistically significant.
Both trans-obturator and retropubic procedures with or without concomitant prolapse surgery were assessed. Heterogeneity of the study population and pelvic floor ultrasound being performed by a single urogynecologist were the limitations of the current study.
Ultrasound visualization of MUS is feasible and has the potential to predict outcomes and complications. High sling-LSM distance was associated with exposure, and low sling-LSM distance with increased satisfaction rate, probability of voiding dysfunction, and recurrent UTI.
本研究旨在评估尿道中段吊带术（MUS）的位置及其与术后结局和并发症的关系。
这是一项前瞻性队列研究。招募了92例行MUS手术的女性，中位随访期为11个月（四分位间距5 - 24个月）。
参与者/材料、设置、方法：使用经阴道探头的二维经阴唇超声来观察尿道长度（UL）、吊带至膀胱颈（BN）以及至尿道纵行平滑肌（LSM）的距离。
吊带-LSM、UL和吊带-BN的平均距离分别为5.97±2.04毫米、28.66±3.19毫米和18.85±4.46毫米。吊带相对于BN的位置（近端 vs. 中间 vs. 远端）与手术结局和并发症无关；然而，发生暴露的患者（4.3%）的平均吊带-LSM显著高于未发生暴露的患者（8.80±1.9毫米 vs. 5.8±2.0毫米，p = 0.048）。此外，平均吊带-LSM距离与患者满意度相关（视觉模拟评分法[VAS] > 6分的满意患者为5.87±2.0毫米，不满意患者为6.29±2.1毫米，p值 = 0.043）。同样，膀胱过度活动症（OAB）症状加重或出现新发症状的患者（8.8%）的平均吊带-LSM距离显著高于OAB症状改善的患者（6.52±2.0毫米 vs. 5.37±1.9毫米，p = 0.007）。复发性尿路感染（UTI）、排尿功能障碍和压力性尿失禁改善的患者的平均吊带-LSM距离较低，而术后性交困难的患者平均吊带-LSM距离较高；然而，这些差异无统计学意义。
评估了经闭孔和耻骨后手术，包括或不包括同期脱垂手术。研究人群的异质性以及由一名泌尿妇科医生进行盆底超声检查是本研究的局限性。
MUS的超声可视化是可行的，并且有可能预测结局和并发症。吊带-LSM距离高与暴露相关，而距离低与满意度增加、排尿功能障碍概率和复发性UTI相关。
