Midterm postoperative results of mid‐urethral slings. Role of ultrasound in explaining surgical failures
Introduction Surgical treatment for stress urinary incontinence (SUI) with mid‐urethral sling (MUS) is considered to have a high success rate. However, between 5% and 20% of MUS fail, with inadequate surgical implantation being a possible cause of SUI persistence or recurrence. Misplacement of a MUS...
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| Veröffentlicht in: | Neurourology and urodynamics 2022-11, Vol.41 (8), p.1834-1843 |
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| container_title | Neurourology and urodynamics |
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| creator | Escura, Sílvia Ros, Cristina Anglès‐Acedo, Sònia Bataller, Eduardo Sánchez, Emília Carmona, Francisco Espuña‐Pons, Montserrat |
| description | Introduction
Surgical treatment for stress urinary incontinence (SUI) with mid‐urethral sling (MUS) is considered to have a high success rate. However, between 5% and 20% of MUS fail, with inadequate surgical implantation being a possible cause of SUI persistence or recurrence. Misplacement of a MUS can be determined by pelvic floor ultrasound (PF‐US). The aim of this study was to investigate the role of PF‐US in patients with persistent or recurrent urinary incontinence (UI) symptoms after MUS surgery for SUI with a midterm follow‐up.
Materials and Methods
A historical cohort study including women undergoing MUS surgery for SUI between 2013 and 2015 was designed. The primary outcome was to correlate the sonographic parameters of MUS with SUI cure (negative International Continence Society‐Uniform Cough Stress Test, Incontinence Questionnaire‐Short Form |
| doi_str_mv | 10.1002/nau.25032 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2709743941</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2730235438</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3532-e3cda4e016e9739dd0b488e76db153781d0fde33451d8498f870f36b4f8edf633</originalsourceid><addsrcrecordid>eNp10cFu1DAQBmALgehSOPACKBIXOGQ7zjixc6wqCkgFJETPkTceF6-cONgxtDcegWfkSXDZwgGJkw_zza-Rf8aecthygOZk1nnbtIDNPbbhbQN1J6W8zzYgEetGdPKIPUppDwAKRf-QHWEHrewVbNj-nTMrxalaQlrDQlGv7itVkVL2a6qCrSZnfn7_kSOtn6P2VfJuvkrb6mPwdDsuLOoU8mwqN1d0vXjt5kKqlOOVG8uG1c6X9fSYPbDaJ3py9x6zy_NXn87e1BcfXr89O72oR2yxqQlHowUB76iX2BsDO6EUyc7seItScQPWEKJouVGiV1ZJsNjthFVkbId4zF4ccpcYvmRK6zC5NJL3eqaQ09BI6KXAXvBCn_9D9yHHuVxXFEKDrUBV1MuDGmNIKZIdlugmHW8GDsNtAUMpYPhdQLHP7hLzbiLzV_758QJODuCb83Tz_6Th_enlIfIXRLaRYg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2730235438</pqid></control><display><type>article</type><title>Midterm postoperative results of mid‐urethral slings. Role of ultrasound in explaining surgical failures</title><source>MEDLINE</source><source>Wiley Journals</source><creator>Escura, Sílvia ; Ros, Cristina ; Anglès‐Acedo, Sònia ; Bataller, Eduardo ; Sánchez, Emília ; Carmona, Francisco ; Espuña‐Pons, Montserrat</creator><creatorcontrib>Escura, Sílvia ; Ros, Cristina ; Anglès‐Acedo, Sònia ; Bataller, Eduardo ; Sánchez, Emília ; Carmona, Francisco ; Espuña‐Pons, Montserrat</creatorcontrib><description>Introduction
Surgical treatment for stress urinary incontinence (SUI) with mid‐urethral sling (MUS) is considered to have a high success rate. However, between 5% and 20% of MUS fail, with inadequate surgical implantation being a possible cause of SUI persistence or recurrence. Misplacement of a MUS can be determined by pelvic floor ultrasound (PF‐US). The aim of this study was to investigate the role of PF‐US in patients with persistent or recurrent urinary incontinence (UI) symptoms after MUS surgery for SUI with a midterm follow‐up.
Materials and Methods
A historical cohort study including women undergoing MUS surgery for SUI between 2013 and 2015 was designed. The primary outcome was to correlate the sonographic parameters of MUS with SUI cure (negative International Continence Society‐Uniform Cough Stress Test, Incontinence Questionnaire‐Short Form < 5 points and no symptoms of SUI), at 5 years postsurgery. Secondary outcomes were changes of maximum urethral closure pressure (MUCP) and symptoms of urgency urinary incontinence (UUI) at 1 and 5 years after surgery.
Results
Eighty‐seven patients (80 transobturator‐MUS, 7 retropubic‐MUS) were included. At 5 years all patients referred improvement of UI and objective cure of SUI was demonstrated in 81.2%. The MUS was sonographically correct in 67 (98.5%) of the 68 patients with cure of SUI. The MUS was considered incorrectly placed in only 4 (28.6%) of the 14 patients with noncured SUI. MUCP decreased from 61.9 to 48.8 cmH2O at 5 years of follow‐up (p < 0.01) and up to 53% of women had UUI symptoms after surgery, with a nonsignificant decrease compared to baseline.
Conclusion
Patients cured of SUI had sonographically correct MUS by PF‐US. Less than one‐third of cases of SUI persistence or recurrence after MUS surgery could be explained by a sonographically incorrect sling. Low urethral resistance and/or UUI symptoms could help to explain the remaining failures. Complete functional and anatomic studies, including urodynamics and PF‐US, should be performed before deciding on the next management strategy in patients with SUI persistence or recurrence after MUS.</description><identifier>ISSN: 0733-2467</identifier><identifier>EISSN: 1520-6777</identifier><identifier>DOI: 10.1002/nau.25032</identifier><identifier>PMID: 36057980</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Cohort Studies ; Cough ; Female ; Humans ; mid‐urethral sling ; Patients ; persistent stress urinary incontinence ; recurrent stress urinary incontinence ; stress urinary incontinence ; Suburethral Slings ; Surgery ; Treatment Outcome ; Ultrasonic imaging ; Ultrasound ; urethral profile ; Urinary incontinence ; Urinary Incontinence - surgery ; Urinary Incontinence, Stress - complications ; Urinary Incontinence, Stress - diagnostic imaging ; Urinary Incontinence, Stress - surgery ; Urologic Surgical Procedures - methods</subject><ispartof>Neurourology and urodynamics, 2022-11, Vol.41 (8), p.1834-1843</ispartof><rights>2022 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3532-e3cda4e016e9739dd0b488e76db153781d0fde33451d8498f870f36b4f8edf633</citedby><cites>FETCH-LOGICAL-c3532-e3cda4e016e9739dd0b488e76db153781d0fde33451d8498f870f36b4f8edf633</cites><orcidid>0000-0003-4423-3650</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fnau.25032$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fnau.25032$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36057980$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Escura, Sílvia</creatorcontrib><creatorcontrib>Ros, Cristina</creatorcontrib><creatorcontrib>Anglès‐Acedo, Sònia</creatorcontrib><creatorcontrib>Bataller, Eduardo</creatorcontrib><creatorcontrib>Sánchez, Emília</creatorcontrib><creatorcontrib>Carmona, Francisco</creatorcontrib><creatorcontrib>Espuña‐Pons, Montserrat</creatorcontrib><title>Midterm postoperative results of mid‐urethral slings. Role of ultrasound in explaining surgical failures</title><title>Neurourology and urodynamics</title><addtitle>Neurourol Urodyn</addtitle><description>Introduction
Surgical treatment for stress urinary incontinence (SUI) with mid‐urethral sling (MUS) is considered to have a high success rate. However, between 5% and 20% of MUS fail, with inadequate surgical implantation being a possible cause of SUI persistence or recurrence. Misplacement of a MUS can be determined by pelvic floor ultrasound (PF‐US). The aim of this study was to investigate the role of PF‐US in patients with persistent or recurrent urinary incontinence (UI) symptoms after MUS surgery for SUI with a midterm follow‐up.
Materials and Methods
A historical cohort study including women undergoing MUS surgery for SUI between 2013 and 2015 was designed. The primary outcome was to correlate the sonographic parameters of MUS with SUI cure (negative International Continence Society‐Uniform Cough Stress Test, Incontinence Questionnaire‐Short Form < 5 points and no symptoms of SUI), at 5 years postsurgery. Secondary outcomes were changes of maximum urethral closure pressure (MUCP) and symptoms of urgency urinary incontinence (UUI) at 1 and 5 years after surgery.
Results
Eighty‐seven patients (80 transobturator‐MUS, 7 retropubic‐MUS) were included. At 5 years all patients referred improvement of UI and objective cure of SUI was demonstrated in 81.2%. The MUS was sonographically correct in 67 (98.5%) of the 68 patients with cure of SUI. The MUS was considered incorrectly placed in only 4 (28.6%) of the 14 patients with noncured SUI. MUCP decreased from 61.9 to 48.8 cmH2O at 5 years of follow‐up (p < 0.01) and up to 53% of women had UUI symptoms after surgery, with a nonsignificant decrease compared to baseline.
Conclusion
Patients cured of SUI had sonographically correct MUS by PF‐US. Less than one‐third of cases of SUI persistence or recurrence after MUS surgery could be explained by a sonographically incorrect sling. Low urethral resistance and/or UUI symptoms could help to explain the remaining failures. Complete functional and anatomic studies, including urodynamics and PF‐US, should be performed before deciding on the next management strategy in patients with SUI persistence or recurrence after MUS.</description><subject>Cohort Studies</subject><subject>Cough</subject><subject>Female</subject><subject>Humans</subject><subject>mid‐urethral sling</subject><subject>Patients</subject><subject>persistent stress urinary incontinence</subject><subject>recurrent stress urinary incontinence</subject><subject>stress urinary incontinence</subject><subject>Suburethral Slings</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><subject>Ultrasound</subject><subject>urethral profile</subject><subject>Urinary incontinence</subject><subject>Urinary Incontinence - surgery</subject><subject>Urinary Incontinence, Stress - complications</subject><subject>Urinary Incontinence, Stress - diagnostic imaging</subject><subject>Urinary Incontinence, Stress - surgery</subject><subject>Urologic Surgical Procedures - methods</subject><issn>0733-2467</issn><issn>1520-6777</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10cFu1DAQBmALgehSOPACKBIXOGQ7zjixc6wqCkgFJETPkTceF6-cONgxtDcegWfkSXDZwgGJkw_zza-Rf8aecthygOZk1nnbtIDNPbbhbQN1J6W8zzYgEetGdPKIPUppDwAKRf-QHWEHrewVbNj-nTMrxalaQlrDQlGv7itVkVL2a6qCrSZnfn7_kSOtn6P2VfJuvkrb6mPwdDsuLOoU8mwqN1d0vXjt5kKqlOOVG8uG1c6X9fSYPbDaJ3py9x6zy_NXn87e1BcfXr89O72oR2yxqQlHowUB76iX2BsDO6EUyc7seItScQPWEKJouVGiV1ZJsNjthFVkbId4zF4ccpcYvmRK6zC5NJL3eqaQ09BI6KXAXvBCn_9D9yHHuVxXFEKDrUBV1MuDGmNIKZIdlugmHW8GDsNtAUMpYPhdQLHP7hLzbiLzV_758QJODuCb83Tz_6Th_enlIfIXRLaRYg</recordid><startdate>202211</startdate><enddate>202211</enddate><creator>Escura, Sílvia</creator><creator>Ros, Cristina</creator><creator>Anglès‐Acedo, Sònia</creator><creator>Bataller, Eduardo</creator><creator>Sánchez, Emília</creator><creator>Carmona, Francisco</creator><creator>Espuña‐Pons, Montserrat</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4423-3650</orcidid></search><sort><creationdate>202211</creationdate><title>Midterm postoperative results of mid‐urethral slings. Role of ultrasound in explaining surgical failures</title><author>Escura, Sílvia ; Ros, Cristina ; Anglès‐Acedo, Sònia ; Bataller, Eduardo ; Sánchez, Emília ; Carmona, Francisco ; Espuña‐Pons, Montserrat</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3532-e3cda4e016e9739dd0b488e76db153781d0fde33451d8498f870f36b4f8edf633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Cohort Studies</topic><topic>Cough</topic><topic>Female</topic><topic>Humans</topic><topic>mid‐urethral sling</topic><topic>Patients</topic><topic>persistent stress urinary incontinence</topic><topic>recurrent stress urinary incontinence</topic><topic>stress urinary incontinence</topic><topic>Suburethral Slings</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Ultrasonic imaging</topic><topic>Ultrasound</topic><topic>urethral profile</topic><topic>Urinary incontinence</topic><topic>Urinary Incontinence - surgery</topic><topic>Urinary Incontinence, Stress - complications</topic><topic>Urinary Incontinence, Stress - diagnostic imaging</topic><topic>Urinary Incontinence, Stress - surgery</topic><topic>Urologic Surgical Procedures - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Escura, Sílvia</creatorcontrib><creatorcontrib>Ros, Cristina</creatorcontrib><creatorcontrib>Anglès‐Acedo, Sònia</creatorcontrib><creatorcontrib>Bataller, Eduardo</creatorcontrib><creatorcontrib>Sánchez, Emília</creatorcontrib><creatorcontrib>Carmona, Francisco</creatorcontrib><creatorcontrib>Espuña‐Pons, Montserrat</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Neurourology and urodynamics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Escura, Sílvia</au><au>Ros, Cristina</au><au>Anglès‐Acedo, Sònia</au><au>Bataller, Eduardo</au><au>Sánchez, Emília</au><au>Carmona, Francisco</au><au>Espuña‐Pons, Montserrat</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Midterm postoperative results of mid‐urethral slings. Role of ultrasound in explaining surgical failures</atitle><jtitle>Neurourology and urodynamics</jtitle><addtitle>Neurourol Urodyn</addtitle><date>2022-11</date><risdate>2022</risdate><volume>41</volume><issue>8</issue><spage>1834</spage><epage>1843</epage><pages>1834-1843</pages><issn>0733-2467</issn><eissn>1520-6777</eissn><abstract>Introduction
Surgical treatment for stress urinary incontinence (SUI) with mid‐urethral sling (MUS) is considered to have a high success rate. However, between 5% and 20% of MUS fail, with inadequate surgical implantation being a possible cause of SUI persistence or recurrence. Misplacement of a MUS can be determined by pelvic floor ultrasound (PF‐US). The aim of this study was to investigate the role of PF‐US in patients with persistent or recurrent urinary incontinence (UI) symptoms after MUS surgery for SUI with a midterm follow‐up.
Materials and Methods
A historical cohort study including women undergoing MUS surgery for SUI between 2013 and 2015 was designed. The primary outcome was to correlate the sonographic parameters of MUS with SUI cure (negative International Continence Society‐Uniform Cough Stress Test, Incontinence Questionnaire‐Short Form < 5 points and no symptoms of SUI), at 5 years postsurgery. Secondary outcomes were changes of maximum urethral closure pressure (MUCP) and symptoms of urgency urinary incontinence (UUI) at 1 and 5 years after surgery.
Results
Eighty‐seven patients (80 transobturator‐MUS, 7 retropubic‐MUS) were included. At 5 years all patients referred improvement of UI and objective cure of SUI was demonstrated in 81.2%. The MUS was sonographically correct in 67 (98.5%) of the 68 patients with cure of SUI. The MUS was considered incorrectly placed in only 4 (28.6%) of the 14 patients with noncured SUI. MUCP decreased from 61.9 to 48.8 cmH2O at 5 years of follow‐up (p < 0.01) and up to 53% of women had UUI symptoms after surgery, with a nonsignificant decrease compared to baseline.
Conclusion
Patients cured of SUI had sonographically correct MUS by PF‐US. Less than one‐third of cases of SUI persistence or recurrence after MUS surgery could be explained by a sonographically incorrect sling. Low urethral resistance and/or UUI symptoms could help to explain the remaining failures. Complete functional and anatomic studies, including urodynamics and PF‐US, should be performed before deciding on the next management strategy in patients with SUI persistence or recurrence after MUS.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36057980</pmid><doi>10.1002/nau.25032</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-4423-3650</orcidid></addata></record> |
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| identifier | ISSN: 0733-2467 |
| ispartof | Neurourology and urodynamics, 2022-11, Vol.41 (8), p.1834-1843 |
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| language | eng |
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| source | MEDLINE; Wiley Journals |
| subjects | Cohort Studies Cough Female Humans mid‐urethral sling Patients persistent stress urinary incontinence recurrent stress urinary incontinence stress urinary incontinence Suburethral Slings Surgery Treatment Outcome Ultrasonic imaging Ultrasound urethral profile Urinary incontinence Urinary Incontinence - surgery Urinary Incontinence, Stress - complications Urinary Incontinence, Stress - diagnostic imaging Urinary Incontinence, Stress - surgery Urologic Surgical Procedures - methods |
| title | Midterm postoperative results of mid‐urethral slings. Role of ultrasound in explaining surgical failures |
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