Translabial Ultrasound: An Effective Modality for Evaluation of Midurethral Sling Revision.

Abstract: Midurethral sling (MUS) surgical procedures, in which a polypropylene synthetic mesh graft is transvaginally placed to support the urethra and manage stress urinary incontinence (SUI), is commonly performed ( Urology. 2013;82(1):38-41; Radiology. 2018;289(3):728-729). Within 10 years of sling placement, about 1 in 20 women undergo subsequent surgery to revise their mesh, in which the mesh is cut or partially excised ( Obstet Gynecol . 2019;133:1099-1108). Translabial ultrasound (TLUS) has been described as a sensitive technique for viewing MUS, although few studies have evaluated its ability to view surgically revised MUS ( Radiology . 2018;289(3):721-727). Understanding the anatomy of the MUS is critical to urologists and urogynecologists striving to optimize management of patients presenting with lower urinary tract symptoms and history of MUS. To assess the clinical utility and reliability of TLUS as a diagnostic tool in its detection of MUS discontinuity, we conducted a retrospective analysis on patients who underwent TLUS at a tertiary care center between September 2017 and May 2020 for indication of lower urinary tract symptoms and history of MUS placement. Performance of TLUS was evaluated by comparing findings with operative or clinical records. Among the 81 women included, detection of MUS revision, which was defined as a discontinuity in sling material, had a sensitivity of 84.6% and specificity of 97.1%. Translabial ultrasound is an inexpensive, nonirradiating, and noninvasive modality that is effective at visualizing MUSs. It is a reliable identifier of previous MUS revision, in which it detects a midline discontinuity of the hyperechoic mesh with an average 10 mm gap.