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

Female Pelvic Med Reconstr Surg. 2017 Mar/Apr;23(2):141-145. doi: 10.1097/SPV.0000000000000375.


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.

Publication types

  • Evaluation Study

MeSH terms

  • Diagnosis, Differential
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Lower Urinary Tract Symptoms / diagnostic imaging
  • Lower Urinary Tract Symptoms / etiology
  • Lower Urinary Tract Symptoms / physiopathology*
  • Middle Aged
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Suburethral Slings / adverse effects*
  • Ultrasonography
  • Urinary Bladder, Overactive / diagnostic imaging
  • Urination / physiology
  • Urodynamics / physiology*
  • Valsalva Maneuver