Translabial ultrasound: a non-invasive technique for assessing “technical errors” after TOT failure

Introduction and hypothesis: The aims of this study were to evaluate by transperineal ultrasound if there were ultrasound-detectable changes over time in the dynamic behavior of the sling in patients who underwent transobturator tape (TOT), and to evaluate if dynamic translabial ultrasonography recognized factors that may be associated with failed surgery. Methods: This was a single-center prospective study. We included women who underwent “out-in” TOT for stress urinary incontinence (SUI). A dynamic translabial ultrasound was performed 6 months post-surgery and again at the last visit. The objective cure for SUI was defined as the absence of urine leakage during the stress test. We evaluated the bladder neck mobility at rest and during Valsalva; the position of the mesh along the urethra; the concordance of urethral movement with the sling during Valsalva; the symmetry of the lateral arms of the sling during straining; and the presence or absence of bladder neck funneling. Results: From December 2012 to February 2016, 80 consecutive patients were included. Six months after surgery, incontinent women compared with continent women had the sling in a proximal or distal position, that moved discordantly with the urethra (p < 0.0001), with asymmetry arm and bladder neck funneling (p < 0.0001). Continent patients had a significant improvement of urethrocele grade both at rest (p = 0.036) and during Valsalva (p = 0.045). Conclusions: Technical and positioning errors can lead to the failure of anti-incontinence surgical treatment. Translabial ultrasound allows the correct positioning of the sling to be evaluated and any errors that need to be analyzed in order to then solve the failure.