Ultrasonographic appearance after tension-free vaginal tape procedure for stress urinary incontinence

Clinical History

Urinary incontinence of 5 months' duration.

Imaging Findings

The patient presented with urinary incontinence of 5 months' duration. She underwent a physical examination, one-hour pad test, perineal ultrasonography, and a urodynamic study including Valsalva leak point pressure.

Preoperatively perineal ultrasonography was performed and the posterior urethrovesical angle (PUVA) was determined at rest and during stress. The PUVA was 132.2° at rest, 141.7° during stress, and the difference between the values at rest and during stress was 9.5°.

A tension-free vaginal tape (TVT) procedure was performed as previously described by Ulmsten et al. The patient's condition improved, with no intraoperative or postoperative complications, after the TVT procedure.

Postoperative follow-up ultrasonography was performed after one month. The PUVA was 119.8° at rest and 123.2° during stress, thus the difference in values had decreased to 3.4°.

Discussion

Stress urinary incontinence (SUI) is defined as the involuntary leakage of urine during increased abdominal pressure in the absence of detrusor contraction. The factors that play a role in SUI are the relationship between the anatomical positions of the proximal urethra, bladder neck and symphysis pubis, and the loss of support of the vesical floor. The integral theory states that stress symptoms, urge symptoms, and symptoms of defective flow may all arise from laxity in the vagina of its supporting ligaments. Recreation of the pubourethral ligaments, and tightening of the suburethral vagina, were found to be important for cure of SUI.

In SUI many criteria have been accepted as ultrasonographic signs of anatomical defects: urethral mobility, PUVA, changes in position of the vesical neck longitudinally and horizontally according to the symphysis pubis and dilatation showing incomplete closing in the proximal urethra. Alper et al. showed that PUVA widening and PUVA differences occurring during the Valsalva manoeuvre have important roles in SUI.

Ulmsten et al. introduced a minimally invasive surgical technique called the TVT procedure. A prolene mesh tape is introduced with trocars through a small vaginal incision to create a hammock-like support for the mid-urethra. The cure rate after the TVT procedure has been found to vary between 80% and 90%. Atherton et al. demonstrated that TVT tape decreases bladder neck angles at rest and on Valsalva, decreases linear movement on Valsalva, and elevates the bladder neck.

Differential Diagnosis List

Final Diagnosis

US appearance after TVT procedure

URL:	https://www.eurorad.org/case/1974
DOI:	10.1594/EURORAD/CASE.1974
ISSN:	1563-4086