open access

Vol 84, No 5 (2013)
ARTICLES
Get Citation

Most of the patients with suburethral sling failure have tapes located outside the highpressure zone of the urethra

Michał Bogusiewicz, Marta Monist, Aleksandra Stankiewicz, Magdalena Woźniak, Andrzej Paweł Wieczorek, Tomasz Rechberger
DOI: 10.17772/gp/1585
·
Ginekol Pol 2013;84(5).

open access

Vol 84, No 5 (2013)
ARTICLES

Abstract

Objectives: The high-pressure zone of the urethra (HPZ), which is crucial for the continence mechanism, extends between the point of the maximum urethral closure pressure and the urethral knee, and has been calculated to lie between 53% and 72% of the functional urethral length. According to recent studies the best results of suburethral slings are achieved when tapes are positioned under this zone. The aim of the study was to determine the location of tapes relative to the urethral length in patients seeking help due to recurrent stress urinary incontinence (SUI) following sling procedures. Material and methods: The study group comprised 61 patients suffering from recurrent SUI following suburethral slings performed from 6 months to 5 years earlier. Forty-nine (80.3%) women were initially treated with a transobturator sling and 12 (19.7%) with a retropubic procedure. Twenty patients had the original sling performed at our department whereas, the other 41 in other institutions. The position of the tapes was determined at the sagittal plane by 3-D transvaginal ultrasound using a linear transducer. The length of the urethra was measured from the bladder neck to the external urethral meatus following the urethral lumen, taking into account its curve. The position of the tapes relative to the percentage of the urethral length was calculated assuming the bladder neck as the proximal end of the urethra. The reference point was set at the midpoint on the tape. Results: Only 13 (21.3%) patients had tapes positioned at 50%-75% of the urethral length. In 45 (73.8%) of women examined the tapes were found under proximal half of the urethra and in 3 (4.9%) distally to the 75% of the urethral length. Conclusions: In most patients in whom slings procedures proved unsuccessful the tapes are located under theproximal half of the urethra, that is outside the HPZ. The position of a tape outside the HPZ may be considered as a cause of suburethral sling failure.

Abstract

Objectives: The high-pressure zone of the urethra (HPZ), which is crucial for the continence mechanism, extends between the point of the maximum urethral closure pressure and the urethral knee, and has been calculated to lie between 53% and 72% of the functional urethral length. According to recent studies the best results of suburethral slings are achieved when tapes are positioned under this zone. The aim of the study was to determine the location of tapes relative to the urethral length in patients seeking help due to recurrent stress urinary incontinence (SUI) following sling procedures. Material and methods: The study group comprised 61 patients suffering from recurrent SUI following suburethral slings performed from 6 months to 5 years earlier. Forty-nine (80.3%) women were initially treated with a transobturator sling and 12 (19.7%) with a retropubic procedure. Twenty patients had the original sling performed at our department whereas, the other 41 in other institutions. The position of the tapes was determined at the sagittal plane by 3-D transvaginal ultrasound using a linear transducer. The length of the urethra was measured from the bladder neck to the external urethral meatus following the urethral lumen, taking into account its curve. The position of the tapes relative to the percentage of the urethral length was calculated assuming the bladder neck as the proximal end of the urethra. The reference point was set at the midpoint on the tape. Results: Only 13 (21.3%) patients had tapes positioned at 50%-75% of the urethral length. In 45 (73.8%) of women examined the tapes were found under proximal half of the urethra and in 3 (4.9%) distally to the 75% of the urethral length. Conclusions: In most patients in whom slings procedures proved unsuccessful the tapes are located under theproximal half of the urethra, that is outside the HPZ. The position of a tape outside the HPZ may be considered as a cause of suburethral sling failure.
Get Citation

Keywords

Stress urinary incontinence, suburethral sling outcome, tape position, ultrasound

About this article
Title

Most of the patients with suburethral sling failure have tapes located outside the highpressure zone of the urethra

Journal

Ginekologia Polska

Issue

Vol 84, No 5 (2013)

Page views

772

Article views/downloads

867

DOI

10.17772/gp/1585

Bibliographic record

Ginekol Pol 2013;84(5).

Keywords

Stress urinary incontinence
suburethral sling outcome
tape position
ultrasound

Authors

Michał Bogusiewicz
Marta Monist
Aleksandra Stankiewicz
Magdalena Woźniak
Andrzej Paweł Wieczorek
Tomasz Rechberger

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl