Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review

Abstract

Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.

Keywords: midurethral sling; sonography; stress urinary incontinence.

Figure 1

Urethral length and bladder neck position at rest. Green marker—bladder neck; red marker—symphysis pubis; yellow mark 1: urethral length, yellow mark 2: bladder neck position over the lower edge of symphysis pubis.

Figure 2

Bladder neck descent and funneling during the Valsalva maneuver. Yellow star—bladder neck; yellow mark 1: position of the bladder neck below lower edge of symphysis pubis.

Figure 3

TVT—coronal view.

Figure 4

MUS located too far from the urethra (greater sling-LSM distance). Red arrow—sling. 5: urethral length, 6: distance from the closer margin of the sling to LSM, 7: sling distance from the bladder neck; 8: the distance between the closest margin of the sling and LSM.

Figure 5

TVT positioned too close to the bladder neck. Red arrow—sling. 4 urethral length; 6 sling distance from the bladder neck; 7 sling distance from LSM.

Figure 6

Close tape-LSM distance, C-shaped tape. Red arrow—tape. 1: urethral length; 2: sling distance from LSM.

Figure 7

Urethral sling erosion. Red arrow—sling.

Figure 8

Two slings implanted in a single patient—coronal view. Red arrows—slings.

Figure 9

Two slings implanted in a single patient—sagittal view. Red arrows—slings.