Sonographic appearance of transobturator slings: implications for function and dysfunction

The aim of this study was to determine associations between the ultrasonic appearance of Monarc suburethral slings and postoperative bladder symptoms at an average follow-up time of 11 months. A prospective clinical audit was conducted on 98 patients after Monarc suburethral sling. The assessment included pelvic floor ultrasound to determine the gap between the sling and symphysis pubis, the angle formed by cranial and caudal ends of the sling at rest and on Valsalva, and the location of the sling relative to the urethra. Patients who reported postoperative stress incontinence (SI) or urge incontinence (UI) had a significantly wider gap between the symphysis pubis and sling (P = 0.032 and P = 0.006, respectively). A narrower gap between the tape and symphysis pubis is associated with both SI and UI cure. Tighter transobturator sling placement seems to be advantageous for the cure of both SI and UI.