Clinical application of 2D and 3D pelvic floor ultrasound of mid-urethral slings and vaginal wall mesh

Introduction and hypothesis This mini-review demonstrates the clinical application of pelvic floor ultrasound for imaging women with mesh following incontinence and prolapse surgical procedures. Methods The images are obtained using two-dimensional (2D) perineal pelvic floor ultrasound (pPFUS) and three-dimensional (3D) endovaginal ultrasound (EVUS). Results 2D pPFUS and 3D EVUS provide confirmation of the presence or absence of vaginal wall mesh (VWM), bulking agents, and the type of mid-urethral sling (MUS). Residual mesh following excision can be located, and presence in the bladder/urethra may be demonstrated. These are crucial for surgical planning and counselling, with the potential to be useful intraoperatively also. The shape and position relative to urethral length and lumen can be assessed, which may correspond with voiding dysfunction or recurrent incontinence. Evidence of inflammation/sepsis or folding of the VWM may be useful in the investigation of pain. Conclusions Pelvic floor ultrasound is the standard of care where imaging is available and utilised and is the only modality capable of reliably visualising mesh. It is clear that there are significant benefits and uses for the clinician for investigating complications of VWM or MUS; although many of the findings may be associated with clinical symptoms, some are incidental findings. Therefore, these scans should be performed by pelvic floor specialists with core competency in pelvic floor ultrasound and interpreted by those familiar with their significance, as an adjunct to patient history, examination and other investigations to assist in the most appropriate management plan for the patient. In addition, there is still a need for standardisation in terminology and measurement techniques, to allow for consistent and comparable reporting.