- Email: [email protected]
Ultrasonography and Clinical Outcomes for Repeat Midurethral Sling Surgery on Recurrent or Persistent Stress Urinary Incontinence (SUI)
Abstracts OPT11-010 Assessing the Feasibility of Normal Fetal Thoracic Development Measured by 2DUS, 3DUS and MRI Xihua Lian, Guorong Lv Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, China Objectives: To compare the feasibility of fetal thorax measured by two dimensional ultrasonography (2D-US), three dimensional ultrasonography (3D-US) and magnetic resonance imaging (MRI) in evaluating the normal fetal thoracic development. Methods: Thirty normal singleton pregnancies at 20-35 gestational weeks(GW) were selected and whose thoracic transverse diameter, anteroposterior diameter, area, circumference, volume and lung volume were measured on the transverse section at the level of the four-chamber view by ultrasonography and MRI. The repeatability and consistency of the measurement were analyzed by intraclass correlation coefficient(ICC) and Bland-Altman plot, and the correlativity of 3D-US virtual organ computer-aided analysis (VOCAL) technique and MRI in measuring the lung and thoracic volume was analysed by Pearson correlation analysis. Results: The inter-/intra-operator reproducibility and consistency of fetal thoracic transverse diameter, anteroposterior diameter, area and circumference measured by 2D-US were higher than the MRI’s, however, the intra-/inter-operator reproducibility and consistency of fetal thoracic volume and lung volume measured by MRI were higher than the 3D-US VOCAL technique. The inter-operator reproducibility and consistency of fetal thoracic transverse diameter were the highest when using ultrasonography, the intraclass correlation coefficient(ICC) was 0.9964 (95%CI, 0.99250.9983), mean difference6standard deviation(d6SD) was -0.004760.0573 (95%CI, -0.0261 0.0167), respectively. The correlativity of 3D-US VOCAL technique and MRI was excellent in measuring the lung and thoracic volume(R2L5 0.915,R2T50.957, P ,0.0001). Conclusions: The 2D-US, 3D-US and MRI are reliable techniques for measuring fetal thoracic development. The ultrasonography is better than MRI in 2D basic measurement, but MRI is better than VOCAL in 3D volumn measurement. OPT11-011 Ultrasonography and Clinical Outcomes for Repeat Midurethral Sling Surgery on Recurrent or Persistent Stress Urinary Incontinence (SUI) Tsia-Shu Lo,1 Clarissa Uy Patrimonio Ma,2 Leng Boi Pue,3 Yiap-Loong Tan,4 Sandy Chua,5 Ling-Hong Tseng,6 Min-Hui Ye7 1 Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Taiwan, 2Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippines, 3 Department of Obstetrics and Gynecology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia, 4Department of Obstetrics and Gynecology, KPJ Healthcare Group, Kuching Specialist Hospital, Kuching, Sarawak, Malaysia, 5Department of Obstetrics and Gynecology, Cebu Velez General Hospital, Cebu City, Philippines, 6Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linko, Taiwan, 7Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Xiamen, China Objectives: To study the outcomes following repeat midurethral sling (MUS) surgery in patients with persistent or recurrent stress urinary incontinence after failure of primary MUS surgery. Methods: 24 patients were enrolled. The ultrasound exploring the sling (xt, yt) and bladder neck position (xbn, ybn) were measured using the rectangular coordinate system at rest and maximal Val-
S139
salva. The mobility and change in the inclination angle between the urethra and pubic axis was measured with introital ultrasonography. Objective cure was defined as no demonstrable involuntary leakage of urine during increased abdominal pressure in the absence of a detrusor contraction observed during filling cystometry, and subjective cure was defined as a negative response to UDI-6 question 3 during follow-up between 6 months and 1 year postoperatively. Results: The objective and subjective cure rates were 79.2 % and 75 %, respectively. There were no differences in demographics between the patients with failure of surgery and those with successful surgery. No significant differences were found in the mobility of the tape or the position of the slings in the midurethral region. Significant independent risk factors for failure of repeat MUS were a change in inclination angle of ,30 , a change in cotton swab angle ,30 , ISD and a mean urethral closure pressure of ,60 cm H2O. In one patient the bladder was perforated. Conclusions: Repeat MUS surgery is safe and has a good short-term success rate, both objectively and subjectively, with independent risk factors for failure related to bladder neck hypomobility and poor urethral function. OPT11-012 Ultrasonographic Evaluation of Urethral Angle and Bladder Neck Mobility after Single Incision Mini-Sling Wu-Chiao Hsieh, Ching-Chung Liang Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan Objectives: To investigate the predictors of persistence or resolution of lower urinary tract symptoms(LUTS) in women following single incision mini-sling(SIMS) surgery for urodynamic stress incontinence(USI). Background: From prior study, we already know that SIMS surgery has similar subjective cure rate to tension-free vaginal tape(TVT). However, postoperative incontinence severity is greater in SIMS than in TVT. It may be related to the design of SIMS, less trauma and poor fixed instability. Greater angular closure provided by TVT may more effectively prevent urine from entering the upper posterior urethra, therefore, decrease postoperative urgency and urge incontinence. We suppose that better fixation of single incision mini-sling causes greater urethral angle when Valsalva, which result in better treatment outcome after SIMS. Methods: Patients with urodynamic stress incontinence undergoing SIMS between October, 2015 and September, 2016 in a tertiary hospital were recruited. All patients underwent evaluation including a structured urogynecological questionnaire, pelvic examination using the POP-quantification system, pelvic ultrasound, and urodynamic testing before and 6 months after surgery. Patient demographics, ultrasonographic findings, and urodynamic findings were analyzed. To test the possible role of urethral angle in maintaining LUTS women. Results: Of 57 patients who underwent SIMS, 20 (35.1%) had postoperative urgency. All patient had subjective cure for USI. Ultrasound analysis showed good repeatability and is not influenced by vesical volume. The beta angle is between the proximal part and the distal part of urethra. Beta angle and urethrovesical mobility are inversely proportional. Urethral angle identifies postoperative urgency better than urethrovesical mobility (sensitivity 92% vs 81%). Conclusions: Better fixation of single incision mini-sling contributes to greater urethral angle when Valsalva and better treatment outcome. Measurement of the urethral angle can provide useful additional information for adjusting the tightness of sling during anti-in.
S139
salva. The mobility and change in the inclination angle between the urethra and pubic axis was measured with introital ultrasonography. Objective cure was defined as no demonstrable involuntary leakage of urine during increased abdominal pressure in the absence of a detrusor contraction observed during filling cystometry, and subjective cure was defined as a negative response to UDI-6 question 3 during follow-up between 6 months and 1 year postoperatively. Results: The objective and subjective cure rates were 79.2 % and 75 %, respectively. There were no differences in demographics between the patients with failure of surgery and those with successful surgery. No significant differences were found in the mobility of the tape or the position of the slings in the midurethral region. Significant independent risk factors for failure of repeat MUS were a change in inclination angle of ,30 , a change in cotton swab angle ,30 , ISD and a mean urethral closure pressure of ,60 cm H2O. In one patient the bladder was perforated. Conclusions: Repeat MUS surgery is safe and has a good short-term success rate, both objectively and subjectively, with independent risk factors for failure related to bladder neck hypomobility and poor urethral function. OPT11-012 Ultrasonographic Evaluation of Urethral Angle and Bladder Neck Mobility after Single Incision Mini-Sling Wu-Chiao Hsieh, Ching-Chung Liang Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan Objectives: To investigate the predictors of persistence or resolution of lower urinary tract symptoms(LUTS) in women following single incision mini-sling(SIMS) surgery for urodynamic stress incontinence(USI). Background: From prior study, we already know that SIMS surgery has similar subjective cure rate to tension-free vaginal tape(TVT). However, postoperative incontinence severity is greater in SIMS than in TVT. It may be related to the design of SIMS, less trauma and poor fixed instability. Greater angular closure provided by TVT may more effectively prevent urine from entering the upper posterior urethra, therefore, decrease postoperative urgency and urge incontinence. We suppose that better fixation of single incision mini-sling causes greater urethral angle when Valsalva, which result in better treatment outcome after SIMS. Methods: Patients with urodynamic stress incontinence undergoing SIMS between October, 2015 and September, 2016 in a tertiary hospital were recruited. All patients underwent evaluation including a structured urogynecological questionnaire, pelvic examination using the POP-quantification system, pelvic ultrasound, and urodynamic testing before and 6 months after surgery. Patient demographics, ultrasonographic findings, and urodynamic findings were analyzed. To test the possible role of urethral angle in maintaining LUTS women. Results: Of 57 patients who underwent SIMS, 20 (35.1%) had postoperative urgency. All patient had subjective cure for USI. Ultrasound analysis showed good repeatability and is not influenced by vesical volume. The beta angle is between the proximal part and the distal part of urethra. Beta angle and urethrovesical mobility are inversely proportional. Urethral angle identifies postoperative urgency better than urethrovesical mobility (sensitivity 92% vs 81%). Conclusions: Better fixation of single incision mini-sling contributes to greater urethral angle when Valsalva and better treatment outcome. Measurement of the urethral angle can provide useful additional information for adjusting the tightness of sling during anti-in.