Ultrasound Evaluation of Midurethral Slings: With and Without Concurrent Apical Suspension.

Introduction And Hypothesis: Midurethral sling (MUS) success may depend on sling positioning along the urethra, which may be affected by concurrent apical prolapse repair. Our prospective cohort study evaluated differences in MUS positioning using translabial ultrasound in women who had MUS only versus those with concurrent apical prolapse repair.

Methods: Women undergoing MUS with or without concurrent prolapse repair were enrolled. MUS was placed after the apical suspension. Ultrasound images were obtained at the beginning of the case, after suspension (if applicable), and following sling placement. Two experts reviewed the images and measured the urethral length, sling positioning along the urethra, and the angle between the urethra and the pubic symphysis. Measurements were averaged for statistical analysis.

Results: Fifty-one women participated: 27 in the MUS alone group and 24 in the concurrent group. There were no differences in urethral length (27.4 vs 27.2 mm, p = 0.728), MUS position (0.24 vs 0.26 mm; p = 0.71), or angle (24° vs 23°, p = 0.574). Both groups demonstrated a significant improvement in Urinary Distress Inventory6 scores.

Conclusions: There have been conflicting reports of MUS success when placed on its own versus at the time of prolapse repair. One hypothesis has been that positioning of the MUS may be affected by the prolapse repair. Our study did not observe any difference in the MUS positioning along the urethra, nor sling angle when placed with or without a concurrent prolapse repair.