Construction of a Prognostic Score for Ultrasound Evaluation of the Transobturator Sling for Stress Urinary Incontinence
Abstract
:1. Introduction
- Position of the sling with respect to the urethra (proximal, middle, or distal third) both at rest and in Valsalva.
- Distance between the sling and the posterior urethral wall is considered adequate if between 3–5 mm (in 2D transperineal). With a high-frequency probe, it is possible to accurately calculate the distance between the sling and the urethral light.
- Sling shape (at rest and Valsalva). The tapes usually have a flat shape at rest, determined by their shape parallel to the urethral lumen, and they deform into a “C” shape in Valsalva in relation to the tension caused by the increase in intra-abdominal pressure.
- Concordance of the urethral movement with that of the sling during the Valsalva (urethral kinking).
- The symmetry of the sling and its arms in the cross-section or corona. It allows assessment of the extrusion or winding of the sling arms.
2. Materials and Methods
3. Results
3.1. Descriptive Study
3.2. Bivariate Analysis of the Sonographic Parameters
3.3. Predictive Model
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | Media ± S.D. | n/N y% |
---|---|---|
Age | 51.71 ± 10.57 | |
Obesity | 36/81 (44%) | |
History of depression/anxiety | 18/81 (22%) | |
Parity | 2.33 ± 1.16 | |
Multiparity | 62/81 (76.54%) | |
Childbirth >4000 g | 12/81 (14.81%) | |
Cesarean deliveries | 2/81 (2.47%) | |
Pre-surgical clinical | ||
Stress UI | 52/81 (64.2%) | |
Mixed UI | 29/81 (35.8%) | |
No clinic | 0/81 (0%) | |
Post-Surgical clinical | ||
Stress UI | 6/81 (7.41%) | |
Mixed UI | 10/81 (12.35%) | |
Urgency | 16/81 (19.75%) | |
No clinic | 49/81 (60.49%) | |
Post-surgery ICIQ-IU | 11.13 ± 11.79 |
Ultrasound Parameter | Value | Non-Clinical Stress UI (n = 33) | Clinical Stress UI (n = 9) | Total |
---|---|---|---|---|
Distance to posterior urethral wall (p < 0.001) | <5 mm | 61 (93.8%) | 8 (50%) | 69 (85.2%) |
>5 mm | 4 (6.2%) | 8 (50%) | 12 (14.8%) | |
Position at rest (p = 0.04) | Not proximal | 65 (100%) | 14 (87.5%) | 79 (97.5%) |
Proximal | 0 (0%) | 2 (12.5%) | 2 (2.5%) | |
Form at rest (p < 0.001) | In C | 5 (7.7%) | 8 (50%) | 13 (16.1%) |
Flat | 60 (92.3%) | 8 (50%) | 68 (84%) | |
Form in Valsalva (p = 0.24) | In C | 57 (87.7%) | 12 (75%) | 69 (85.2%) |
Flat | 8 (12.3%) | 4 (25%) | 12 (14.8%) | |
Resting length—Valsalva (p = 0.17) | <15 mm | 63 (96.9%) | 14 (87.5%) | 77 (95.1%) |
15–25 mm | 2 (3.1%) | 2 (12.5%) | 4 (4.9%) | |
Increased posterior urethrovesical angle (Valsalva—rest) (p = 0.21) | <15° | 58 (89.2%) | 12 (75%) | 70 (86.4%) |
>15° | 7 (10.8%) | 4 (25%) | 11 (13.6%) | |
Symmetry (p = 0.0083) | Asymmetric | 8 (12.3%) | 7 (43.8%) | 15 (18.5%) |
Symmetrical | 57 (87.7%) | 9 (56.2%) | 66 (81.5%) | |
Urethral concordance (p = 0.04) | Yes | 65 (100%) | 14 (87.5%) | 79 (97.5%) |
No | 0 (0%) | 2 (12.5%) | 2 (2.5%) |
Parameter | OR | IC 95% | p-Value |
---|---|---|---|
Distance sling to posterior urethral wall < 5 mm | 10.84 | 2.20–63.11 | 0.004 |
Flat shape of the sling at rest | 11.63 | 2.41–66.24 | 0.003 |
Sling symmetry | 6.95 | 1.48–36.96 | 0.016 |
Clinical Stress UI | Non-Clinical Stress UI | Total | ||
---|---|---|---|---|
Clinic | YES | 16 (100%) | 0 (0%) | 16 (19.8%) |
NO | 0 (0%) | 65 (100%) | 65 (80.2%) | |
Score | 0–1 points | 9 (56.2%) | 2 (3.1%) | 11 (13.6%) |
2–3 points | 7 (43.8%) | 63 (96.9%) | 81 (100%) |
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Cristina, E.-G.; Lorena, S.-M.; Rita, P.-G.; Santiago, G.-M.E.; Salvador, J.-L.J. Construction of a Prognostic Score for Ultrasound Evaluation of the Transobturator Sling for Stress Urinary Incontinence. J. Clin. Med. 2022, 11, 1296. https://doi.org/10.3390/jcm11051296
Cristina E-G, Lorena S-M, Rita P-G, Santiago G-ME, Salvador J-LJ. Construction of a Prognostic Score for Ultrasound Evaluation of the Transobturator Sling for Stress Urinary Incontinence. Journal of Clinical Medicine. 2022; 11(5):1296. https://doi.org/10.3390/jcm11051296
Chicago/Turabian StyleCristina, Espada-Gonzalez, Sabonet-Morente Lorena, Perez-Gonzalez Rita, Gonzalez-Mesa Ernesto Santiago, and Jimenez-Lopez Jesus Salvador. 2022. "Construction of a Prognostic Score for Ultrasound Evaluation of the Transobturator Sling for Stress Urinary Incontinence" Journal of Clinical Medicine 11, no. 5: 1296. https://doi.org/10.3390/jcm11051296
APA StyleCristina, E.-G., Lorena, S.-M., Rita, P.-G., Santiago, G.-M. E., & Salvador, J.-L. J. (2022). Construction of a Prognostic Score for Ultrasound Evaluation of the Transobturator Sling for Stress Urinary Incontinence. Journal of Clinical Medicine, 11(5), 1296. https://doi.org/10.3390/jcm11051296