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  • José Antonio García-Mejido1,2,*,
  • Pedro Blasco-Hernandez3 and
  • José Antonio Sainz-Bueno1,2
  • et al.

Reviewer 1: Akif Erbin Reviewer 2: Anonymous

Round 1

Reviewer 1 Report

Dear Authors,

I reviewed your study titled ‘’ Are ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?’’

Transperineal ultrasound seems to be used more and more in incontinence surgery. I have not seen a similar study in the literature. So, I think that the present study is valuable for clinical practice and literature. However, it needs some revisions and is appropriate to re-evaluate after revisions;

1.      Title: should be changed to "Are transperineal ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?"

 

  1. Abstract: should be added a short and clear sentence summarizing the hypothesis/base of the study before the first sentence.
  2. Abstract: This study is a cross-sectional study. It is controversial to define cross-sectional studies as retrospective or prospective. Only 'prospective cohort' or 'prospective randomized' studies should be specified as 'prospective'.
  3. Abstract: should include the period of the study and the characteristics (urogynecology center; tertiary clinic, etc.) of the center that carried out the study.
  4. Abstract: ‘’In conclusion, the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to study SUI in patients with SIMS’’ This sentence is a one-to-one repetition sentence with results; it should include conclusions with different expressions for clinical practice.
  5. Methods: should include the exclusion criteria
  6. Discussion: should include further discussion associated with the study.
  7. Figure: Basic anatomical structures should be written with arrows on the picture.
  8. Ultrasound assessment: Sagital tape angle (6)….Axial tape angle (28)….should contain an explanation.
  9. Results:  I couldn't see the tables in  main text file and  system
  10. Conclusions: ‘’ In conclusion’’ should be removed and this part should be written with at least 3-4 sentences. 

Author Response

I reviewed your study titled ‘’ Are ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?’’

Transperineal ultrasound seems to be used more and more in incontinence surgery. I have not seen a similar study in the literature. So, I think that the present study is valuable for clinical practice and literature. However, it needs some revisions and is appropriate to re-evaluate after revisions;

  1. Title:should be changed to "Are transperineal ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?" 

Reply: The title has been changed.

  1. Abstract: should beadded a short and clear sentence summarizing the hypothesis/base of the study before the first sentence.

 

Reply: A hypothesis has been introduced in the abstract.

Text: “It would be logical to think that single-incision mini-slings (SIMS) should behave like the rest of the tension-free vaginal tape and, therefore, to believe that they present a similar ultrasound appearance, but there are no studies on this matter. Therefore, the main aim”

 

  1. Abstract:This study is a cross-sectional study. It is controversial to define cross-sectional studies as retrospective or prospective. Only 'prospective cohort' or 'prospective randomized' studies should be specified as 'prospective'.

 

Reply: This study is of a prospective cohort since the patients are included before being operated on and subsequently followed up for 6 months where the clinical evolution and the ultrasound appearance of the tapes are seen. This study presents a typical characteristic of prospective cohort studies in that participants are enrolled in the study before they develop the outcome in question.

 

  1. Abstract: should include the period of the study and the characteristics (urogynecology center; tertiary clinic, etc.) of the center that carried out the study.

 

Reply: Suggestions have been included in the text.

Text: A prospective observational study was carried out including 94 patients who were candidates for SUI corrective surgery with SIMS between 1st January, 2021 to 31st December, 2021 at the Universitary Hospital of Valme (Seville, Spain).

 

  1. Abstract:‘’In conclusion, the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to study SUI in patients with SIMS’’ This sentence is a one-to-one repetition sentence with results; it should include conclusions with different expressions for clinical practice.

 

Reply: The conclusion has been changed to make it more understandable in clinical practice.

Text: “In conclusion, the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to define continence in patients with SIMS.”

 

  1. Methods:should include the exclusion criteria

 

 

Reply: It has been included in the text.

Text: “Patients with corrective pelvic floor surgery were excluded.”

 

  1. Discussion:should include further discussion associated with the study.

 

Reply: It has been included in the text.

Text: “Previous studies with other types of MUS define different measurements to determine SUI (4,6,16,18-28). However, we have described that the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to define continence in patients with SIMS.”

 

 

  1. Figure: Basic anatomical structures should be written with arrows on the picture.

 

Reply: The location of the basic anatomical structures have been included in the image: Pubis (P), Bladder (Bl) Urethra (U)

 

  1. Ultrasound assessment:Sagital tape angle (6)….Axial tape angle (28)….should contain an explanation.

 

Reply: It has been included in the text.

 

Text:

“Sagital tape angle (6): Angle showing the tape in the midsagittal image

Axial tape angle (28). Angle showing the tape in the axial image”

 

  1. Results:  I couldn't see the tables in  main text file and  system

 

Reply: I attach the tables to the main document

 

  1. Conclusions:‘’ In conclusion’’ should be removed and this part should be written with at least 3-4 sentences. 

 

Reply: It has been included in the text.

 

Text: A concordant movement between the tape and the urethra is the most useful ultrasound parameter to define urinary continence in patients with SIMS. However, a discordant movement between the tape and the urethra is associated with SUI in patients with SIMS.

Reviewer 2 Report

The article “Are ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?” is presenting, with a statistical evaluation the value of several ultrasound imaging parameters and the value of different parameters assessed during ultrasound 6 month after surgery with single-incision mini-slings (SIMS). There are several studies about ultrasound evaluation of different surgical procedures including tapes for urinary stress incontinence but there is a lack in the evaluation of surgery with single-incision mini-slings.

Author Response

The article “Are ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?” is presenting, with a statistical evaluation the value of several ultrasound imaging parameters and the value of different parameters assessed during ultrasound 6 month after surgery with single-incision mini-slings (SIMS). There are several studies about ultrasound evaluation of different surgical procedures including tapes for urinary stress incontinence but there is a lack in the evaluation of surgery with single-incision mini-slings.

 

 

 

Reply: The evaluation of the surgical result was evaluated 6 months after surgery as indicated in the method: "Post-surgical clinical analysis was performed 6 months after surgery and was similar to the one performed pre-surgical." As can be seen in Table 1, after surgery, 63 patients remained asymptomatic and 29 symptomatic (SUI=20; MUI=31). If it is true that we have not studied the severity of incontinence in patients after surgery, that is why we have included it as a limitation: "Our main weakness lies in the fact that we have not clinically assessed the severity of SUI, not being able to relate the severity of urinary incontinence to ultrasound findings."