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Readjustable Sling in Women With Stress Urinary Incontinence and Hypomobile Urethra: Understanding the Mechanisms of Closure by Transperineal Ultrasound

Readjustable Sling in Women With Stress Urinary Incontinence and Hypomobile Urethra:... IntroductionMid‐urethral slings (MUS) are the most common surgical treatment for women with stress urinary incontinence (SUI). The sonographic pattern of MUS is established in the literature and correlates with symptoms and complications.1 Higher cure rates are associated with a symmetrical MUS located in the middle third of the urethra at 3 to 5 mm from the urethral lumen.2,3 Dynamic interaction of the urethra with the MUS during the Valsalva maneuver is a determinant factor of surgical success.2,3The urethra is considered to move concordant with the MUS if the sling location at maximal Valsalva relative to the urethral length is identical to that at rest, causing urethral kinking.2,4 When there is no contact between the MUS and the urethra during Valsalva, or the sling location relative to the urethral length differs from that at rest, the urethral movement is considered discordant.2Apart from MUS, there is another type of suburethral sling for SUI called the readjustable sling (RAS). RAS (Remeex®, Neomedic) is a closed system with a suburethral sling fixed to a device located in the suprapubic region, which allows sling tension regulation after placement and achieves urethral closure moving toward the urethra, extrinsically compressing it during Valsalva.5 Due to its special http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Ultrasound in Medicine Wiley

Readjustable Sling in Women With Stress Urinary Incontinence and Hypomobile Urethra: Understanding the Mechanisms of Closure by Transperineal Ultrasound

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References (25)

Publisher
Wiley
Copyright
© 2022 American Institute of Ultrasound in Medicine
ISSN
0278-4297
eISSN
1550-9613
DOI
10.1002/jum.16076
Publisher site
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Abstract

IntroductionMid‐urethral slings (MUS) are the most common surgical treatment for women with stress urinary incontinence (SUI). The sonographic pattern of MUS is established in the literature and correlates with symptoms and complications.1 Higher cure rates are associated with a symmetrical MUS located in the middle third of the urethra at 3 to 5 mm from the urethral lumen.2,3 Dynamic interaction of the urethra with the MUS during the Valsalva maneuver is a determinant factor of surgical success.2,3The urethra is considered to move concordant with the MUS if the sling location at maximal Valsalva relative to the urethral length is identical to that at rest, causing urethral kinking.2,4 When there is no contact between the MUS and the urethra during Valsalva, or the sling location relative to the urethral length differs from that at rest, the urethral movement is considered discordant.2Apart from MUS, there is another type of suburethral sling for SUI called the readjustable sling (RAS). RAS (Remeex®, Neomedic) is a closed system with a suburethral sling fixed to a device located in the suprapubic region, which allows sling tension regulation after placement and achieves urethral closure moving toward the urethra, extrinsically compressing it during Valsalva.5 Due to its special

Journal

Journal of Ultrasound in Medicine – Wiley

Published: Dec 1, 2022

Keywords: hypomobile urethra; mid‐urethral sling; readjustable sling; stress urinary incontinence; ultrasound

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