V2-11: UTILIZING TRANSLABIAL ULTRASOUND FOR IDENTIFICATION AND ASSESSMENT OF SYNTHETIC VAGINAL MESH
Assessment of bothersome synthetic suburethral slings or mesh in the clinic or operating room can be challenging. Often, synthetic slings or mesh cannot be adequately evaluated by physical examination, cystoscopy, CT, or MRI. Furthermore, patients are frequently unable to give an accurate history regarding their synthetic mesh or slings. Translabial ultrasound (TUS) is an underutilized yet very useful tool for the detection of synthetic mesh.
The accompanying video demonstrates basic TUS technique for general and standardized assessment of pelvic floor anatomy as well as for the assessment of synthetic mesh in the clinic or operating room. The following represents a common clinical scenario in which TUS is useful: A 76 year-old female with history of mixed urinary incontinence and prior synthetic suburethral sling placement presented to clinic with vaginal and pelvic pain, dysuria, obstructive voiding symptoms, and recurrent urinary tract infections. Pelvic exam and cystoscopy did not demonstrate any extruded mesh. TUS performed in clinic using a curvilinear 4-8 MHz transducer demonstrated the presence of a transobturator sling. No other mesh was seen.
The patient underwent surgery due to her symptoms. Intraoperative TUS confirmed the prior clinical finding of a synthetic transobturator sling. There was also a urethral kink seen which was caused by her sling. The sling otherwise appeared intact and was not folded. The sling was excised and the patient also underwent urethrolysis and cystocele repair. Two weeks postoperatively, the patient reported that her pelvic and vaginal pain have resolved. She is awaiting rectus fascia suburethral sling placement to treat her stress urinary incontinence.
TUS enables the urologist to identify and assess synthetic mesh material in the pelvic floor in the clinic and operating room settings. TUS is non-invasive, provides instant diagnostic feedback, and is well-tolerated by patients.