Autologous rectus fascial slings for stress urinary incontinence: can we see them on ultrasound?

Abstract

Recent times have witnessed a resurgence in the use of autologous fascial slings as treatment for stress urinary incontinence. They have been found to have a high success rate, without risk of complications related to synthetic implanted material [1, 2]. Following Food and Drug Administration cautions and a temporary ban on the use of tapes for stress urinary incontinence in some countries, there is resultant patient fear, stigma and litigation associated with pelvic floor mesh [2]. This will likely lead to further utilization of autologous slings in the future. Correlations among ultrasound, surgical success and complications for mid-urethral slings with mesh have been described [3]. There is a paucity of research on the imaging of autologous slings for predicting either operative success or complications. We present these images to demonstrate how pelvic floor ultrasound could be used in the immediate post-operative period to image autologous sling position in relation to the urethral length and urethral lumen to correlate with operative success as well as investigate immediate post-operative complications. The fascial sling is very distinct in the immediate post-operative period but with time as it undergoes fibrosis it appears less echogenic. The fascial sling in Figs. 1 and 2 demonstrates a sling at the level of the midurethra. Figures 3 and 4 show a retropubic haematoma which was managed conservatively. The patient had urgency and frequency which were explained by the diagosis. With resolution of the haematoma her symptoms improved. The images were carried out by validated techniques [3] of pelvic floor scanning with 2D perineal pelvic floor ultrasound (type 8802; 4.3–6 MHz) and 3D endovaginal ultrasound (type 8838; 6–12 MHz, 360 rotational probe) using the Flexfocus 500 ultrasound system (BK Medical, Herlev, Denmark).