E2261. Translabial Ultrasound for Evaluation of Synthetic Midurethral Sling Erosion
  1. Daniela Wermuth; University of Colorado
  2. Ellen Clark; University of Colorado
  3. Alison Sheridan; University of Colorado
The purpose of this retrospective, observational study is to evaluate translabial ultrasound (TL US) detection of midurethral sling (MUS) erosion into the urethra and vagina as compared to physical exam, cystourethrography and operative correlates.

Materials and Methods:
We conducted a retrospective database search of women who underwent translabial ultrasound assessment of pelvic mesh at a tertiary care center (June 2017- June 2020). Women with a complete history and physical exam, cystourethroscopy report and a MUS identified on TL US were included in our study. A database was created to compile patient demographic information, relevant clinical data, operative notes and translabial ultrasound reports. To determine the diagnostic performance of TL US in detecting MUS erosion, ultrasound findings were compared to the reference standard of clinical and intraoperative findings of visible mesh extrusion. Translabial ultrasounds images were interpreted by a single fellowship trained attending radiologist.

Our total cohort included 79 women with a mean age of 59.5 +/- 13.8 (SD) years and mean BMI of 29.45 +/- 6.5 (SD). Of the 79 patients, all were experiencing symptoms associated with MUS complications at presentation. 20 patients (25%) were found to have preoperative findings concerning for mesh erosion, such as visible mesh extrusion or “near”-erosion in during pelvic exam or urinary tract mucosa during cystourethroscopy. 15 of these 20 patients elected for surgical exploration of eroded mesh; the sensitivity and specificity of TL US detection of MUS urethral erosion in this group was 85% and 85%, respectively.

Translabial ultrasound is an inexpensive, well-tolerated method for imaging midurethral slings. Translabial ultrasound is a reliable detector of midurethral sling urethral erosion into and superior to urethroscopy. TL US is inferior to physical examination for detection of mesh erosion into vaginal mucosa.