2D and 3D echographic evaluation of the efficiency of treatment for combined types of pelvic organ prolapse and stress urinary incontinence

Objective: To enhance the efficiency of treatment for combined types of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) with mesh implants and to introduce an ultrasound-based algorithm for examining patients with this disease. Materials and methods: The investigation enrolled 51 female patients aged 55±3.0 years with grades 2 and 3 genital prolapse and SUI who had undergone surgical treatment with mesh implants. POP was corrected with the INGyneous mesh implant in 26 patients and with OPUR in 25 examinees. A control group consisted of 32 healthy women of comparable age without POP and SUI. All the patients underwent pre- and postoperative two- and three-dimensional ultrasound examinations in addition to clinical examination. The main parameters of ultrasound-based evaluation were the presence and structure of the pubovesical fascia, the shape of the bladder, α/β angles, and the shape of the urethral sphincters. So, the resulting complete disappearance or pronounced changes in the structure of the pubovesical fascia at the preoperative stage regulate the mandatory correction of cystocele. Results: Ultrasound performed on days 3-5 after surgery showed that correction of α and β angles, as well as the shape of the bladder to normal values, was achieved in all the patients both in resting and during straining, suggesting that the anatomy of the pelvic organs was properly restored. Assessment of the long-term results indicated that complete and incomplete clinical and ultrasound effects on SUI were achieved in 58.8 and 23.5% of cases, respectively. SUI was relieved completely in 17.6% of the patients. Before surgery, all the patients with preserved SUI were diagnosed to have severe urethral hypermobility, α angle deviation greater more than 40° during the Valsalva maneuver, and funnel-shaped expansion of the proximal urethra, indicating urethral sphincter incompetence. Doppler ultrasound and gray scale imaging could record the reverse flow of urine from the urethra to the bladder due to the inversion of the urethral and vesicular pressure gradient. The combination of similar ultrasound criteria gives a pessimistic prognosis of incontinence. The result of the investigation was to identify the place of ultrasound in the diagnosis of combined forms of POP and SUI. Conclusion: Thus, surgical treatment for POP with mesh implants is a reliably effective treatment method. Preoperative ultrasound allows prognostic assessment of the correction of SUI in POP

mesh im/lant, incontinence markers, α,β angle, pubovesical fascia, funnel-shaped urethral dilatation, urethral hypermobility