Reliabilität der Introitussonografie nach Einlage eines spannungsfreien Vaginalbands nach dem TVT-Verfahren

Zusammenfassung

Ziel: Wir untersuchten die Interrater- und Intrarater-Reliabilität der Introitussonografie bei Patientinnen nach TVT-Implantation. Material und Methoden: Bei 202 Patientinnen konnte die Position und Form des Bandes bestimmt werden. Die Bandposition wurde charakterisiert durch die Relation der Distanz zwischen Blasenausgang und Band zur Urethralänge (%) und durch den Abstand zwischen Band und Urethra (mm). Die Übereinstimmung wurde durch den Intra-Klassen-Korrelation (ICC) und Kappa-Koeffizient (KK) ermittelt. Ergebnisse: Für die Intrarater-Reliabilität konnte bei der Beurteilung der Bandposition (Ruhe ICC 0,90, Valsalva ICC 0,96) und des Abstands in Ruhe (ICC 0,83), aber nicht beim Pressen (ICC 0,74) eine gute Reproduzierbarkeit ermittelt werden. Bei der Bandform wurde eine Übereinstimmung von 81 % (Ruhe) und 79 % (Pressen) ermittelt. Der KK war mit 0,68 und 0,6 relativ gering. Die Interrater-Reliabilität war gut bei der Bestimmung der Bandposition (Ruhe ICC 0,93, Pressen ICC 0,89) und des Abstands (Ruhe ICC 0,89, Pressen ICC 0,87). Bei der Bandform zeigte sich eine geringe Übereinstimmung (Ruhe 71 %, Pressen 72 %). Schlussfolgerung: Die Introitussonografie in der midsagittalen Ebene zeigt eine gute Reproduzierbarkeit der sonografischen Bandcharakterisierung hinsichtlich Position und Abstand.

Abstract

Purpose: To date, the evaluation of TVT by ultrasound has not been standardized. The aim of this observational study was to evaluate the intraobserver and interobserver variability of introital ultrasound. Materials and Methods: Follow-up was performed for 202 patients after TVT procedure. The tape was characterized by the position in relation to urethral length (%) and the distance to the hypoechoic center of the urethra (mm). Furthermore, we assessed the shape of the tape (straight, curved or folded). All evaluations were performed by two experienced examiners (A, B) at rest and during Valsalva maneuver. All sonograms were archived digitally without measurement results. After 6 to 12 months, the sonograms were re-evaluated by one investigator (A). Depending on the first investigator, the results were compared as intraobserver (A-A) or interobserver (B-A) agreement. The first results were blinded for the second measurement. Agreement concerning the distances was assessed using the intraclass correlation coefficient (ICC). The concordance of the descriptive evaluation of the shape of the tape was characterized by the kappa coefficient (KC). Results: The tape was regularly identified as an echogenic structure dorsal to the urethra. The intraobserver reliability concerning the position of the tape in relation to urethral length showed good reproducibility (at rest ICC 0.90, Valsalva maneuver: ICC 0.96). For the distance between the tape and the urethra at rest (ICC 0.83), there was also good reproducibility, but not during Valsalva maneuver (ICC 0.74). The shape of the tape showed only moderate reproducibility with accordance of 81 % at rest (KC 0.68) and of 79 % during Valsalva maneuver (KC 0.6). The interobserver comparisons showed good concordance in measuring the POS at rest (ICC 0.93), and during Valsalva maneuver (ICC 0.89), and the DIS at rest (ICC 0.89), and during Valsalva maneuver (ICC 0.87). The congruence of the estimation of the shape was 71 % at rest (KC 0.44) and 72 % during Valsalva maneuver (KC 0.49). Conclusion: The characterization of the TVT in the sagittal view by introital ultrasound shows good reproducibility with respect to position and distance, but not shape.

Key words

bladder - urethra - ultrasound - surgery

Literatur

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