MRI-fusion sonography for the evaluation of Trans Vaginal Colposuspension treatment success

Purpose: Trans Vaginal Colposuspension (TVC) is a novel, minimally invasive technique for the treatment of stress urinary incontinence (SUI). To reconstruct the pubourethral or pubovesicular ligaments we use an MRI visible suturable mini sling (SlimSling) which allows for the preservation of normal anatomy without any mesh material under the urethra. To follow up the success of this procedure we use MRI fusion sonography along with a clinical evaluation of outcomes. By using MRI fusion sonography we are able to see the fixation points and the mesh position angle which in not possible with traditional imaging. The aim of this study is to show that MRI fusion sonography is a superior tool for evaluating the treatment success of TVC.

Method: Between August 2013 and April 2016 116 patients underwent a TVC procedure. Peri and postoperative complications were recorded. Patients were followed up at six weeks, three and six months and objective and subjective outcomes were evaluated. All patients underwent magnetic resonance imaging (MRI) and then MRI fusion sonography to evaluate the position of the mesh sling following the procedure.

Results: We found that with ultrasound alone the correct angle of the sling was not able to be measured accurately but with the addition of MRI fusion the outcome of the procedure is easily measurable. Visualization of the 3 mm prolene mesh sling is easier using MRI fusion and a larger field of view is obtained. The paraurethral fixating points of the mesh are seen in only 68% of cases but with MRI fusion nearly 96% are seen. The imaging shows that the traction angle of the sling is the same as the normal anatomy.

Conclusion: MRI fusion sonography allows for measurable follow up of TVC performance and also proves that it is a good alternative to traditional colposuspension or midurethral slings.

Fig. 1: MRI-US-Fusion_TVC