Use of intraoperative ultrasound to improve tension-free vaginal tape-obturator placement: A pilot study.

Objective: To evaluate the use of intraoperative ultrasound (IUS) to achieve a postoperative optimal placement of the tension-free vaginal tape-obturator (TVT-O).

Methods: A cohort study was performed among women who underwent TVT-O placement. In 25 women, ultrasound was used for the placement, and based on current evidence, the optimal intraoperative and postoperative ultrasound pattern was selected. They were compared with 25 women where IUS was not used.

Results: IUS increased operative time (by 7.5 min), and in 36% (9/25) of cases it was necessary to perform some corrections based on the ultrasound findings. After 1 month, in patients of the IUS group, the tapes were more frequently placed at a distance of 3-5 mm (P = 0.01), and it was more common for it to be placed between 40% and 70% relative to the urethral length (P = 0.011). Of tapes placed with IUS, 76% (met the optimal postoperative ultrasound pattern, as opposed to only 48% placed without IUS (P = 0.041). No differences were found in the complications or the functional results at 1 month post-surgery.

Conclusion: The use of IUS for the placement of TVT-O allows us to position them optimally and avoid erroneous placements, although IUS increases the operative time without improving the functional results and the rate of complications.