RESUMO
OBJETIVO: Descrever a importância da ultra-sonografia transvulvar na avaliação das diferenças anatômicas induzidas pelas cirurgias de sling de fáscia lata e tension-free vaginal tape. MATERIAIS E MÉTODOS: Quarenta mulheres com incontinência urinária de esforço, com idades entre 30 e 60 anos, foram tratadas por sling de fáscia lata (20 pacientes) ou tension-free vaginal tape (20 pacientes). A ultra-sonografia transvulvar da junção uretrovesical e da uretra proximal foi a principal ferramenta de investigação pré- e pós-operatória. Os parâmetros estudados foram: distância vertical e distância horizontal da junção uretrovesical, distância pubouretral e comprimento da uretra proximal. RESULTADOS: A distância vertical da junção uretrovesical não variou significativamente após a sling de fáscia lata (p > 0,10). A distância pubouretral e a uretra proximal tornaram-se menores (p < 0,003) e a distância horizontal da junção uretrovesical tornou-se menor só no repouso (p = 0,03) após a sling de fáscia lata. A tension-free vaginal tape diminuiu o deslocamento vertical da junção uretrovesical (p = 0,0005) e o comprimento da uretra proximal (p = 0,02). CONCLUSÃO: A ultra-sonografia transvulvar foi fundamental para documentar que as cirurgias de sling de fáscia lata e tension-free vaginal tape alongam a uretra proximal, sendo a sling de fáscia lata de forma mais eficaz. A sling de fáscia lata enfoca a diminuição da distância pubouretral e a tension-free vaginal tape, o deslocamento vertical da junção uretrovesical.
OBJECTIVE: The aim of this study was to describe the role of transvulvar ultrasonography in the assessment of anatomical changes following fascia lata sling or tension-free vaginal tape procedures. MATERIALS AND METHODS: Forty women in the age range between 30 and 60 years had fascia lata sling (20 patients) or tension-free vaginal tape (20 patients) placement for treating stress urinary incontinence. Transvulvar ultrasonography was utilized, both pre- and post-operatively, as the main investigational tool in these cases for evaluating the urethrovesical junction vertical and horizontal distances, pubo-urethral distance and proximal urethra length. RESULTS: The urethrovesical junction vertical distance did not vary significantly after the fascia lata sling surgery (p > 0.10). Both the pubo-urethral distance and the proximal urethra length became shorter (p < 0.003), and the urethrovesical junction horizontal distance was reduced only at rest (p = 0.03). The tension-free vaginal tape procedure resulted in a reduction of the urethrovesical junction vertical distance (p = 0.0005) and of the proximal urethra length (p = 0.02). CONCLUSION: Transvulvar ultrasonography was of utmost importance in the demonstration that both the fascia lata sling and tension-free vaginal tape surgical procedures elongate the proximal urethra, even though the fascia lata sling technique does it more effectively. The fascia lata sling technique is more focused on shortening the pubo-urethral distance, and the tension-free vaginal tape, on the correction of the vertical displacement of the urethrovesical junction.