OP07.04: Prediction of vesicouterine adhesions by transvaginal sonographic sliding sign technique

Adhesions between the uterus, bladder, and anterior abdominal wall are associated with chronic pelvic pain, infertility, and dyspareunia. The transvaginal sonographic (TVS) sliding bladder sign is a minimal invasive diagnostic tool to evaluate the presence of these adhesions. This study aims to determine the predictive value and intra- and interobserver variation of the TVS sliding sign for vesicouterine adhesions. A prospective observational double-blind cohort study was conducted in the Amsterdam UMC. Patients scheduled for gynecologic laparoscopic surgery for a benign disorder between January 2020 and December 2022 were included consecutively. All patients underwent a preoperative TVS, including a sliding bladder sign exam. Independent assessors were unaware of clinic data and scored the sliding bladder sign on ultrasound recordings. Presence of vesicouterine adhesions on laparoscopic recordings, assessed independently, in random order and blinded for the ultrasound results, were used as reference test. The predictive value of the sliding bladder sign and the inter- and intraobserver variability were calculated. 57 of the 116 included women had an absent sliding bladder on TVS. During laparoscopy 28 women had severe and 51 had mild vesicouterine adhesions. Absent sliding of the bladder on TVS had a PPV of 94.7% for any adhesions and a sensitivity of 89.3% for severe adhesions. The presence of sliding of the bladder had a NPV of 94.9% for severe adhesions and a specificity of 91.9% for any adhesions. The inter- and intraobserver agreement between experienced gynecologists was ‘good’. The sliding bladder sign using TVS is a reliable tool in the prediction of vesicouterine adhesions. In case of a negative sliding bladder sign, there is a high risk of vesicouterine adhesions. A positive sliding bladder sign makes the presence of severe adhesions unlikely. Establishing vesicouterine adhesions by TVS may optimise preoperative planning. We recommend using the sliding bladder sign routinely whenever preoperative TVS is performed.