Application for high performance linear probe for transperineal ultrasound increases anatomic depiction of fascial slings

Stress urinary incontinence (SUI) surgery has evolved through successive techniques, with synthetic mid-urethral slings dominating since the early 2000s. The re-emergence of autologous fascial slings, due to mesh-related complications, has revived interest in non-mesh alternatives. Fascial slings carry a higher risk of post-operative voiding dysfunction. Ultrasound may offer a non-invasive method to evaluate sling morphology and position, aiding clinical decision-making. We developed a standardized perineal ultrasound protocol for evaluating fascial sling position, morphology, and dynamic function. Examinations were performed using a GE Voluson E10 with linear, curved, 3D/4D, and transvaginal probes. Parameters measured included urethral length, sling location relative to urethra and bladder neck, sling morphology, sling-pubis and sling-lumen gaps, bladder neck position and mobility, urethral rotation, and bladder volumes. Dynamic manoeuvres (valsalva/coughing) were routinely performed. Twenty patients underwent ultrasound, with successful sling visualization in all cases. Morphological variations and abnormal sling positioning (e.g., embedding in urethra or bladder neck) were observed in patients with voiding dysfunction or persistent SUI. Sling-lumen and sling-pubis gap values varied between asymptomatic patients and those with obstruction or treatment failure. While preliminary findings suggest associations between ultrasound parameters and clinical outcomes, no definitive cut-off values can yet be established due to small case volume. This standardized ultrasound protocol reliably identifies fascial slings and provides reproducible measurements of sling morphology and position. There are potential correlations with clinical outcomes, particularly in differentiating between effective sling function, obstruction, or treatment failure. Rather than defining cut-off values, this early work supports ultrasound as a useful adjunct to clinical and urodynamic assessment following fascial sling placement. Larger studies are required to establish validated thresholds for clinical application.