Ultrasound in Female Urinary Incontinence.

Urinary incontinence (UI) is a common health condition that may interfere with the quality of life. A comprehensive evaluation of female UI helps with effective and safe treatments. Ultrasound has gained popularity to explore UI recently because it can collect crucial information for treatment planning and counseling. Translabial and introital approaches are commonly and reliably applied to ultrasound. The images can be obtained using two-dimensional and three-dimensional ultrasounds. Ultrasound is the only modality capable of confirming the presence or absence of a mid-urethral sling (MUS) and is able to demonstrate bulking agents as well. Although some of the ultrasound findings may only be incidental or supplementary to the patient's symptoms, ultrasound benefits for investigating the pathophysiology of UI and surgical outcomes of MUS procedures. It is anticipated that standardization in terminology, measurement techniques, and reporting can be established in the near future.

Laser Speckle Contrast Imaging Guides Needling Treatment of Vascular Complications from Dermal Fillers.

BACKGROUND: Although laser Doppler imaging (LDI) accurately delineates a hypoperfused area to help target hyaluronidase treatment, laser speckle contrast imaging (LSCI) is more appropriate for assessing microvascular hemodynamics and has greater reproducibility than LDI. This study investigated the use of LSCI in the evaluation and treatment of six patients who developed vascular complications after facial dermal filler injections. METHODS: The areas of vascular occlusion were accurately defined in real time by LSCI and were more precise than visual inspections or photographic evidence for guiding needling and hyaluronidase treatment. RESULTS: All patients had achieved satisfactory outcomes as early as Day 2 of treatment and no procedure-related complications were reported after a median follow-up of 9.5 (7-37) days. CONCLUSION: LSCI accurately and noninvasively delineated vascular occlusions in real time among patients experiencing complications of facial dermal filler injections. Moreover, LSCI was more accurate than visual and photographic evaluations. Clinicians can use LSCI to reliably follow-up therapeutic outcomes after salvage interventions for vascular occlusions. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Transumbilical Silicone Implants Breast Augmentation (TUSBA).

Transumbilical breast augmentation with pre-filled silicone implants has been performed previously, but technical challenges remain to accommodate more implant options and dissection planes. We aimed to demonstrate the feasibility of transumbilical breast augmentation using various types of pre-filled silicone implants (TUSBA), and its applicability for subglandular, subfascial, dual-plane implantation. In the early stage, TUSBA was primarily performed using endoscope-assisted blunt dissection, and later converted to full endoscopy dissection to achieve better results. Endoscope was used to confirm the pocket and check bleeding for both groups. For endoscope-assisted group, surgical techniques were modified from conventional TUBA. In full endoscopy TUSBA, the entire dissection process was performed under endoscopic monitoring. Preliminary data of patients undergoing TUSBA from June 2016 to April 2021 were retrospectively reviewed. Breast implants with smooth, textured or nanotextured surface properties and round or anatomical shapes were used, with sizes up to 500 mL. Seventy-four patients with mean age 36.4 years (range: 21-55 years) were enrolled in this study. Follow-up ranged from 1 month to 4 years and 6 months (mean: 15.6 months). No excessive postoperative pain in breast or abdomen was reported. Surgery outcomes were aesthetically pleasing in both groups. In the endoscope-assisted group, 3 (4.6%) required major revisional procedures. No revision was required in the full endoscopy group. TUSBA with various types of silicone implants is feasible, and accommodable to all dissection planes. Full endoscopy technique is helpful in reducing the higher complication rate.

Cross-Domain Transfer of EEG to EEG or ECG Learning for CNN Classification Models.

Electroencephalography (EEG) is often used to evaluate several types of neurological brain disorders because of its noninvasive and high temporal resolution. In contrast to electrocardiography (ECG), EEG can be uncomfortable and inconvenient for patients. Moreover, deep-learning techniques require a large dataset and a long time for training from scratch. Therefore, in this study, EEG-EEG or EEG-ECG transfer learning strategies were applied to explore their effectiveness for the training of simple cross-domain convolutional neural networks (CNNs) used in seizure prediction and sleep staging systems, respectively. The seizure model detected interictal and preictal periods, whereas the sleep staging model classified signals into five stages. The patient-specific seizure prediction model with six frozen layers achieved 100% accuracy for seven out of nine patients and required only 40 s of training time for personalization. Moreover, the cross-signal transfer learning EEG-ECG model for sleep staging achieved an accuracy approximately 2.5% higher than that of the ECG model; additionally, the training time was reduced by >50%. In summary, transfer learning from an EEG model to produce personalized models for a more convenient signal can both reduce the training time and increase the accuracy; moreover, challenges such as data insufficiency, variability, and inefficiency can be effectively overcome.

Comparison of two outside-in transobturator midurethral slings in the treatment of female urodynamic stress incontinence.

OBJECTIVE: To explore the difference between two brands of outside-in transobturator midurethral sling (TOT) for urodynamic stress incontinence (USI). MATERIALS AND METHODS: Women who underwent an outside-in TOT procedure by either Monarc or Obtryx were retrospectively reviewed. Data of women with available information at baseline and postoperative 12-month follow-up were analyzed. The analyzed data included standardized interview, pelvic examination, as well as sling location and sling tension explored by introital four-dimensional ultrasound. Sling position were explored through the distances between the sling center and the caudal margin of the pubic symphysis (SPd) as well as sling percentile (SP) along the urethral length as a percentage in the midsagittal plane. SPd was also used to explore sling tension. Clinical outcomes were compared between two groups. Sling location and sling tension were compared in success cases between two groups. RESULTS: There were 138 women in Monarc group and 140 women in Obtryx group. Rates of stress urinary continence and adverse events were not statistically different after two TOT. SPd was similar between both procedures. Obtryx located more ventrally than Monarc, indicated by a smaller SP during resting (41.6% vs 58.5%, P < 0.001), straining (38.0% vs 54.4%, P < 0.001), and coughing (39.8% vs 48.8%, P < 0.001). CONCLUSION: At 12-month assessment, both outside-in TOT procedures were not significantly different in terms of clinical results and sling tension, while Obtryx sling located more ventrally than Monarc.

A urethral diverticulum presenting with pure stress urinary incontinence.

OBJECTIVE: To report the management for a urethral diverticulum presenting with pure stress urinary incontinence (SUI). CASE REPORT: A 67-year-old postmenopausal woman resorted to urogynecological outpatient department for the treatment of bothersome SUI. She denied other lower urinary tract symptoms and previous pelvic surgeries. On examination, there was stage I anterior vaginal wall prolapse. Urinalysis showed negative findings. Urodynamic studies revealed negative findings. An ultrasound disclosed a complex paraurethral lesion and no urethral hypermobility. A magnetic resonance image of the pelvis revealed a 4-cm circumferential urethral diverticulum. A urethral diverticulectomy was performed. Histopathological examination confirmed the diagnosis of urethral diverticulum. The patient recovered uneventfully and reported freedom from SUI postoperatively. CONCLUSION: In women deemed uncomplicated stress urinary incontinence after undertaking a holistic urogynecological evaluation including detailed clinical history, physical examination, and urodynamic studies, further image studies investigating lower urinary tract is required for disclosing other rare conditions that necessitate different management from anti-incontinence surgery.

A solitary fibrous tumor of the ovary.

OBJECTIVE: We report a case of an ovarian solitary fibrous tumor (SFT), which rarely occurs in the female genital system. CASE REPORT: A 63-year-old postmenopausal woman resorted to the tertiary center seeking management for an intra-abdominal mass. Physical examination disclosed a local abdominal distention. Ultrasound revealed an 18-cm complex mass with inner neovascularization. A whole abdominal computed scan (CT) demonstrated an 18-cm abdominal tumor. The woman then underwent a left salpingo-oophorectomy. Histological examination and immunohistochemical stains of the tumor confirmed the diagnosis of SFT. The patient recovered uneventfully and remained free of recurrence 6 months postoperatively. CONCLUSION: SFTs in the female genital system are extremely rare and not fully understood. The metastatic risk of the patient was intermediate, according to the modified four-variable risk models based on the World Health Organization (WHO) classification of soft tissue tumors. Close monitoring with clinical evaluation and imaging studies will be conducted.

An Investigation on the Hardness of Polylactic Acid Parts Fabricated via Fused Deposition Modeling.

This paper investigated the hardness property of the fused deposition modeling (FDM)-printed PLA samples via different process parameters of printing and raster angles. The hardness data were sampled from the flat and edge surfaces of the samples. In addition, the effect of hardness characters after the ultraviolet (UV) curing process was analyzed. Furthermore, this research found that the printing and raster angles significantly affected the hardness value of the PLA part, which slightly increased after the UV irradiation. Moreover, the results of this study will provide a reference for the field of FDM application.

Longitudinal Effects of a Combined Program of Pelvic Floor Muscle Training and Yoga on Genitourinary Symptoms in Asian Women of Older Age: A Randomized Experimental Study.

This parallel-two-group randomized experimental study including a supervised group and an unsupervised group examined the longitudinal effects of pelvic floor muscle training (PFMT) combined with yoga on genitourinary symptoms and the health-related quality of life (HRQOL), and compared practice adherence rates of the two groups. A sample of women experiencing ≥1 genitourinary symptom(s) were recruited and assigned to a supervised group or an unsupervised group. The supervised group attended supervised group practice sessions and performed at-home practice of PFMT and yoga. The unsupervised group performed at-home practice of PFMT and yoga. Information was collected at five time points (n = 91). Generalized estimating equation procedures were used to examine the intervention effects. An independent t-test was conducted to compare the practice adherence rates. Both groups' genitourinary symptoms and HRQOL significantly improved over time. The supervised group displayed greater improvements in genitourinary symptoms and HRQOL and better adherence than did the unsupervised group.

Safety and Efficacy of Submuscular Implantation With Resterilized Cardiac Implantable Electronic Device in Patients With Device Infection: A Retrospective Observational Study in Taiwan.

Background: Reuse of cardiac implantable electronic devices (CIEDs) can reduce the cost of using these expensive devices. However, whether resterilized CIEDs will increase the risk of reinfection in patients with previous device infection remains unknown. The aim of the present study is to compare the reinfection rates in patients who had initial CIED infection and underwent reimplantation of resterilized CIEDs or new devices. Methods: Data from patients with initial CIED infection who received debridement of the infected pocket and underwent reimplantation of new or resterilized CIEDs at MacKay Memorial Hospital, Taipei, Taiwan, between January 2014 and June 2019 were retrospectively analyzed. Patient characteristics, relapse rates of infection, and potential contributing factors to the infection risk were examined. Results: Twenty-seven patients with initial CIED infection and reimplanted new CIEDs (n = 11) or resterilized CIEDs (n = 16) were included. During the 2-year follow-up, there were 1 (9.1%) and 2 (12.5%) infection relapses in the new and resterilized CIED groups, respectively. No relapse occurred for either group if the lead was completely removed or cut short. The median duration between debridement and device reimplantation in patients with infection relapse vs patients without relapse was 97 vs 4.5 days for all included patients, and 97 vs 2 days and 50.5 vs 5.5 days for the new and resterilized CIED groups, respectively. Conclusions: Subpectoral reimplanting of resterilized CIEDs in patients with previous device infection is safe and efficacious. With delicate debridement and complete extraction of the leads, the CIED pocket infection relapse risk can be greatly decreased.

Efficacy and safety of pectoralis muscle flap combined rectus abdominis muscle sheath fasciocutaneous flap for reconstruction of sternal infection.

Few studies have assessed the efficacy and safety of reconstruction of sternal infection using a pectoralis muscle flap combined with a rectus abdominis muscle (RAM) sheath fasciocutaneous flap. We report here our experience with this procedure to reconstruct the sternal defect in patients (n = 46) with a deep sternal wound infection (DSWI) after cardiac surgery. After wound reconstruction, the proportion of prolonged mechanical ventilation use and intensive care unit (ICU) stay were 17.4% (n = 8) and 21.7% (n = 10), respectively. The 30-day all-cause mortality was 15.2%; recurrence rate was 17.4%; postoperative complications were 15.2%; and median hospital stay was 31 (0-157) days. Multivariate logistic regression analysis revealed that hypertension (ß = 21.32, 95%CI 4.955-37.68, P = .014), drainage-tube use (ß = 0.944, 95%CI 0.273-1.614, P = .008), and prolonged intensive care unit stay (ß = 53.65, 95%CI 31.353-75.938, P < .001) were significantly correlated with hospital stay. In conclusion, a procedure including surgical debridement, sternal reconstruction with bilateral PM and RAM sheath flap, long-term antibiotics, and adequate drainage is a beneficial technique in the reconstruction of deep sternal wound infection after cardiac surgery. Duration of drainage tube use may be as an index for a hospital stay or wound healing.

Effects of Printing Temperature and Filling Percentage on the Mechanical Behavior of Fused Deposition Molding Technology Components for 3D Printing.

Additive manufacturing (AM) has the advantages of providing materials with lightweight microporous structures and customized features, and being environmentally safe. It is widely used in medical sciences, the aerospace industry, biological research, engineering applications, and other fields. Among the many additive manufacturing methods, fused deposition modeling (FDM) is relatively low-cost, wastes less raw material and has a lower technical threshold. This paper presents a study on 3D printing based on FDM by changing two printing parameters, namely the printing temperature and filling percentage. The produced polylactic acid (PLA) material was analyzed through tensile and Shore D hardness tests and the differences in mechanical properties before and after the UV curing process were analyzed. The results show that increasing the filling percentage or increasing the printing temperature can effectively improve the tensile Young's modulus, ultimate tensile strength, elongation, and Shore hardness of the material. The UV curing process could enhance the rigidity and hardness of the material significantly but reduced the strength and toughness of the material. These findings could benefit researchers studying FDM with the goal of achieving sustainable manufactured materials.

Laser Doppler Imaging for Treating Vascular Complications from Procedures Involving Dermal Fillers: Case Series and Literature Review.

Vascular occlusion is a rare but severe complication of dermal filler injections. Early treatment of this complication produces better outcomes. Current diagnostic methods for vascular occlusion in the skin are subjective and imprecise; these include capillary refill time, skin color, and reports of pain. This study aimed to assess the use of laser Doppler imaging (LDI) in the evaluation and treatment of vascular complications caused by dermal filler injections. This retrospective study used laser Doppler imaging (LDI) in 13 patients who developed vascular occlusion after facial dermal filler injections, with subsequent follow-up. The precise areas of perfusion observed on LDI were compared with the findings of clinical and photographic evaluation. The results showed that LDI accurately identified areas of vascular occlusion and improved treatment precision among these thirteen patients. The procedure was more precise than visual inspection or photographic evidence. Satisfactory outcomes were achieved for all patients, and no procedure-related complications were reported. Collectively, LDI provides fast, noninvasive, and accurate delineation of areas of vascular occlusion caused by complications of dermal filler injections and avoids several subjective shortcomings of visual and photographic evaluations. Thus, LDI effectively tracks treatment outcomes. However, large-scale studies are required to confirm the present findings.

Association of Baseline Pelvic Floor Muscle Activities With Sexual and Urinary Functions In Female Stress Urinary Incontinence.

BACKGROUND: The presence of reactive and strong pelvic floor muscle (PFM) activities is supposed to be associated with better urinary and sexual functions in female stress urinary incontinence (SUI). AIM: This study was to explore the association of baseline PFM activities, both volitional and reflex, with urinary and sexual functions in women with SUI but who had no experience of PFM training programs before. METHODS: Secondary analysis of a prospectively maintained database identified 125 sexually active women with SUI who had met the eligibility criteria. All patients had undergone intravaginal digital examination and pelvic ultrasound to detect volitional and reflex PFM activities, respectively, and responded to questionnaire surveys, including short forms of the urogenital distress inventory, incontinence impact questionnaire-7, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. On pelvic ultrasound, an inward clitoral motion and an anorectal lift preceding or during coughing were regarded as the presence of reflex activities of the PFM. OUTCOMES: The relationship of volitional and reflex PFM activities with pelvic floor dysfunction relating questionnaires and urethral function on urodynamic studies was analyzed. RESULT: Of the 125 women studied, 30 (24.0%) had volitional PFM contraction strength less than grade 2, 74 (59.2%) grade 2 to 3, and 21 (16.8%) greater than grade 3 based on the modified Oxford grading scale. During or preceding coughing, an inward clitoral motion was not observed on ultrasound in 9 (7.2%) women and an anorectal lift was not observed in 8 (6.4%) women. The strength of volitional PFM contraction and the presence or absence of anorectal lift reflex was not associated with urethral and sexual function. In contrast, the absence of reflex inward clitoral motion was significantly associated with lower maximum urethral closure pressure (P = .042) and higher scores of urogenital distress inventory-6 (P = .006) and incontinence impact questionnaire-7 (P = .029). CLINICAL IMPLICATIONS: Higher volitional PFM contraction strength was not associated with better sexual and urinary functions; however, loss of one reflex PFM activity was associated with poorer urinary function. STRENGTHS & LIMITATION: To our knowledge, this is the first study that evaluates the association of baseline PFM activities with sexual and urinary functions in female SUI. Nevertheless, the cross-sectional design of this study cannot well support the cause-effect relationship CONCLUSION: Besides PFM physiotherapy for enhancing sexual and urinary functions in female SUI, additional treatment strategies such as neuromodulation should take into consideration for those who had absent reflex PFM activities. Yang E, Yang SH, Huang WC, et al. Association of Baseline Pelvic Floor Muscle Activities With Sexual and Urinary Functions In Female Stress Urinary Incontinence. J Sex Med 2021;18:1698-1704.

Effect of Printing Parameters on the Tensile Properties of 3D-Printed Polylactic Acid (PLA) Based on Fused Deposition Modeling.

In order to optimize the efficiency of the Fused deposition modeling (FDM) process, this study used polylactic acid (PLA) material under different parameters (the printing angle and the raster angle) to fabricate specimens and to explore its tensile properties. The effect of the ultraviolet (UV) curing process on PLA materials was also investigated. The results showed that the printing and raster angles have a high impact on the tensile properties of PLA materials. The UV curing process enhanced the brittleness and reduced the elongation of PLA material. Different effects were observed on tensile strength and modulus of specimens printed with different parameters after UV curing. The above results will be a great help for researchers who are working to achieve sustainability of PLA materials and FDM technology.

Effect of Printing Parameters on the Thermal and Mechanical Properties of 3D-Printed PLA and PETG, Using Fused Deposition Modeling.

Fused Deposition Modeling (FDM) can be used to manufacture any complex geometry and internal structures, and it has been widely applied in many industries, such as the biomedical, manufacturing, aerospace, automobile, industrial, and building industries. The purpose of this research is to characterize the polylactic acid (PLA) and polyethylene terephthalate glycol (PETG) materials of FDM under four loading conditions (tension, compression, bending, and thermal deformation), in order to obtain data regarding different printing temperatures and speeds. The results indicated that PLA and PETG materials exhibit an obvious tensile and compression asymmetry. It was observed that the mechanical properties (tension, compression, and bending) of PLA and PETG are increased at higher printing temperatures, and that the effect of speed on PLA and PETG shows different results. In addition, the mechanical properties of PLA are greater than those of PETG, but the thermal deformation is the opposite. The above results will be a great help for researchers who are working with polymers and FDM technology to achieve sustainability.

Percutaneous Debridement of and Fibrin Glue Injection Into a Pretibial Morel-Lavallée Lesion: A Case Report and Literature Review.

ABSTRACT: The Morel-Lavallée lesion (MLL) is a posttraumatic close degloving injury, which is often underdiagnosed at first. Patients with MLLs usually present with tender and enlarging soft tissue swelling with fluctuation, decreased skin sensation, ecchymosis, or even skin necrosis hours to days after the inciting injury. The lesion can lead to intractable morbidity if it remains untreated. There is no consensus regarding the treatment for MLL at present. Here, we report an MLL in the pretibial region of a 43-year-old woman who experienced a low-energy contusion in a motorbike accident. The pretibial lesion was diagnosed using sonography and fine-needle aspiration. We successfully treated the patient by performing percutaneous debridement via a small incision and injections of fibrin after conservative treatment failed. The method we herein propose achieved the goal of open surgical debridement, providing faster recovery and a high degree of patient comfort. We reviewed the available pertinent literature and propose our own treatment protocol with the aim to establish common therapies ofMLL.

Four-Dimensional Introital Ultrasound in Assessing Perioperative Pelvic Floor Muscle Functions of Women with Cystoceles.

PURPOSE: Research on the use of ultrasound to explore the pelvic floor in women is rarely done with introital ultrasound. This study aimed to investigate the performance of four-dimensional (4D) introital ultrasound in the perioperative assessment of pelvic floor muscle (PFM) function in women with cystocele. MATERIALS AND METHODS: The reliability and agreement of ultrasound measurements were determined by intraclass correlation coefficients (ICC) with 95 % confidence interval and Bland-Altman analysis in 20 women. The validity of ultrasound parameters was assessed by correlating squeezing ultrasound measurements with the modified Oxford scale (MOS) in 317 women. 4D introital ultrasound data of 241 women with (n = 29) and without (n = 212) postoperative cystocele at the 12-month postoperative assessment were retrospectively analyzed. Levator avulsion was diagnosed using tomographic ultrasound imaging. Involuntary and voluntary PFM functions were explored by dynamic changes in the bladder neck and genital hiatus, respectively, upon coughing and squeezing on 4D introital ultrasound. RESULTS: The ICC for the reliability of all tested ultrasound parameters was good to very good. The changes and change ratios of most ultrasound measurements from resting to squeezing were fairly correlated with MOS. Women with postoperative cystocele demonstrated more rates of complete levator avulsion [41.3 % vs. 4.7 %, P < 0.001, odds ratio (OR) 14.26, 95 % confidence interval (CI) 4.88-42.42] and fewer rates of capable voluntary PFM contraction (65.5 % vs. 92.5 %, P < 0.001, OR 0.16, 95 % CI 0.06-0.43) than those without postoperative cystocele postoperatively. CONCLUSION: 4D introital ultrasound is feasible to assess perioperative PFM function in women with cystocele.

The significance of pelvic floor support on the pelvic floor muscle functions of women with lower urinary tract symptoms.

OBJECTIVE: To explore the significance of pelvic organ prolapse (POP) on pelvic floor muscle (PFM) function among women with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Four-dimensional ultrasound data of 577 women with LUTS were retrospectively analyzed. The bladder neck and genital hiatus were assessed during resting, coughing, and squeezing. The bladder neck location, genitohiatal size, and genitohiatal location were evaluated with bladder neck distance (BNd) and bladder neck angle (BNa), genitohiatal dimension (GHd) and genitohiatal area (GHAR), and genitohiatal angle (GHa), respectively. RESULTS: Compared with women without POP (n = 306), women with POP (n = 271) exhibited higher rates of levator complete avulsion (6.5% vs. 40.2%, P < 0.001), shorter BNd (2.84 ± 1.56 cm vs. 2.45 ± 0.45 cm, P = 0.018), larger BNa (92 ± 15° vs. 101 ± 21°, P < 0.001), longer GHd (5.25 ± 0.72 cm vs. 5.60 ± 0.87 cm, P < 0.001), larger GHa (141 ± 10° vs. 145 ± 9°, P = 0.004), and larger GHAR (20.0 ± 4.7 cm2 vs. 24.2 ± 5.6 cm2, P < 0.001) during resting. Fewer women with POP were able to maintain stable bladder neck location (79.5% vs. 65.5%, P < 0.001), genitohiatal size (60.7% vs. 51.9%, P = 0.042), and genitohiatal location (61.6% vs. 52.8%, P = 0.044) following coughing. Fewer women with POP were capable of squeezing (77.8% vs. 58.3%, P < 0.001). CONCLUSION: Among women with LUTS, the presence of POP is associated with weaker resting, involuntary, and voluntary PFM functions.

Five-year clinical and imaging outcomes of primary transobturator midurethral sling procedures for uncomplicated urodynamic stress incontinence.

OBJECTIVES: To report 5-year clinical and imaging outcomes of primary transoburator midurethral sling (TOT) procedures for uncomplicated urodynamic stress incontinence (USI). MATERIALS AND METHODS: We retrospectively investigated the data of 136 women who underwent primary TOT procedures for uncomplicated USI. All women received preoperative as well as 1-year and 5-year postoperative assessments comprising clinical interview, pelvic examination, and introital four-dimensional (4D) ultrasound. The primary outcome was stress urinary incontinence (SUI), defined as the report of SUI in patient interview, a positive response to item 3 of the short form of the Urogenital Distress Inventory (UDI-6), or a positive cough stress test and negative dysuria or urinalysis. Secondary outcomes included SUI severity, SUI bother, scores on the short forms of the UDI-6 and Incontinence Impact Questionnaire (IIQ-7), rates of de novo overactive bladder (OAB) symptoms, de novo voiding dysfunction, groin/thigh pain, and sling exposure, as well as ultrasound manifestations of bladder neck, midurethra, and sling. RESULTS: At 1 and 5 years, rates for SUI (7.4% vs 8.8%, P = 0.824), de novo OAB symptoms (4.4% vs 5.1%, P = 1.000), de novo voiding dysfunction (11.2% vs 10.3%, P = 1.000), groin/thigh pain (3.7% vs 0.7%, P = 0.216), and sling exposure (2.2% vs 0.0%, P = 0.246) were similar. Scores on the UDI-6 and IIQ-7 were significantly decreased postoperatively. Sling location and a more cranioventral midurethral location were sustained during follow-up. CONCLUSIONS: For uncomplicated USI, TOT has good and sustained clinical and imaging outcomes, though a notable rate of de novo voiding dysfunction.