Are Transperineal Ultrasound Parameters Useful to Predict Incontinence in Patients with Single-Incision Mini-Slings?

Round 1

Reviewer 1 Report

Dear Authors,

I reviewed your study titled ‘’ Are ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?’’

Transperineal ultrasound seems to be used more and more in incontinence surgery. I have not seen a similar study in the literature. So, I think that the present study is valuable for clinical practice and literature. However, it needs some revisions and is appropriate to re-evaluate after revisions;

1.      Title: should be changed to "Are transperineal ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?"

2. Abstract: should be added a short and clear sentence summarizing the hypothesis/base of the study before the first sentence.
3. Abstract: This study is a cross-sectional study. It is controversial to define cross-sectional studies as retrospective or prospective. Only 'prospective cohort' or 'prospective randomized' studies should be specified as 'prospective'.
4. Abstract: should include the period of the study and the characteristics (urogynecology center; tertiary clinic, etc.) of the center that carried out the study.
5. Abstract: ‘’In conclusion, the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to study SUI in patients with SIMS’’ This sentence is a one-to-one repetition sentence with results; it should include conclusions with different expressions for clinical practice.
6. Methods: should include the exclusion criteria
7. Discussion: should include further discussion associated with the study.
8. Figure: Basic anatomical structures should be written with arrows on the picture.
9. Ultrasound assessment: Sagital tape angle (6)….Axial tape angle (28)….should contain an explanation.
10. Results:  I couldn't see the tables in  main text file and  system
11. Conclusions: ‘’ In conclusion’’ should be removed and this part should be written with at least 3-4 sentences. 

Author Response

I reviewed your study titled ‘’ Are ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?’’

Transperineal ultrasound seems to be used more and more in incontinence surgery. I have not seen a similar study in the literature. So, I think that the present study is valuable for clinical practice and literature. However, it needs some revisions and is appropriate to re-evaluate after revisions;

1. Title:should be changed to "Are transperineal ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?" 

Reply: The title has been changed.

2. Abstract: should beadded a short and clear sentence summarizing the hypothesis/base of the study before the first sentence.

Reply: A hypothesis has been introduced in the abstract.

Text: “It would be logical to think that single-incision mini-slings (SIMS) should behave like the rest of the tension-free vaginal tape and, therefore, to believe that they present a similar ultrasound appearance, but there are no studies on this matter. Therefore, the main aim”

3. Abstract:This study is a cross-sectional study. It is controversial to define cross-sectional studies as retrospective or prospective. Only 'prospective cohort' or 'prospective randomized' studies should be specified as 'prospective'.

Reply: This study is of a prospective cohort since the patients are included before being operated on and subsequently followed up for 6 months where the clinical evolution and the ultrasound appearance of the tapes are seen. This study presents a typical characteristic of prospective cohort studies in that participants are enrolled in the study before they develop the outcome in question.

4. Abstract: should include the period of the study and the characteristics (urogynecology center; tertiary clinic, etc.) of the center that carried out the study.

Reply: Suggestions have been included in the text.

Text: A prospective observational study was carried out including 94 patients who were candidates for SUI corrective surgery with SIMS between 1^st January, 2021 to 31^st December, 2021 at the Universitary Hospital of Valme (Seville, Spain).

5. Abstract:‘’In conclusion, the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to study SUI in patients with SIMS’’ This sentence is a one-to-one repetition sentence with results; it should include conclusions with different expressions for clinical practice.

Reply: The conclusion has been changed to make it more understandable in clinical practice.

Text: “In conclusion, the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to define continence in patients with SIMS.”

6. Methods:should include the exclusion criteria

Reply: It has been included in the text.

Text: “Patients with corrective pelvic floor surgery were excluded.”

7. Discussion:should include further discussion associated with the study.

Reply: It has been included in the text.

Text: “Previous studies with other types of MUS define different measurements to determine SUI (4,6,16,18-28). However, we have described that the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to define continence in patients with SIMS.”

8. Figure: Basic anatomical structures should be written with arrows on the picture.

Reply: The location of the basic anatomical structures have been included in the image: Pubis (P), Bladder (Bl) Urethra (U)

9. Ultrasound assessment:Sagital tape angle (6)….Axial tape angle (28)….should contain an explanation.

Reply: It has been included in the text.

Text:

“Sagital tape angle (6): Angle showing the tape in the midsagittal image

Axial tape angle (28). Angle showing the tape in the axial image”

10. Results:  I couldn't see the tables in  main text file and  system

Reply: I attach the tables to the main document

11. Conclusions:‘’ In conclusion’’ should be removed and this part should be written with at least 3-4 sentences. 

Reply: It has been included in the text.

Text: A concordant movement between the tape and the urethra is the most useful ultrasound parameter to define urinary continence in patients with SIMS. However, a discordant movement between the tape and the urethra is associated with SUI in patients with SIMS.

Reviewer 2 Report

The article “Are ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?” is presenting, with a statistical evaluation the value of several ultrasound imaging parameters and the value of different parameters assessed during ultrasound 6 month after surgery with single-incision mini-slings (SIMS). There are several studies about ultrasound evaluation of different surgical procedures including tapes for urinary stress incontinence but there is a lack in the evaluation of surgery with single-incision mini-slings.

Author Response

The article “Are ultrasound parameters useful to predict incontinence in patients with single-incision mini-slings?” is presenting, with a statistical evaluation the value of several ultrasound imaging parameters and the value of different parameters assessed during ultrasound 6 month after surgery with single-incision mini-slings (SIMS). There are several studies about ultrasound evaluation of different surgical procedures including tapes for urinary stress incontinence but there is a lack in the evaluation of surgery with single-incision mini-slings.

Reply: The evaluation of the surgical result was evaluated 6 months after surgery as indicated in the method: "Post-surgical clinical analysis was performed 6 months after surgery and was similar to the one performed pre-surgical." As can be seen in Table 1, after surgery, 63 patients remained asymptomatic and 29 symptomatic (SUI=20; MUI=31). If it is true that we have not studied the severity of incontinence in patients after surgery, that is why we have included it as a limitation: "Our main weakness lies in the fact that we have not clinically assessed the severity of SUI, not being able to relate the severity of urinary incontinence to ultrasound findings."