Comparison of solvent-dehydrated allograft dermis and autograft rectus fascia for pubovaginal sling: questionnaire-based analysis

Surgery for Stress Urinary Incontinence: Autologous Fascial Sling

This article describes the operative technique of autologous fascial pubovaginal sling (AFPVS) surgery, examines the senior author's outcomes with AFPVS, compares these outcomes with those of other large studies and meta-analyses, and compares the safety and efficacy of AFPVS with those of the synthetic midurethral sling (SMUS). Recently, the SMUS has become the treatment of choice for most surgeons. The efficacy of the SMUS remains unchallenged and comparable with that of AFPVS, but SMUS are associated with more severe complications. In the author's opinion, the AFPVS should remain the gold standard for treating SUI.

Pubovaginal sling materials and their outcomes

Stress urinary incontinence (SUI) is the most common type of urinary incontinence, and approximately 200 different methods have been described for its surgical management. A better understanding of the pathophysiology of SUI has led to the development of surgical therapies focused on creating a strong suburethral supportive layer and urethral resistance. The most important advantage of the pubovaginal sling (PVS) procedure is that it restores urethral resistance during stress maneuvers to prevent incontinence, while improving urethral coaptation at rest and allowing for spontaneous micturition. Various autologous, allograft, xenograft and synthetic materials have been used for the PVS. The autologous PVS procedure for the treatment of SUI offers the highest success rate and is the most commonly used PVS surgical method. Unlike xenograft and allograft materials, the autologous procedure does not result in a tissue reaction and is associated with a low rate of material-related complications.