Autologous Fascial Slings for Surgical Management of Stress Urinary Incontinence: A Come Back

Autologous rectus abdominis fascia sling surgery following unsuccessful synthetic midurethral sling

Introduction

We performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling.

Case presentation

At the age of 76 years, the patient experienced stress urinary incontinence recurrence. A 1-h pad test resulted in 259 g of leakage. A pressure flow study verified urine leakage while coughing and straining without detrusor overactivity. Abdominal leak point pressure was 10 cmH2O. Autologous rectus abdominis fascia sling surgery was performed using Advantage™. One month postoperatively, a 1-h pad test resulted in 0 g of leakage.

Conclusion

We believe that this method will allow the fascia sling procedure to be performed reliably even if one is unfamiliar with conventional autologous rectus abdominis fascia sling surgery.

Comparison of perioperative adverse events following suburethral sling placement using synthetic mesh, autologous rectus fascia, and autologous fascia lata in a national surgical registry

AIMS

To assess and compare 30-day perioperative adverse events following suburethral sling surgery using synthetic mesh, autologous rectus fascia, and autologous fascia lata in women.

METHODS

This was a retrospective cohort study of patients who underwent fascial or synthetic sling placement for stress urinary incontinence between 2008 and 2021 using the American College of Surgeons' National Surgical Quality Improvement Program database. Current Procedural Terminology codes were used to identify patients undergoing each type of sling procedure. Multivariable regression analysis with stepwise regression was used to assess the odds of composite adverse events (e.g., urinary tract infection, surgical site infection, pulmonary embolism, and other reportable events) between cohorts.

RESULTS

Of the 41 533 female patients who underwent isolated suburethral sling placement without concurrent procedures, 41 292 (99.4%) received a synthetic mesh sling, and 241 (0.6%) received an autologous facial sling. In the fascial sling cohort, 160 (66.4%) underwent rectus fascia harvest and 81 (33.6%) underwent fascia lata harvest. Sling surgeries involving autologous fascia were associated with increased odds of adverse events compared to those involving synthetic mesh, even after adjusting for confounders (adjusted odds ratio [aOR]: 3.63, 95% confidence interval [CI]: 2.56-5.15). Compared to fascial slings from rectus fascia, slings from fascia lata were associated with increased odds of composite adverse events (aOR: 2.11, 95% CI: 1.03-4.04). However, with the exclusion of urinary tract infections, the adverse event rate was similar between slings using the two fascial harvest techniques (aOR: 1.93, 95% CI: 0.81-4.63).

CONCLUSIONS

In this retrospective database study, suburethral sling surgeries using autologous fascia were independently associated with a 3.6-fold increase in odds of 30-day perioperative adverse events compared to sling surgeries using synthetic mesh.

Google searches for stress urinary incontinence treatment options: a worldwide trend analysis in the synthetic mesh controversy era

PURPOSE

To analyze trends in worldwide public interest in the treatment options for stress urinary incontinence around the latest FDA 2019 ban on vaginal mesh for prolapse.

METHODS

We used the web-based tool Google Trends to analyse online searches related to the following terms: 'pelvic floor muscle exercises', 'continence pessary', 'pubovaginal slings', 'Burch colposuspension', 'midurethral slings', 'injectable bulking agents'. Data were expressed as relative search volume on a scale of 0-100. Comparisons of annual relative search volume and average annual percentage change, were analyzed to assess loss or gain of interest. Finally, we assessed the impact of the last FDA alert.

RESULTS

The mean annual relative search volume for midurethral slings was 20% in 2006 and significantly decreased until 8% in 2022 (p < 0.01). A regular decrease interest was recorded for autologous surgeries but a regain of interest for pubovaginal slings was registered since 2020 (+ 2.8%; p < 0.01). Conversely, a steep interest was noted for injectable bulking agents (average annual percentage change: + 4.4%; p < 0.01) and conservative therapies (p < 0.01). When trends were compared before and after the FDA 2019 alert, a lower research volume was found for midurethral slings, while a higher research volume was observed all others treatments (all p < 0.05).

CONCLUSION

The online public researches about midurethral slings have considerably decreased following warnings on the use of transvaginal mesh. There seems to be a growing interest in conservative measures, bulking agents, and recently pubovaginal slings.

Accreditation of an old surgical technique for stress urinary incontinence: long-term outcomes of modified autologous fascial pubovaginal sling

PURPOSE

To evaluate long-term outcomes of modified autologous fascial pubovaginal sling (AFPVS) in women with stress urinary incontinence (SUI).

METHODS

To evaluate long-term outcomes of modified AFPVS, we retrospectively reviewed the medical records of our patients from 2004 to 2015. From 2 decades ago, we have made modifications to classic surgical technique to make it simpler and faster.

RESULTS

199 patients were contacted with mean age of 52 years. The mean follow-up period was 107 months. According to Revised Urinary Incontinence Scale (RUIS) questionnaire, overall success rate was 83.9%. In patients with positive history for SUI surgery, success rate was 73% compared to 87% in those without it. Body mass index was negatively associated with cure rate. We did not encounter any major complications and most of the issues were managed conservatively. Recurrence of SUI occurred in 6 patients (3.5%) after initial improvement.

CONCLUSION

Modified AFPVS is an effective surgical technique for treatment of SUI with high and durable success rate. At the present time with concerns regarding the use of transvaginal synthetic mesh, there is increasing interest and request for modified traditional procedures. It is likely that AFPVS may become more popular in upcoming years.

Role of Incontinence Severity Index in Evaluating Severity and Impact of Treatment Of Stress Urinary Incontinence

Background

Stress urinary incontinence (SUI) is a common ailment in affecting quality of life. This study was performed to see role of incontinence severity index (ISI) in evaluating severity of SUI and to see the impact of treatment of SUI.

Materials and Methods

A total of 40 women with the diagnosis of SUI on history and clinical examination were enrolled. ISI was calculated on all the women before treatment. All women were treated with either conservative treatment (pelvic floor exercises, life style modification, and duloxetine therapy) (4, 10%) or Burch's colposuspension (18, 45%) or tension-free obturator tape (18, 45%) as per clinical situation after discussion with patients. ISI was again calculated 6 months after treatment.

Results

Mean age, parity, body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m², respectively. All 40 (100%) patients had SUI with the mean duration of symptoms being 4.04 years. A total of 11 (27.5%) had moderate SUI (ISI 3-6), while 24 (60%) had severe SUI (ISI 8-9), while 5 (12.5%) had very severe SUI (ISI 12). Range of pretreatment ISI was 3-12 with mean being 8.8 ± 3.2. Posttreatment ISI reduced significantly with range of 1-4 and mean of 1.3 ± 0.4 (P < 0.001). The reduction was significant for all the groups, but there was no significant difference in efficacy of three treatment groups. Statistical analysis was done using SPSS IBM Version 2-1-0 using Chi-square test, Fisher's Extract test, and ANOVA test as appropriate.

Conclusion

ISI is a useful modality to evaluate the severity of SUI and to see the impact of treatment modalities on SUI.