Salvage autologous fascial sling after failed synthetic midurethral sling: Greater than 3-year outcomes

2015 ◽  
Vol 23 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Steven P Petrou ◽  
Andrew J Davidiuk ◽  
Bhupendra Rawal ◽  
Michelle Arnold ◽  
David D Thiel
Keyword(s):  
Midurethral Sling ◽  
Fascial Sling ◽  
Autologous Fascial Sling

scholarly journals Management of patients with stress urinary incontinence after failed midurethral sling

2017 ◽  
Vol 11 (6S2) ◽  
pp. 143 ◽  
Author(s):  
Alex Kavanagh ◽  
May Sanaee ◽  
Kevin V. Carlson ◽  
Gregory G. Bailly
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Midurethral Sling ◽  
Cochrane Review ◽  
Quality Data ◽  
Bulking Agents ◽  
Failure Rates ◽  
Patient Goals ◽  
Fascial Sling

Surgical failure rates after midurethral sling (MUS) procedures are variable and range from approximately 8‒57% at five years of followup. The disparity in long-term failure rates is explained by a lack of long-term followup and lack of a clear definition of what constitutes failure. A recent Cochrane review illustrates that no high-quality data exists to recommend or refute any of the different management strategies for recurrent or persistent stress urinary incontinence (SUI) after failed MUS surgery. Clinical evaluation requires a complete history, physical examination, and establishment of patient goals. Conservative treatment measures include pelvic floor physiotherapy, incontinence pessary dish, commercially available devices (Uresta®, Impressa®), or medical therapy. Minimally invasive therapies include periurethral bulking agents (bladder neck injections) and sling plication. Surgical options include repeat MUS with or without mesh removal, salvage autologous fascial sling or Burch colposuspension, or salvage artificial urinary sphincter insertion. In this paper, we present the available evidence to support each of these approaches and include the management strategy used by our review panel for patients that present with SUI after failed midurethral sling.

Surgical Management of Stress Urinary Incontinence

2018 ◽  
Author(s):  
Danielle Patterson
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Midurethral Sling ◽  
Preoperative Evaluation ◽  
Urine Volume ◽  
Urodynamic Testing ◽  
Fascial Sling ◽  
Urethral Bulking ◽  
Postvoid Residual Urine ◽  
Distressing Condition

Stress urinary incontinence (SUI) is a prevalent and distressing condition that affects up to 50% of women over their lifetime. If nonsurgical treatments are not effective, surgery is highly successful. Preoperative evaluation includes at minimum a thorough history and physical examination, urinalysis, demonstration of SUI, assessment of urethral mobility, and measurement of postvoid residual urine volume. The midurethral sling is the most studied surgical procedure for urinary incontinence and is safe and highly effective. With the recent concern about permanent mesh in urogynecologic surgery, many patients might choose a laparoscopy- or robot-assisted Burch colposuspension or fascial sling. This review contains 5 figures, 5 tables and 38 references Key words: intrinsic sphincter deficiency, mesh, midurethral sling, minimally invasive surgery, preoperative evaluation, retropubic colposuspension, stress urinary incontinence, urethral bulking, urodynamic testing

scholarly journals Modified autologous fascial sling technique (‘sling on a string’) for stress incontinence

2021 ◽  
Author(s):  
Victoria Asfour ◽  
Kostis I. Nikolopoulos ◽  
Giuseppe Alessandro Digesu ◽  
Simon Emery ◽  
Zainab Khan
Keyword(s):  
Randomized Controlled Trial ◽  
Pelvic Floor ◽  
Stress Incontinence ◽  
Controlled Trial ◽  
Rectus Sheath ◽  
Complication Rates ◽  
Sling Procedure ◽  
Randomized Controlled ◽  
Fascial Sling ◽  
Autologous Fascial Sling

Abstract Introduction and hypothesis Describe the modified autologous fascial sling procedure that has been employed in the largest randomized controlled trial comparing autologous slings, mesh slings and xenografts. Methods The video aims to demonstrate the modified Aldridge technique. The surgical procedure is demonstrated. A 6-cm suprapubic incision is made to harvest the rectus sheath fascia. Loop-0-PDS sutures are attached on either end of the sling. A marking suture is placed in the middle of the graft to facilitate tension-free adjustment. A vaginal incision is made at the mid-urethra. Paraurethral dissection is performed to create a tunnel for the fascial graft to be passed through (in the same manner as with transvaginal mesh slings). The ends of the graft PDS sutures are passed through the paraurethral tunnel. One hand is placed abdominally below the rectus muscles to palpate the pelvic floor from above. The graft sutures are passed through the pelvic floor with control on either side. A cystoscopy is performed to check the bladder integrity. The graft placement is adjusted to be tenson-free. The incisions are closed. The short- and long-term outcomes of this technique have been investigated and published. Results The cure rates and complication rates were no different in the mesh and autologous slings. The xenograft had inferior outcomes. Conclusion Autologous fascial slings can be used in the surgical management of urodynamic stress incontinence. The technique demonstrated in this video is the technique employed in the largest randomized controlled trial investigating the efficacy of autologous fascial slings to xenografts and tapes.

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