Autologous Pubovaginal Sling for the Treatment of Concomitant Female Urethral Diverticula and Stress Urinary Incontinence

Autologous rectus fascia sling for treatment of stress urinary incontinence in women: A review of the literature

“…Also, ARFS should be considered in situations when the synthetic MUS is less preferred and/or contraindicated. Those situations include violation of the urethral mucosa either incidental during periurethral dissection or intentional during excision of urethral diverticulum, closure of urethra‐vaginal fistula, and/or excision of an eroded synthetic sub‐urethral sling . We also favor ARFS for treatment of SUI in women with prior pelvic irradiation, women on chronic steroid therapy, extensive tissue fibrosis and scarring, and women with chronic pelvic pain and/or dyspareunia.…”

Outcomes of treatment of stress urinary incontinence associated with female urethral diverticula: A selective approach

“…Those authors who favor concomitant repair have suggested that the use of autologous fascia at the time of repair not only treats the UI, but also acts as an interposition graft buttressing the repair, as well as potentially reducing the need for a second separate incontinence procedure. This could be an argument for a “prophylactic” sling at the time of TVUD . However, there are inherent risks and potential increased morbidity (urinary retention, obstruction, etc), convalescence time and cost associated with SUI repair which may mitigate against concomitant anti‐incontinence surgery in all patients.…”

“…There is no consensus on appropriate timing of surgical management of UD and SUI, and some surgeons favor a staged procedure, while others recommend simultaneous treatment of stress urinary incontinence with an autologos pubovaginal fascial sling (APVS). Concomitant APVS placement has been found to be safe and effective for treating stress urinary incontinence at the time of urethral diverticulectomy . However, APVS is an invasive procedure which requires additional operative time, and is associated with the potential for additional complications such as de novo voiding dysfunction, urinary retention as well fascial harvest site problems.…”

“…UD have been reported in 1.4% of women who present for evaluation of incontinence, 7 and anywhere between 10% and 60% of women with UD present with SUI. 3,[8][9][10] Incontinence associated with UD may be due to concomitant SUI secondary to intrinsic sphincteric deficiency, or paradoxical incontinence due to loss of urine associated with intermittent drainage of the diverticulum. Conversely, UD can mask SUI due to the mass effect in 10-33% of patients, especially in large and proximal UD.…”

“…Concomitant APVS placement has been found to be safe and effective for treating stress urinary incontinence at the time of urethral diverticulectomy. 9,12 However, APVS is an invasive procedure which requires additional operative time, and is associated with the potential for additional complications such as de novo voiding dysfunction, urinary retention as well fascial harvest site problems. While the concomitant use of a minimally invasive midurethral synthetic mesh sling at time of urethral diverticulectomy may mitigate some of these considerations, and a single small case series has reported the successful use of this modality, 13 the AUA guidelines recommend against the use of synthetic materials in the setting of UD due to the potential risk of erosion of the synthetic graft into the urethra.…”