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

Abstract

Aims Stress urinary incontinence (SUI) is common in the adult females. Surgical treatment options include synthetic mid‐urethral sling (MUS), autologous sling, bulking agents, and Burch colposuspension. The autologous pubovaginal sling (PVS) has re‐emerged in response to complications of synthetic MUSs and FDA communications regarding the use of vaginal mesh. This resulted in patients’ fear related to vaginal mesh and drop in number of patients seeking surgical treatment of SUI. PVS has re‐emerged as an option for treatment of primary SUI. The aim of this review is to familiarize, disseminate information, and share tips for the practicing female pelvic surgeons related to the practice of the autologous fascia sling. Methods We reviewed the literature related to the autologous sling. We used the following data bases and search engines: GoPubMed (Transinsight), Cochrane reviews (Wiley Interscience), google scholar (google), and Scopus (Elsevier). Because it is the most commonly investigated and utilized, we focused on the autologous rectus fascia sling. We also focused on the retropubic sling approach because the literature on transobturator rectus fascia sling is sparse. Results Out of 307 articles related to the subject found, 22 articles were included and the rest were excluded. Conclusion ARFS is a valid primary method of treatment for female SUI. Also, it is used in particular indications such as patients with intrinsic sphincter deficiency (ISD), prior pelvic irradiation, failed and/or complicated synthetic MUS, and violated urethral lumen.

Modified autologous transobturator tape surgery — evaluation of short term results

“…Literature indicates that PVS, BC and MUSS have similar complication rates [29][30][31][32]. For instance, perioperative bleeding requiring blood transfusion is a serious problem associated with all of these procedures and may occur in up to 2% of the cases [29][30][31][32].…”

“…In the present study, however, no patient had significant blood loss. Another feared complication of these three techniques is bowel, bladder or urethral injury which has been reported in up to 9% of the cases [29][30][31][32]. Higher rates were reported after RT procedures for bladder, vascular and bowel injuries [18].…”

“…A biological graft material is needed to avoid the use of synthetic mesh and a Cochrane review by Rehman et al [33] suggested that rectus muscle fascia is the most appropriate and most commonly preferred material for PVS. Mahdy et al [31] suggested the use of fascia lata when it is impossible to harvest rectus fascia. In our study, no material other than rectus fascia was required in any patient.…”

“…Abraham et al [34] suggested that the symptoms of de novo urgency are as bothersome for the patients as the symptoms of preoperative stress urinary incontinence. Mahdy et al [31] reported the incidences of de novo urgency and urge incontinence after PVS as 15-20% and 7.2%, respectively. On the other hand, a similar incidence of de novo urgency has been reported for BC and MUSS (10%), more common after RT than TOT [18,30].…”

“…Voiding dysfunction and urinary retention requiring urethral catheterization are two well-known complications reported after SUI surgery and have been shown to be associated with urinary bladder detrusor dysfunction and iatrogenic urethral obstruction [30][31][32][33]. The incidence of urinary retention after PVS, BC and MUSS has been reported to be 20%, 8%, and 3%, respectively [19,[31][32]. In our study, no patient had urinary retention and there was no significant difference between pre-and post-operative scores of the voiding subsection of ICIQ-FLUTS.…”