Autologous transobturator sling as an alternative therapy for stress urinary incontinence

Abstract

Objective To evaluate efficacy and outcomes of the autologous transobturator midurethral sling for treatment of stress urinary incontinence (SUI). Methods In a prospective cohort study, an autologous transobturator mid‐urethral sling was used to treat SUI among women attending a university hospital in Montevideo, Uruguay, from June 2017 to July 2018. In the first phase, autologous tissue of the abdominis rectus fascia was collected. In the second phase, the midurethral sling was placed via the transobturator approach. Outcomes were measured every 3 months by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ‐FLUTS) Score. Preoperative and postoperative results were compared by Wilcoxon test. Results Eighteen women with a median age of 51 years were enrolled. The median follow‐up was 9 months (range 6–15 months). Overall, 17 women showed symptomatic improvement after the procedure. In a comparison of preoperative versus postoperative ICIQ‐FLUTS questionnaires, improvement in the incontinence subscore was observed at 3 (P<0.001), 6 (P<0.001), and 12 (P=0.008) months. No severe complications were observed. Conclusion Use of an autologous transobturator urethral sling was found to be technically feasible and safe for SUI, with good short‐term outcomes. Longer follow up and larger series are needed to validate the procedure.

“Mesh free” autologous transobturator mid urethral sling placement for predominant stress urinary incontinence: A pilot study

“…The surgery took a mean operative time of 57.33 min, with the duration being longer for patients with a higher BMI or a previous Pfannenstiel incision scar, which is similar to the time taken by other authors (range of 56.5–75 min) who have reported their experience with the autologous mid‐urethral sling 18,19 . In the present study, 20 patients reported “zero” in incontinence subscale, while the rest had occasional leak as per incontinence subscale score at 3 and 12 month follow‐up visits.…”

“…Linder and Elliott reported 84.8% re-treatment free success at median follow-up of 14.9 months. 18 Laufer et al 19 in their study of 18 women reported a 94% success rate at a mean follow-up of 9 months.…”

“…Linder and Elliott reported 84.8% re-treatment free success at median follow-up of 14.9 months. 18 Laufer et al 19 in their study of 18 women reported a 94% success rate at a mean follow-up of 9 months. We found a significant improvement in ICIQ-FLUTS scale and ICIQ-FLUTS bother scale and also in filling and incontinence subscale at 3 and 12-months follow-up.…”

“…18 In another prospective cohort study, Laufer et al 19 reported a significant improvement in filling (.01 and .008) and incontinence (.006 and .007) sub-scales of ICIQ-FLUTS and bother scale, respectively at 12 months. 19 In our study, all the patients were discharged successfully without the need for readmission or recatheterization and with a PVRU less than 100 ml. However, two patients reported poor flow of urine with PVRU of more than 100 ml at 3 months follow-up, for which both the patients required urethral dilatation.…”

“…Linder and Elliott in 18 patients, for whom scores were available for at least 1 year, reported a significant improvement in the filling ( p = .007), voiding ( p = .02), and incontinence ( p = .004) subscale of ICIQ FLUTS and also in filling ( p = .008), voiding ( p = .002), and incontinence ( p = .01) subscale of bother scale, but these included patients in whom concomitant procedures including colporrhaphy, sacrocolpopexy, and fistula repair were performed 18 . In another prospective cohort study, Laufer et al 19 reported a significant improvement in filling (.01 and .008) and incontinence (.006 and .007) sub‐scales of ICIQ‐FLUTS and bother scale, respectively at 12 months 19 …”