Medium-term follow-up on use of freeze-dried, irradiated donor fascia for sacrocolpopexy and sling procedures

Abstract

The aim of this study was to document longerterm follow-up of patients in a previously reported series who underwent either sacrocolpopexy (SCP) or suburethral sling procedures utilizing freeze-dried, irradiated donor fascia. Subjects from the initial series of 67 SCPs and 35 slings were included in this retrospective chart review of postoperative follow-up where surgical follow-up longer than 3 months from the procedure was available. Subjects undergoing SCP were examined at the time of any clinical visit and their pelvic organ support evaluated utilizing the POP-Q system. The SCP procedure was considered to be unsuccessful if any anterior vaginal wall point (Aa or Ba) was at the hymen or beyond, or if the vaginal apical point (C or D) descended to a point at least halfway to the hymen from a position of perfect apical support. Subjects who did not return for clinical examination after their 3-month postoperative visit but who had been in telephone contact with the clinic stating that they had experienced symptomatic recurrence of their POP were also included as having unsuccessful SCP procedures. Those similarly in contact with the office by telephone, but not clinically examined, who indicated no subjective return of their POP, were coded as successful. The outcome of the sling procedure was primarily evaluated subjectively, with the patient indicating that stress incontinence symptoms were present or absent. Follow-up was available for 75 patients, who had undergone 54 SCP and 27 sling procedures (6 patients had undergone both SCP and sling procedures). When failure was defined according to any of the criteria listed in the methods section, 45 (83%) patients experienced SCP failure at a median of 12 months after surgery. A total of 14 (52%) sling procedures were failures, with recurrent SUI symptoms experienced from 2 weeks to 24 months (median 3 months) after the procedure. One year after surgery, 23 (43%) SCPs were known to be failures, and 11 (41%) slings were known to be failures. The remaining 13 (48%) slings were subjectively successful when last seen 7-51 months after surgery. We reoperated on 21 (40%) patients. At the time of repeat SCP (chosen by 16 patients) we found graft between the sacrum and vagina in just 3 patients (19%). The use of freeze-dried, irradiated donor fascia for both SCP and sling procedures was associated with an unacceptably high failure rate in our series.

Tension-Free Vaginal Tape and Autologous Rectus Fascia Pubovaginal Sling for the Treatment of Urinary Stress Incontinence: A Medium-Term Follow-Up

“…There are many studies evaluating TVT and sling methods, but the majority are retrospective observational studies and not randomized controlled trials [18][19][20] . However, there are a few randomized studies comparing TVT with other procedures [21][22][23][24] .…”

“…We elected to use autologous rectus fascia because a high failure rate has been reported using cadaveric donor fascia [18] . There are many studies evaluating TVT and sling methods, but the majority are retrospective observational studies and not randomized controlled trials [18][19][20] .…”

Outcome of Abdominal Sacrocolpopexy for Post Hysterectomy Vaginal Vault Prolapse

“…12 To avoid mesh erosion, the biologic graft : allograft fascia lata has been used as an alternative to mesh, but resulted in unexpected failures in which no mesh could be seen during reoperation. [13][14][15][16] In this study we adopted the same procedure of ASC using permanent synthetic polypropylene mesh.…”

Surgical outcome of abdominal sacrocolpopexy with synthetic mesh versus abdominal sacrocolpopexy with cadaveric fascia lata

“…No patient who received synthetic mesh showed such failure. Subsequent follow-up of these patients shows that, depending on the definition of failure, up to 80% of those who received freeze-dried, irradiated cadaveric fascia had an unsuccessful sacrocolpopexy [18].…”

“…While there are several reports of successful use of allogeneic fascia lata for suburethral slings [13,14] and the use of other alternative materials (including autologous rectus fascia) for ASC [10,15,16], there are few preliminary studies to otherwise support the use of allogeneic fascia lata for ASC [17,18]. Because gynecologic use differs significantly from orthopedic use, there is cause for concern that this cadaveric fascia lata may not provide long-term vaginal support.…”