https://doi.org/10.4081/uij.2021.272

Autologous mid-urethral fascial sling for stress urinary incontinence: Long term outcomes

Vol. 33 No. 1 (2021)
Published: 17 September 2021
Stress urinary incontinence, autologous sling
Abstract Views: 1665
PDF: 189
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Theo Malthouse
theo.malthouse@doctors.org.uk
https://orcid.org/0000-0002-5949-7686
East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, Kings Dr, Eastbourne, United Kingdom.
Ian Rudd
https://orcid.org/0000-0001-9118-1617
East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, Kings Dr, Eastbourne, United Kingdom.
Chris Down
https://orcid.org/0000-0001-5095-2972
East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, Kings Dr, Eastbourne, United Kingdom.
James Moore
East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, Kings Dr, Eastbourne, United Kingdom.

There has been an increasing interest in mesh-free surgical options for Stress Urinary Incontinence (SUI). Traditionally rectus fascia autologous slings were placed at the bladder neck but more recently they are positioned at the mid-urethra (aMUS). The long-term outcomes for these patients are described. A retrospective analysis of aMUS patients between 2009-2014 by a single surgeon for primary SUI was performed. All patients were evaluated preoperatively with urodynamics. Patient reported outcomes were collected via postal questionnaire using the ICIQ-UI short-form questionnaire, 7-point Global Impression of Improvement score, questions on pad usage, self-catheterisation, overactive bladder treatment and re-operation rates. Results included 31 patients (response rate 63.8%). The median age was 49 years and median BMI was 27. Twenty-seven per cent (27%) of patients had stress predominant mixed urinary incontinence pre-operatively. Median length of follow up was 8 years (5- 11); 60% of patients were dry and pad-free. Seventy-seven per cent (77%) found the surgery led to “much improvement” or “very much improvement” in quality of life. Thirteen per cent (13%) of patients reported a deterioration in quality of life. The median ICIQ-UI short form score was 5.5. 16.7% were taking medication and 1 patient received botulinum toxin therapy for overactive bladder symptoms. All these patients had mixed urinary incontinence on preoperative urodynamics. The re-operation rate was 13.3%. One patient was selfcatheterising. Three out of 31 (10%) had experienced pelvic pain, with 2 out of 31 (6%) experiencing dyspareunia. AMUS shows good long-term continence outcomes and is associated with low rates of de-novo overactive bladder symptoms and voiding dysfunction.

Altmetrics

Downloads

Download data is not yet available.
NICE. NICE - 1.5 Surgical management of stres surinary incontinence. 2019. Accessed: 30 December 2019.Available from: https://www.nice.org.uk/guidance/ng123/chapter/recommendations#autologous-rectus-fascial-sling
Aldridge A. Transplantation of fascia for the relief of urinary stress incontinence. Am J Obstet Gynecol 1942;44;398-441. DOI: https://doi.org/10.1016/S0002-9378(42)90477-0
Ulmstem U, Henriksen L, Johnson P, Varhos G. An ambulatory surgical procedure under local anaesthetic for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1996;7:81. DOI: https://doi.org/10.1007/BF01902378
McGuire E, Lytton B. Pubovaginal sling procedure for stress incontinence. J Urol 1978;119:82-4. DOI: https://doi.org/10.1016/S0022-5347(17)57390-5
Malde S, Moore J. Autologous mid-urethral sling for stress urinary incontinence: Preliminary results and description of a contemporary technique. J Clin Urol 2016;9:40-47. DOI: https://doi.org/10.1177/2051415815589900
Brubaker L, Richter H, Norton P, et al. Five year continence rates, satisfaction and adverse events of burch urethropexy and fascial sling surgery for urinary incontinence. J Urol 2012;187:1324-30. DOI: https://doi.org/10.1016/j.juro.2011.11.087
Khan Z, Nambiar A, Morley R, et al. Long-term follow-up of a multicentre randomised controlled trial comparing tension-free vaginal tape, xenograft and autologous fascial slings for the treatment of stress urinary incontinence in women. Br J Urol Int 2015;115:968-77. DOI: https://doi.org/10.1111/bju.12851
Cubuk F, Yanaral A, Sahan A, et al. Modified autologous transobturator tape surgery - a prospective comparison with transobturator tape surgery. Urology 2020;146:72-8. DOI: https://doi.org/10.1016/j.urology.2020.09.018
Yalcin I, Bump RC. Validation of two global impression questionnaires for incontinence. Am J Obst Gynecol 2003;1:98-101. DOI: https://doi.org/10.1067/mob.2003.379
Ostergard D. Primary slings for everyone with genuine stress incontinence? The argument against. Int Urogynecol J Pelvic Floor Dysfunct 1997;8:321-2. DOI: https://doi.org/10.1007/BF02765588
Nilsson C, Palva K, Aarnio R, et al. Seventeen years’ follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int Urogynecol J 2013;24:1265-9. DOI: https://doi.org/10.1007/s00192-013-2090-2
Lim R, Long Liong M, Lau Y, Yuen K. Validity, reliability, and responsiveness of the ICIQ‐UI SF and ICIQ‐LUTSqol in the Malaysian population. Neurourol Urodynam 2015;36:2. DOI: https://doi.org/10.1002/nau.22950
Nystrom E, Sjostrom M, Stenlund H, Samuelsson E. ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence. Neurourol Urodynam 2015;34:747-51. DOI: https://doi.org/10.1002/nau.22657
Mitsui T, Tanaka H, Moriya K, et al. Clinical and urodynamic outcomes of pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence. Int J Urol 2007;14:1076-9. DOI: https://doi.org/10.1111/j.1442-2042.2007.01909.x
Albo M, Richter H, Brubaker L, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 2007;24:2143-55. DOI: https://doi.org/10.1056/NEJMoa070416
Osman N, Hillary C, Mangera A, et al. The midurethral fascial “sling on a string”: an alternative to midurethral synthetic tapes in the era of mesh complications. European Urology 2018;74:191-6. DOI: https://doi.org/10.1016/j.eururo.2018.04.031
Zycznski H, Albo M, Goldman H, et al. Change in overactive bladder symptoms after surgery for stress urinary incontinence in women. Obstet Gynecol 2015;126:423-30. DOI: https://doi.org/10.1097/AOG.0000000000000929
Jeon M, Jung H, Chung S, et al. Comparison of the treatment outcome of pubovaginal sling, tension-free vaginal tape, and transobturator tape for stress urinary incontinence with intrinsic sphincter deficiency. Am J Obstet Gynecol 2008;199:1-4. DOI: https://doi.org/10.1016/j.ajog.2007.11.060
Flisser AJ, Blaivas JG. Outcome of urethral reconstructive surgery in a series of 74 women. J Urol 2003;169:2246-9. DOI: https://doi.org/10.1097/01.ju.0000061763.88247.16
Morgan T, Westney O, McGuire E. Pubovaginal sling: 4-year outcome analysis and quality of life assessment. J Urol 2000;163:1845-8. DOI: https://doi.org/10.1016/S0022-5347(05)67557-X
Morgan D, Dunn R, Fenner D. Comparative analysis of urinary incontinence severity after autologous fascia pubovaginal sling, pubovaginal sling and tension-free vaginal tape. J Urol 2007;177:604-8. DOI: https://doi.org/10.1016/j.juro.2006.09.062
Ayorinde AA, Bhattacharya S, Druce KL, Jones GT, Macfarlane GJ. Chronic pelvic pain in women of reproductive and post-reproductive age: a population-based study. Eur J Pain 2017;21:445-55. DOI: https://doi.org/10.1002/ejp.938
Zondervan KT, Yudkin P, Vessey M, et al. The prevalence of chronic pelvic pain in women in the United Kingdom: a systematic review. Br J Obstet Gynecol 1998;105:93-9. DOI: https://doi.org/10.1111/j.1471-0528.1998.tb09357.x
Çubuk A, Şahan A, Özkaptan O, et al. Impact of autologous transobturator sling surgery on female sexual function: a comparative study with mesh used mid-urethral sling surgeries. Urol Int 2021. doi: 10.1159/000514415. DOI: https://doi.org/10.1159/000514415
Lifford KL, Townsend MK, Curhan GC, et al. The epidemiology of urinary incontinence in older women: incidence, progression, and remission. J Am Geriatr Soc 2008;56:1191-8. DOI: https://doi.org/10.1111/j.1532-5415.2008.01747.x
Tennstedt SL, Litman HJ, Zimmern P, et al. Urinary Incontinence Treatment Network. Quality of life after surgery for stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:1631-8. DOI: https://doi.org/10.1007/s00192-008-0700-1

How to Cite



Autologous mid-urethral fascial sling for stress urinary incontinence: Long term outcomes. (2021). Urogynaecologia, 33(1). https://doi.org/10.4081/uij.2021.272

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.


Similar Articles

11-20 of 89

You may also start an advanced similarity search for this article.