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J Urol. 2015 Mar;193(3):916-20. doi: 10.1016/j.juro.2014.09.038. Epub 2014 Sep 20.

Success of autologous pubovaginal sling after failed synthetic mid urethral sling.

Author information

1
Department of Urology, University of Michigan, Ann Arbor, Michigan.
2
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
3
Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: annepell@med.umich.edu.

Abstract

PURPOSE:

There is no consensus on the management of persistent or recurrent stress incontinence after a failed synthetic mid urethral sling. After a mesh complication or sling failure many women and surgeons prefer to avoid a repeat mesh procedure and choose an autologous pubovaginal sling. However, little empirical work has been performed to assess the efficacy.

MATERIALS AND METHODS:

We performed a retrospective review of 66 women who underwent autologous pubovaginal sling with rectus fascia after 1 or more failed synthetic mid urethral sling from 2007 to 2012.

RESULTS:

Mesh removal was performed before autologous pubovaginal sling in 21 patients (31.8%) while 6 (9.1%) had mesh removed simultaneously with autologous pubovaginal sling. Indications for the autologous pubovaginal sling were pure stress urinary incontinence in 16 patients (24.2%) and mixed incontinence in 50 (75.8%), 8 of whom were deemed complex with a prior urethral diverticulum or urethrovaginal fistula/urethral mesh erosion. At a mean of 14.5 months after autologous pubovaginal sling 46 (69.7%) patients reported cure of stress urinary incontinence. Of these patients 25 (37.9%) had complete cure with no stress or urgency incontinence, 17 had cure of stress urinary incontinence but had persistent urgency incontinence, and 4 had cure of stress urinary incontinence but experienced do novo urgency incontinence. Requiring a mesh excision did not predict worse outcomes compared to cases in which mesh was not removed (p=0.13). Patients with pure stress urinary incontinence were significantly more likely to be cured of all incontinence (62.5%) than those women with preoperative mixed incontinence (30.0%) (p=0.006).

CONCLUSIONS:

Even after a failed synthetic mid urethral sling, autologous pubovaginal sling is effective and cured stress urinary incontinence in 69.7% of cases.

KEYWORDS:

autografts; stress; suburethral slings; surgical mesh; urinary incontinence

PMID:
25245488
DOI:
10.1016/j.juro.2014.09.038
[Indexed for MEDLINE]

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