Rectus fascial slings – case series

StudyStudy type and ELNo. patientsPatient characteristicsInterventionLength of follow-upOutcome measuresEffect sizeAdditional comments
Chou 2003890Case series
EL = 3
98F median age 66 years (45–84) with stress (49%) or mixed (51%) UI
Exclusions: urethral diverticulum, neoplasm, urinary fistula
Autologous rectus fascial slingMedian 3 years (1–7)Combined cure and improved rate (on UI Outcome Score)97% vs 93% (stress vs mixed UI)Funding: Institute for Bladder and Prostate Research.
Retrospective review of cases treated 1995–2001.
Complications2% de novo DO
1% (n = 1) prolonged retention (reqd surgical revision of sling)
Hassouna 1999891Case series
EL = 3
78 (70% of 112 treated)F mean age 56 years (37–82) with stress UI owing to ISD. 49% had stress UI, 51% mixed. 13% had DO
70% had prior continence surgery, mean 1.4 (1–3) procedures
60% underwent concomitant surgery
Autologous rectus fascial sling (7 x 2.5 cm)Mean 3.4 (0.5–8)Subjective success81% success
19% failure (not improved and using > 1 pad per day)
Funding: none declared.
Questionnaire follow-up of cases treated by 1 surgeon between 1988 and 1996.
3rd party followed-up non-responders by telephone.
test–retest reliability of questionnaire evaluated in 28%.
Complications21% de novo urge UI
1.3% (n = 1) straining during voiding
25% discomfort or pain related to surgical procedure
0 retention
0 CISC for > 4 weeks
Satisfaction86% satisfied
79% would undergo same surgery
845 would recommend
74% procedure improved social activity
37% (of 51) reported improved sexual activity
Reichelt 2003892Case series
EL = 3
86 (67% of 129 treated)F mean age 57 years with stress UI
Exclusions: neurogenic UI
Mean 0.4 continence surgical procedures per pt
Autologous rectus fascial slingMean 39 monthsChange in continence symptoms26% dry at all times.
% improvement:
65% reported 50–100% improvement
15% with 10–40% improvement
17% no change
2% worse
(61% using 0–2 pads/day)
Funding: none declared.
Procedures undertaken by 2 urologists between 1989 and 1998.
Questionnaire follow-up and retrospective review of charts.
No information on complications.
Satisfaction63% satisfied
59% would recommend to others
Cross 1998893Case series
EL = 3
134 (89% of 150 treated)F mean age 57 (24–79) with stress UI (34% mixed UI). 2% severe urgency
36% type 2 UI (ALPP > 90 cmH2O): included if failed continence surgery, engaged in vigorous athletic activity, had chronic pulmonary condition, or grade 3 or 4 cystocele)
54% type 3; ALPP < 60.
12% had type 2/3
58% had prior continence surgery
42% underwent concomitant surgery (mainly cystocele or rectocele repair or hysterectomy)
Autologous rectus fascial sling22 months (6–42)Objective cure (on urodynamics)93% cure
7% failure
(cure of urge UI in 36/48 [75%])
Funding: none declared.
F unable to attend clinic follow-up interviewed by telephone by 3rd party.
Complications19% de novo urge UI or urgency at 3 months
3% persistent urge UI
0.7% (n = 1) prolonged lower abdominal pain (suture removed, and pt pain free)
4% UTI
3% new, symptomatic enterocele
8% not voiding spontaneously at 1 month
4% (n = 6) permanent ISC (4/6 [3%] had urethrolysis at 3 months; other 2 had undergone augmentation cystoplasty for neurogenic UI, and remain on ISC)
Haweekins 2002894Case series
EL = 3
198 (80% of 246 treated)*F mean age 51 (36–75) years with stress UI
26% had prior continence surgery
15% concomitant procedures undertaken
Autologous rectus fascial slingMedian 6 years (2–18)Subjective success72% (cured or much improved on symptom severity score and on pts perception of change)Funding:
UK study, DGH based.
*who responded to questionnaire sent to F treated between 1979 and 1996.
Patients perception41% cure
38% much better
15% little better
4% no change
25 worse
Complications (info derived from notes; n = 178)4% haemorrhage requiring transfusion
3% wound infection
1.7% bladder perforation
1.1% reqd sling release
Complications (questionnaire)9% often/always voiding difficulty
29% urgency
11% abdominal pain attributed to surgery
4% recurrent UTI
3% loss of abdominal tone
4.5% incisional hernia
4% had subsequent prolapse or UI surgery
Morgan 2000895Case series
EL = 3
235 (95% of 247 treated)F mean age 55 years (10–84) with stress UI
54% type 2 SUI (ALPP > 90 cmH2O and urethral mobility > 2 cm): 46% type 3 (ALPP < 60)
73% had urgency, 45% urge UI
65% had concomitant procedures, incl. cystocele, rectocele, enterocele repair; hysterectomy)
Autologous rectus fascial sling (6 to 8 x 1 to 1.5 cm)Mean 52 months (24–70)Subjective cure or stress UI (SUI resolved and no urge UI)88% (91% type 2 grp, 84% type 3 grp)
In 88 pts with > 5 years follow-up, 85% cured
Funding: none declared but one author declared financial interest and/or other relationship with Bard Urologic.
Retrospective review with postal questionnaire; 95% response rate; al respondents retested by telephone.
Procedures undertaken Jan 1993-Dec 1996.
6% had secondary surgery for sling failure (collagen to repeat sling).
*mean duration catheterisation 8.4 days; 98% voided normally at 3 months.
Subjective cure of urge UI74%
Satisfaction92% highly satisfied
Complications23% de novo urgency
7% de novo urge UI
94% transient retention (reqd catheterisation for > 1 day)*
2% prolonged ( > 3 months) catheterisation; redq urethrolysis
3% sling failure
2% hypersuspended urethra
0.8% pelvic haematoma
0.8% incisional hernia
0.4% (n = 1) DVT
0.4% PE
0 sling erosion
Chaikin 1998896Case series
EL = 3
251F mean age 56 years (19–80) with stress UI. 25% ‘simple’ cases (prior surgical failure or DO without urge UI); 75% cases complicated (urge UI, fistula, urethral diverticulum, grade 3 or 4 cystocele or neurogenic bladder)
Mean no. prior procedures 0.78 (0–3) simple vs 3.1 (0–19) complex
Autologous rectus fascial slingMean 3.1 years (1–15)Combined subjective and objective cure/ improvement73% cure (dry under all circumstances and < 2 g on 1 h pad test)
19% improved (≥ 50% reduction in UI symptoms and pad test results)
8% failure ( < 50% reduction in UI symptoms and pad test results)
Funding: no funding declared.
Retrospective analysis of cases.
One surgeon.
Complications2% permanent retention
3% de novo urge UI
23% persistent urge UI
0.8% bladder injury
0.4% prolonged pain
0.4% death
0 urethral injury
Muller 1993897Case series
EL = 3
108 (90% of 120 treated)F mean age 47 years (22–76) with stress UI, not neurological or congenital or following gynae surgery or radiation
67% prior continence surgery
28% concomitant surgery (mainly hysterectomy)
Autologous rectus fascial sling (~2 cm x 10–12)Mean 5 years (max. 15)Subjective cure67%Funding: none declared.
Operations between 1969 and 1987.
Complications33% transient retention (catheterisation for 4–6 weeks)
2% permanent CISC
7% bladder injury
2% retropubic haematoma or wound infection
2% hernia of the abdominal wall
Borup 2002898Case series
EL = 3
32F mean age 50 (30–79) years with stress UI.
53% had prior pelvic surgery
Autologous rectus fascial sling5 yearsSubjective cure (n = 31; 1 lost to follow-up)97% (dry during stress)
3% improved
Funding: none declared.
Operations undertaken between Dec 92 and Dec 95. Consecutive pts.
All pts familiar with ISC pre-op.
6/7 with pre-op DO free of DO post-op.
residual volumes and uroflow data reported for each pt – data not reproduced here.
Complications16% de novo urgency (2/5 using antimuscarinics occasionally)
69% CISC post-op
38% at 6 months
16% at 1 year
6% at 5 years (1/2 used CISC pre-op)
41% UTI
22% recurrent UTI (≥ 2 episodes)
3% sling erosion into urethra
3% re-operation owing to difficulty with CISC
0 pain
0 dyspareunia
Zaragoza 1996899Case series
EL = 3
60F mean age 57 (34–78) years with stress UI (42%) or mixed UI/stress UI with urgency (58%)
40% had prior continence surgery
5% prior pelvic radiation, 5% prior radical pelvic surgery
Autologous rectus fascial slingMean 25 months (11–34)Subjective cure95% cure
5% failure (DO with urge UI)
Funding: no funding declared.
Consecutive pts.
Complications60% transient retention (median 6.5 days [1 day to 5 weeks])
12% de novo urgency (none urge UI; urgency treated with antimuscarinic)
13% UTI
5% persistent incisional pain
0 bladder injury
0 urethral injury

From: Evidence tables for included studies

Cover of Urinary Incontinence
Urinary Incontinence: The Management of Urinary Incontinence in Women.
NICE Clinical Guidelines, No. 40.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2006 Oct.
Copyright © 2006, National Collaborating Centre for Women’s and Children’s Health.

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