V1-04: Autologous Mid Urethral Sling - Technique and preliminary results
VideoIntroductions and Objectives
The surgical treatment of female stress urinary incontinence (SUI) has changed significantly over the past decade, with synthetic mid-urethral tape insertion currently the most widely performed procedure. However, the widespread adoption of this technique has resulted in a small but significant incidence of serious mesh-related complications. Autologous fascial / pubovaginal sling insertion is well established and has equivalent long-term success rates to TVT and TOT but the classic surgical technique has been associated with higher post-operative morbidity and de novo overactive bladder symptoms. We believe that refinements in technique may overcome these problems with none of the risks associated with mesh implantation. Here we demonstrate our technique and preliminary results with autologous midurethral sling (aMUS) placement.
We retrospectively reviewed the case-notes of all patients who underwent autologous mid urethral sling insertion by a single surgeon at our institution over a 4-year period (2008-2012). The technique presented in the surgical video demonstrates the use of a small suprapubic incision, creation of a 'sling-on-a-string', a modified reusable retropubic needle and mid-urethral sling positioning in a tension-free fashion. Demographic, and subjective follow-up data have been included.
Thirty-eight patients were identified. 53% reported pure SUI whilst 47% had mixed symptoms. Patients used an average of 3 pads per day (0-8), and 26% of patients had at least one previously failed SUI procedure. Post-operative symptom questionnaires revealed mean Patient Global Impression of Improvement (PGI) scores of 1.8 (1-4), indicating that patients were mainly very much or much improved. Only 8% of patients reported de novo OAB symptoms. Intraoperative bladder perforation occurred in only two patients. There was no incidence of chronic pain, sexual dysfunction or erosion.
In a heterogeneous group of women with primary or recurrent stress urinary incontinence, the aMUS was found to have good subjective medium-term cure rates with acceptable patient-reported satisfaction scores. We report a low rate of de novo OAB symptoms,no cases of erosion and no chronic pelvic, groin, or vaginal pain. We believe that aMUS is a good alternative to synthetic midurethral sling surgery and could be offered to women contemplating surgery for stress urinary incontinence.