V2-03: Pubovaginal Sling with Tensor Fascia Lata
VideoIntroductions and Objectives
The use of autologous fascia for the treatment of stress urinary incontinence has been well-established, with the most common sites of harvest including the rectus fascia and tensor fascia lata. In the past we preferred the use of rectus fascia for our fascial slings, but due to an increase in patients with elevated BMIs and complicated histories of abdominal surgery, we have transitioned to the use of tensor fascia lata. We describe our surgical technique and outcomes with the pubovaginal sling using tensor fascia lata.
A retrospective review was performed using medical records of patients at our tertiary care center who had undergone pubovaginal slings with tensor fascia lata for stress urinary incontinence from January 2014 to October 2014. With the patient in the lateral position, tensor fascia lata was harvested through a single incision in the lateral thigh, utilizing the Crawford stripper. The patient was then repositioned into the dorsal lithotomy position for standard pubovaginal sling placement.
Pubovaginal sling with tensor fascia lata was performed in 22 patients. Mean age was 55.8 years, and mean BMI was 29.5. 15/22 (68.2%) had undergone previous abdominal surgery, and 20/22 (91.0%) had undergone prior mesh sling removal. Mean hospital stay was 1.09 days. 2/22 (9.1%) of patients developed complications following the procedure, including one pelvic hematoma and one incisional hematoma at the site of the fascial harvest. None complained of leg pain or difficulties ambulating at their initial post-operative visit, and all reported improvement in continence at their first post-operative visit.
Based on our initial experience, we have found the use of tensor fascia lata in autologous fascial slings to be less challenging, especially in patients with elevated BMIs and in those with a history of multiple abdominal surgeries. Pubovaginal slings using tensor fascia lata was found to be safe and well-tolerated in patients requiring treatment for stress urinary incontinence.