Processed porcine small intestine submucosa as a graft material for pubovaginal slings: durability and results

To describe our surgical technique and results with implantation of processed porcine small intestine submucosa (SIS) as a pubovaginal sling in 152 consecutive female patients with stress urinary incontinence (SUI).

Processed SIS is a biocompatible, acellular, collagen matrix. SIS attracts local host cells to infiltrate and replace its substance. Our procedure uses bone screws to anchor the sling to the pubis. Patients were followed up closely after surgery to evaluate cure rates, side effects, and complications.

Of 152 patients, 142 (93.4%) were relieved of their SUI during the 4-year series. Three additional patients had marked improvement. Seven patients (4.6%) did not have satisfactory continence after the initial surgery. SUI recurred in 5 of the 7 patients with failure within 3 months of surgery. The other two failures occurred at 9 and 11 months after surgery. Of the 152 patients, 77 (50.7%) had varying degrees of urgency/frequency preoperatively. Although relieved of SUI postoperatively, most of these patients continued to use medication for urgency. Patients undergoing simple sling procedures were discharged from the hospital the day after surgery and were catheter free by the next day. One required self-catheterization for 3 days and another a Foley catheter for 5 days. Patients undergoing pubovaginal sling placement and additional pelvic procedures were hospitalized for 2 to 3 days with a catheter in place during that time. Sling infection, erosion, or rejection did not develop in any case during the 4 years of this series.

Processed SIS is strong, durable, biocompatible, infection resistant, and gradually replaced by host tissues.