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Published on: January 7, 2019
Minimally Invasive Autologous Fascia Sling at the Midurethra: A Case Series
Jonathan S Shaw1, Kristen A Gerjevic1, Catherine Pollack2
1Division of Urogynecology, Department of Obstetrics & Gynecology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon (Drs. Shaw, Gerjevic, and Strohbehn).
Study Objective:
The primary objective was to determine the improvement in stress urinary incontinence symptoms using autologous fascia lata sling placed at the midurethra. The secondary objective was to determine the presence of leg pain after harvest of fascia lata graft.
Design:
Case series.
Setting:
Rural academic tertiary care center.
Patients:
All women who underwent an autologous fascia midurethral sling over a 1-year period between June 2019 and September 2020.
Interventions:
Autologous fascia lata midurethral sling.
Measurements:
Incontinence severity index, urodynamic distress inventory-6, and Likert pain scale.
Main Results:
Nineteen women received an autologous fascial sling at the midurethra using the described technique-16 fascia lata and 3 rectus fasciae. Mean improvement in incontinence severity index score was 6 points. Mean improvement in urodynamic distress inventory-6 and SUI subscale scores was 14 and 53, respectively, surpassing the minimally important difference for each. Median follow-up time was 9 months (range 2-16). Leg pain at the harvest site was bothersome in 1 patient beyond 6 weeks. Median time to passing voiding trial was 4 days (range 1-13 days). Four patients (21%) had postoperative voiding dysfunction, 3 of which resolved after sling loosening at a mean of 60 days after sling placement.
Conclusion:
Midurethral autologous fascial sling placement significantly improves symptoms of SUI but carries a risk of voiding dysfunction. Harvesting fascia lata using a fascial stripper is associated with minimal postoperative morbidity.
