Ultra Long-term Follow-up of the Autologous Pubovaginal Sling for Stress Incontinence: Results at 23 Years

To examine the efficacy, safety, and long-term durability of the autologous pubovaginal sling for stress incontinence over a 29-year period.

A total of 192 consecutive female patients with stress urinary incontinence who underwent autologous pubovaginal sling from 1993 through 1999 were analyzed over a 29-year period. Intermediate and ultra long-term follow-up were obtained at a mean of 4 and 23 years, respectively. A total of 51 patients had sufficient data at both time intervals and were evaluated using a standardized questionnaire for resolution of stress incontinence, the primary endpoint, as well as resolution of urge incontinence, overall dryness, and voiding dysfunction.

At intermediate-term follow-up (mean 45.3 months), 96% of 51 patients reported no stress incontinence. In addition, 76% of patients experienced resolution of their preoperative urge incontinence. Overall dryness occurred in 84%. At ultra long-term follow-up (mean 22.9 years), 84% reported no stress incontinence and an overall dryness rate of 53%. Postoperative voiding dysfunction included de novo urge incontinence (3 patients) and persistent urinary obstruction requiring urethrolysis (1 patient).

The autologous pubovaginal sling is effective, safe, and durable at a mean of 23 years, the longest known follow-up in the literature. Given the U.S. Food and Drug Administration (FDA) warnings regarding transvaginal mesh and growing concerns with the synthetic midurethral sling, the autologous pubovaginal sling should be offered as an option to those women seeking treatment for stress urinary incontinence.