Autologous fascial slings for stress urinary incontinence in patients with neuropathic bladder.

Abstract

Retrospective review. Stress urinary incontinence in the neurogenic population can have a profound effect on quality of life. It can lead to significant skin breakdown and non-healing pressure sores. Surgical management options for stress incontinence include an autologous pubovaginal sling (PVS). We performed a retrospective review of female patients undergoing PVS insertion in a specialised unit to assess short-term efficacy and safety in this complex neurogenic population. Princess Royal Spinal Injuries Unit, Sheffield, UK. A retrospective review of all patients (n = 22) who had undergone insertion of a PVS was carried out in a single specialised spinal injury unit between 2015 to 2019. Patients were identified from a prospectively maintained database and from the electronic theatre records. Data was collected from the database, electronic patient records and radiological systems. All procedures were carried out by two experienced neurourology consultants. The majority of patients were continent (n = 19, 86.4%) and 2 (13.5%) patients had an improvement in SUI following PVS insertion at a mean follow-up of 20 months. Pad use decreased from 5 to <1 and mean ICIQ-UI score improved from 17 to 1. One patient had a recurrence of stress urinary incontinence at 28 months. The median length of stay was three days. Three patients (13.6%) had a Clavien-Dindo Grade III-IV complication. One patient developed de-novo neurogenic detrusor overactivity. The autologous PVS is a safe and efficacious procedure for the management of stress urinary incontinence in the neurogenic population with an acceptable morbidity and excellent short-term outcomes.