Autologous Transobturator Urethral Sling Placement for Female Stress Urinary Incontinence

Abstract

We describe and evaluate a transobturator approach to urethral sling placement using autologous rectus fascia for the management of female stress urinary incontinence. We performed a feasibility study of 10 cases of autologous transobturator mid urethral sling placement for stress urinary incontinence. The procedure includes an anterior vaginal dissection performed in the standard fashion for a mid urethral sling and harvest of a strip of rectus fascia. A trocar is passed through each obturator foramen and the fascial stay sutures are retracted through the skin incisions. The sling is appropriately tensioned and the stay sutures are tied. Patient outcomes were measured by a 24-hour pad weight test and ICIQ-FLUTS score. Median patient age was 57 years (IQR 48, 69.5) and median body mass index was 30.3 kg/m(2) (IQR 25.2, 32.4). Median followup was 4 months (range 3 to 5). All patients demonstrated a reduction in leakage with 80% being completely dry (0 gm on 24-hour pad test and not wearing pads). Overall there was significant improvement in postoperative vs preoperative 24-hour pad weight (p=0.02). Likewise, all subscores of the ICIQ-FLUTS were significantly improved after surgery, including frequency (p=0.006), voiding (p=0.04) and incontinence (p=0.002). Of the 9 eligible cases 6 (67%) were performed on an outpatient basis. One patient performed intermittent self-catheterization for 24 hours after sling placement. No patients experienced severe (Clavien III-V) postoperative complications or required urethrolysis. Autologous transobturator urethral sling placement appears to be technically feasible with excellent short-term outcomes. Longer followup and larger series are needed for validation.