Autologous Rectus Fascia Sling Research Articles

No mess with mesh; vaginal natural orifice transluminal endoscopic surgery (vNOTES) autologous posterior rectus fascia mesh for vaginal urinary incontinence procedures

Urinary incontinence affects 25–45 % of women with the gold standard surgical approach being placement of mid-urethral synthetic slings; tension-free vaginal tape (TVT) and trans-obturator tape (TOT). Due to the controversies regarding vaginal mesh the last decade, an increasing demand has evolved for incontinence treatment without vaginal synthetic mesh. The short term results of autologous rectus fascia sling for TOT surgery have shown similar success rates compared to those after the use of synthetic mesh, but the harvesting of the mesh is less minimally invasive and is associated with longer surgical time.vNOTES is a combination of a vaginal entrance to the abdomen and endoscopy via the vagina.The aim with the video is to show a new surgical technique with a fully vaginal, scarless vNOTES approach for harvesting the posterior rectus fascia for TVT and TOT procedures.

Oral 14 - Patient outcomes following primary autologous rectus fascia sling for the management of stress urinary incontinence since the suspension of vaginal mesh

Oral 14 - Patient outcomes following primary autologous rectus fascia sling for the management of stress urinary incontinence since the suspension of vaginal mesh

Autologous rectus fascia sling for post-vesicovaginal fistula repair stress incontinence: case series from a Nigerian experience

BackgroundSuccessful outcome of a urinary fistula repair involves a successful closure of the fistula without residual incontinence. However, a few women have post-repair stress urinary incontinence despite closure of the fistula, which requires special surgical technique to achieve total continence.Case presentationFour women with post-vesicovaginal fistula repair residual incontinence were selected for sling operation using autologous rectus fascia in a low resource setting. Their ages ranged between 20 and 30 years. None had a fistulous opening on vaginal examination and dye test. Two patients had one previous attempt at repair of post-repair stress incontinence, while the others had two and three attempts, respectively, without success. The patients had none to mild vaginal adhesion. Following the procedure, they were followed up for 6 months and they remained continent of urine.ConclusionAll patients achieved total urinary continence following autologous rectus fascia slings with minimal complications. This demonstrates the possibility of achieving a successful outcome despite lack of modern equipment for diagnosis and follow-up, a typical problem of low-income country like Nigeria.

A comparative study of autologous rectus fascia pubovaginal sling surgery and synthetic transobturator vaginal tape procedure in treatment of women with urodynamic stress urinary incontinence

ObjectiveTo compare short term results of autologous rectus fascia pubovaginal sling surgery with synthetic transobturator vaginal tape procedure in treatment of female stress urinary incontinence (SUI) Study designIt was a comparative study on 30 women between 25−65 years of age with urodynamic proven SUI who were randomly allocated to autologous rectus fascia pubovaginal sling surgery (Group I)(15 women) and synthetic transobturator vaginal tape procedure (Group II) (15 women). Preoperative and postoperative ICIQ (International Consultation on Incontinence Questionnaire) score, urodynamic study and serum CRP and IL-6 were done in all cases. ResultsThe baseline characteristics in terms of age, body mass index (BMI), parity, mean ICIQ score and mean preoperative CRP and IL-6 levels were similar in two groups. Mean operative time was significantly longer (55.60 ± 5.77 vs 25.27 ± 4.32 minutes, p = 0.001) in group I than group II. Mean hospital stay of 7.1 ± 1.2 vs 1.2 ± 0.4 days, mean duration of catheterization 5.8 vs 1.2 day (<0.01) and postoperative urinary retention requiring recathterization were all significantly higher in group I than II. Wound infection was more in group I than in group II (p = 0.01) while groin pain was significantly more in group II (p = 0.01). One patient developed vesicovaginal fistula, while one patient required cutting of tape in group I. Pdet at Q max (Detrusor pressure at peak urine flow) increased significantly in both the groups after surgery. ICIQ score was zero in both the groups indicating 100 % success. Surgical trauma was more in group I as shown by significantly higher CRP levels. ConclusionThe success rate of the two groups was similar but, autologous rectus fascia sling surgery took longer, had more complications and urinary retention as compared to transobturator vaginal tape procedure.

Autologous rectus fascia sling for treatment of stress urinary incontinence in women: A review of the literature.

Stress urinary incontinence (SUI) is common in the adult females. Surgical treatment options include synthetic mid-urethral sling (MUS), autologous sling, bulking agents, and Burch colposuspension. The autologous pubovaginal sling (PVS) has re-emerged in response to complications of synthetic MUSs and FDA communications regarding the use of vaginal mesh. This resulted in patients' fear related to vaginal mesh and drop in number of patients seeking surgical treatment of SUI. PVS has re-emerged as an option for treatment of primary SUI. The aim of this review is to familiarize, disseminate information, and share tips for the practicing female pelvic surgeons related to the practice of the autologous fascia sling. We reviewed the literature related to the autologous sling. We used the following data bases and search engines: GoPubMed (Transinsight), Cochrane reviews (Wiley Interscience), google scholar (google), and Scopus (Elsevier). Because it is the most commonly investigated and utilized, we focused on the autologous rectus fascia sling. We also focused on the retropubic sling approach because the literature on transobturator rectus fascia sling is sparse. Out of 307 articles related to the subject found, 22 articles were included and the rest were excluded. ARFS is a valid primary method of treatment for female SUI. Also, it is used in particular indications such as patients with intrinsic sphincter deficiency (ISD), prior pelvic irradiation, failed and/or complicated synthetic MUS, and violated urethral lumen.

The first Iraqi experience with the rectus fascia sling and transobturator tape for female stress incontinence: A randomised trial

ObjectivesTo present the first experience in Iraq of autologous rectus fascia sling (RFS) procedures and transobturator tape (TOT) for treating female stress urinary incontinence (SUI), and to review the validity of the RFS in the era of synthetic tapes. Patients and methodsFrom December 2004 to July 2012, 80 female patients with SUI were enrolled in the study, and randomly assigned into two types of surgery, with 40 treated by RFS (retropubic route) and 40 by TOT. The surgical results were compared between the groups and with those from previous studies. ResultsThe mean operative duration was 80min for RFS vs. 20min for TOT. The early cure rate was 98% for RFS (with one failure due to prolonged urinary retention) and 95% for TOT (with two failures due to persistent incontinence). The early complications were mainly abdominal wound problems (20%) for RFS, and groin and upper thigh pain (13%) for TOT. The late complications were the development of postvoid residual urine (8% in RFS vs. 5% in TOT) and de novo detrusor overactivity (5% in each group). There were no vaginal or urethral erosions up to the end of the study. ConclusionsRFS and TOT have comparable efficacy and safety in treating SUI. Nevertheless RFS, with its more invasive nature and long operative duration, should only be used when synthetic tapes are not available or not preferable.

Hyperbaric Oxygen Therapy to Promote Vaginal Wall Healing after Salvage Surgery for Mesh-related Complication

Patients with multiple failed vaginal surgeries utilizing synthetic mesh present a therapeutic challenge. We present a case of a 75-year-old woman with severe stress urinary incontinence and mesh extrusion after two failed synthetic sling surgeries. Surgical reconstruction consisted of mesh excision, urethral reconstruction with vaginal tubularization, autologous rectus fascia sling placement. The patient developed a vaginal hematoma and wound dehiscence post-operatively, which was treated with surgical debridement and hyperbaric oxygen (HBO). The patient’s wound healed well, and she regained full continence, which was sustained at 10 months postoperatively. HBO therapy promotes wound healing after complex transvaginal reconstructive surgery.

Treating stress urinary incontinence in female patients with neuropathic bladder: the value of the autologous fascia rectus sling

The aim of this study was to evaluate the efficacy of the autologous fascia rectus sling in treating stress urinary incontinence in female patients with neuropathic bladder. Furthermore, correlations between preoperative parameters and outcome were evaluated. We retrospectively reviewed operative logs from a single surgeon (EM) of 33 female patients with neuropathic bladder treated over a 3-year period for stress urinary incontinence by implantation of an autologous fascia rectus sling. Efficacy was evaluated objectively in terms of the number of pads used per day, while subjective patient satisfaction was also recorded using a global assessment question. Possible correlations between age, obesity, preoperative Valsalva leak point pressure and incontinence severity and outcome were investigated using univariate analysis. The mean follow-up time was 52 months, while the mean age of the patients was 37 years. Causes of neuropathic bladder were myelomeningocele in 21 (63.63 %) and spinal cord injury in 12 patients (36.36 %). A total of 30 patients were successfully treated and satisfied with the outcome of the operation (90.9 %). Twenty-five patients (75.75 %) were totally dry, while 5 patients (15.15 %) had markedly improved but still required one pad per day. The complication rate was 15.20 %. Univariate analysis failed to show any correlation between the final outcome and the checked parameters. The free autologous rectus fascia sling is a highly effective technique for the treatment of female stress incontinence in patients with neuropathic bladder, while the morbidity is mild.

Efficacy and Preoperative Prognostic Factors of Autologous Fascia Rectus Sling for Treatment of Female Stress Urinary Incontinence

To evaluate the efficacy of the autologous fascia rectus sling in treating female stress urinary incontinence. A total of 264 patients treated during a 3-year period for SUI using the autologous fascia rectus sling were retrospectively reviewed. Efficacy was evaluated by the number of pads used daily. Patient satisfaction and correlations between the preoperative parameters and outcome were assessed. The mean follow-up time was 27.8 months. Of the 264 patients, 224 (85%) were successfully treated and satisfied with the outcome of the operation. Of the 224 patients, 200 (75.8%) were totally dry and 24 (9.1%) had improved markedly. The complication rate was 29.2%, with postoperative urgency the most common problem (49 of 264, 18.5%). None of the preoperative parameters were associated with the final outcome. The free autologous rectus fascia sling is a highly effective technique for the treatment of female stress incontinence with mild morbidity.

Postoperative magnetic resonance imaging characterization of slings for female stress urinary incontinence

The aim was to characterize different types of slings such as autologous rectus fascia (ARF), porcine dermis (PD) and tension-free vaginal tape (TVT) in the early postoperative period with regard to its visibility and location by using magnetic resonance imaging (MRI). Between October 2003 and June 2007, total of 60 patients underwent MRI after a sling procedure. Thirty-six patients had ARF slings. Twelve patients had a PD sling and 12 had a TVT. All patients had pelvic MRI 6-8 hr postoperatively. Six patients in the ARF sling group had both preoperative and postoperative images at 6 hr and 3 months. MRI images were analyzed with regard to visibility and location. All data were collected prospectively. ARF slings were clearly visible in both T1W and T2W images. ARF appeared as low signal intensity area with surrounding high signal intensity due to fat attached to the rectus fascia in the MRI images obtained 6 hr after the procedure. Although the fatty component of the sling was diminished but was still visible on MRI scan 3 months postoperatively. On the other hand PD and TVT sling materials were not visible by MRI. Most of the ARF slings were located just below the bladder neck. The ARF sling is easily identifiable on MRI in the early postoperative period primarily because of the fat attached to the autologous rectus fascia. However, depiction of the PD and TVT slings in the early postoperative period is very poor.

Results of the SISTEr Randomized Surgical Trial Comparing the Autologous Rectus Fascia Sling to the Burch Colposuspension

Results of the SISTEr Randomized Surgical Trial Comparing the Autologous Rectus Fascia Sling to the Burch Colposuspension

Tension-Free Vaginal Tape and Autologous Rectus Fascia Pubovaginal Sling for the Treatment of Urinary Stress Incontinence: A Medium-Term Follow-Up

Objectives: To compare two different procedures, tension-free vaginal tape (TVT) and autologous rectus fascia sling, according to their medium-term subjective and objective outcomes and satisfaction rates in the treatment of urinary stress incontinence in women. Subjects and Methods: One hundred women with type II urinary stress incontinence were randomized to be treated with either TVT or autologous rectus fascia sling. They were evaluated by means of a cough-induced stress test, 1-hour pad test, Incontinence Impact Questionnaire (IIQ), and urodynamic study. They were reevaluated postoperatively every 6 months, and the collected data of more than 1 year’s follow-up were compared with preoperative assessments. Results: All patients completed the full 6-month postoperative assessment. However, of the 100 patients, only 61 (25 in the TVT and 36 in the sling group) were followed for more than 1 year. Mean follow-up time was 38.5 and 40 months in the TVT and sling group, respectively. Objective cure was achieved in 22 (88%) of the TVT group and in 30 (83%) of the sling group (p = 0.78) using a cough-induced stress test, and in 76 and 75% of the women in the TVT versus sling group (p = 0.83), respectively, using a 1-hour pad test. Postoperative mean IIQ scores were 44.3 (range 35.5–61.5) and 48.5 (range 38.5–69.7) in the TVT versus sling group (p = 0.46). Five (20%) and 11 (30%) of the TVT and sling group, respectively, reported some changes in the voiding pattern or posture at more than 1 year’s follow-up. Conclusion: There is no significant difference between the TVT and autologous rectus fascia sling procedures in the treatment of urinary stress incontinence at medium-term follow-up. There were changes in the voiding pattern for patients in both groups at more than 1 year postoperatively, which were not evident at early follow-up.

1676: Results of the Sister Randomized Surgical Trial Comparing the Autologous Rectus Fascia Sling to the Burch Colposuspension

1676: Results of the Sister Randomized Surgical Trial Comparing the Autologous Rectus Fascia Sling to the Burch Colposuspension