Autologous fascia pubovaginal slings after prior synthetic anti-incontinence procedures for recurrent incontinence: A multi-institutional prospective comparative analysis to de novo autologous slings assessing objective and subjective cure

作者：Parker William P^*; Gomelsky Alex; Padmanabhan Priya

来源：Neurourology and Urodynamics, 2016, 35(5): 604-608.

DOI：10.1002/nau.22759

• autologous pubovaginal sling
• midurethral sling
• street urinary incontinece
• surgical mesh

AimsGiven the paucity of prospective data on the treatment of incontinent women with prior synthetic mid-urethral sling (MUS), we sought to report our prospective experience with autologous fascia pubovaginal sling placement (AF-PVS) after prior synthetic mid-urethral sling (MUS).
MethodsAn IRB-approved, multi-institutional, prospective cohort of patients from 2010 to 2013 undergoing AF-PVS for urinary incontinence was evaluated and stratified for the presence of a prior MUS. Pre-operative characteristics and validated quality of life questionnaires (IIQ-7 and UDI-6) were compared to post-operative pad usage, scores on the IIQ-7 and UDI-6, complications, and visual analog scale assessment of improvement.
Results288 patients met inclusion criteria, 59 (20.4%) of whom had undergone a prior MUS before AF-PVS placement. Of these 59 patients, 20 (33.9%) had a prior vaginal extrusion and 5 (8.5%) had suffered from obstruction requiring sling lysis or excision. With a median of 14 months follow-up, prior MUS placement was not associated with a significant difference in objective (55.9% vs. 62.4%, P=0.37) or subjective cure (66.1% vs. 69.0%, P=0.75) when compared to patients undergoing placement of an initial AF-PVS. Patients undergoing AF-PVS after prior MUS did have a significantly higher rate of urinary retention requiring intermittent catheterization (8.5% vs. 3.1%, P<0.001) and re-operation (13.6% vs. 3.5%, P=0.01) for persistent incontinence.
ConclusionsDespite higher rates of retention and need for repeat operation, AF-PVS after failed MUS is an acceptable treatment option with no difference in success as compared to patients undergoing initial AF-PVS placement. Neurourol. Urodynam. 35:604-608, 2016.

• 出版日期2016-6