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Success of autologous pubovaginal sling after failed synthetic mid urethral sling.
J Urol. 2015 Mar; 193(3):916-20.JU

Abstract

PURPOSE

There is no consensus on the management of persistent or recurrent stress incontinence after a failed synthetic mid urethral sling. After a mesh complication or sling failure many women and surgeons prefer to avoid a repeat mesh procedure and choose an autologous pubovaginal sling. However, little empirical work has been performed to assess the efficacy.

MATERIALS AND METHODS

We performed a retrospective review of 66 women who underwent autologous pubovaginal sling with rectus fascia after 1 or more failed synthetic mid urethral sling from 2007 to 2012.

RESULTS

Mesh removal was performed before autologous pubovaginal sling in 21 patients (31.8%) while 6 (9.1%) had mesh removed simultaneously with autologous pubovaginal sling. Indications for the autologous pubovaginal sling were pure stress urinary incontinence in 16 patients (24.2%) and mixed incontinence in 50 (75.8%), 8 of whom were deemed complex with a prior urethral diverticulum or urethrovaginal fistula/urethral mesh erosion. At a mean of 14.5 months after autologous pubovaginal sling 46 (69.7%) patients reported cure of stress urinary incontinence. Of these patients 25 (37.9%) had complete cure with no stress or urgency incontinence, 17 had cure of stress urinary incontinence but had persistent urgency incontinence, and 4 had cure of stress urinary incontinence but experienced do novo urgency incontinence. Requiring a mesh excision did not predict worse outcomes compared to cases in which mesh was not removed (p=0.13). Patients with pure stress urinary incontinence were significantly more likely to be cured of all incontinence (62.5%) than those women with preoperative mixed incontinence (30.0%) (p=0.006).

CONCLUSIONS

Even after a failed synthetic mid urethral sling, autologous pubovaginal sling is effective and cured stress urinary incontinence in 69.7% of cases.

Authors+Show Affiliations

Department of Urology, University of Michigan, Ann Arbor, Michigan.Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.Department of Urology, University of Michigan, Ann Arbor, Michigan.Department of Urology, University of Michigan, Ann Arbor, Michigan.Department of Urology, University of Michigan, Ann Arbor, Michigan.Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: annepell@med.umich.edu.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

25245488

Citation

Milose, Jaclyn C., et al. "Success of Autologous Pubovaginal Sling After Failed Synthetic Mid Urethral Sling." The Journal of Urology, vol. 193, no. 3, 2015, pp. 916-20.
Milose JC, Sharp KM, He C, et al. Success of autologous pubovaginal sling after failed synthetic mid urethral sling. J Urol. 2015;193(3):916-20.
Milose, J. C., Sharp, K. M., He, C., Stoffel, J., Clemens, J. Q., & Cameron, A. P. (2015). Success of autologous pubovaginal sling after failed synthetic mid urethral sling. The Journal of Urology, 193(3), 916-20. https://doi.org/10.1016/j.juro.2014.09.038
Milose JC, et al. Success of Autologous Pubovaginal Sling After Failed Synthetic Mid Urethral Sling. J Urol. 2015;193(3):916-20. PubMed PMID: 25245488.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Success of autologous pubovaginal sling after failed synthetic mid urethral sling. AU - Milose,Jaclyn C, AU - Sharp,Kristen M, AU - He,Chang, AU - Stoffel,John, AU - Clemens,J Quentin, AU - Cameron,Anne P, Y1 - 2014/09/20/ PY - 2014/09/12/accepted PY - 2014/9/24/entrez PY - 2014/9/24/pubmed PY - 2015/10/1/medline KW - autografts KW - stress KW - suburethral slings KW - surgical mesh KW - urinary incontinence SP - 916 EP - 20 JF - The Journal of urology JO - J Urol VL - 193 IS - 3 N2 - PURPOSE: There is no consensus on the management of persistent or recurrent stress incontinence after a failed synthetic mid urethral sling. After a mesh complication or sling failure many women and surgeons prefer to avoid a repeat mesh procedure and choose an autologous pubovaginal sling. However, little empirical work has been performed to assess the efficacy. MATERIALS AND METHODS: We performed a retrospective review of 66 women who underwent autologous pubovaginal sling with rectus fascia after 1 or more failed synthetic mid urethral sling from 2007 to 2012. RESULTS: Mesh removal was performed before autologous pubovaginal sling in 21 patients (31.8%) while 6 (9.1%) had mesh removed simultaneously with autologous pubovaginal sling. Indications for the autologous pubovaginal sling were pure stress urinary incontinence in 16 patients (24.2%) and mixed incontinence in 50 (75.8%), 8 of whom were deemed complex with a prior urethral diverticulum or urethrovaginal fistula/urethral mesh erosion. At a mean of 14.5 months after autologous pubovaginal sling 46 (69.7%) patients reported cure of stress urinary incontinence. Of these patients 25 (37.9%) had complete cure with no stress or urgency incontinence, 17 had cure of stress urinary incontinence but had persistent urgency incontinence, and 4 had cure of stress urinary incontinence but experienced do novo urgency incontinence. Requiring a mesh excision did not predict worse outcomes compared to cases in which mesh was not removed (p=0.13). Patients with pure stress urinary incontinence were significantly more likely to be cured of all incontinence (62.5%) than those women with preoperative mixed incontinence (30.0%) (p=0.006). CONCLUSIONS: Even after a failed synthetic mid urethral sling, autologous pubovaginal sling is effective and cured stress urinary incontinence in 69.7% of cases. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/25245488/Success_of_autologous_pubovaginal_sling_after_failed_synthetic_mid_urethral_sling_ L2 - https://www.jurology.com/doi/10.1016/j.juro.2014.09.038?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -