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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.
Neurourol Urodyn. 2016 06; 35(5):604-8.NU

Abstract

AIMS

Given 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).

METHODS

An 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.

RESULTS

288 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.

CONCLUSIONS

Despite 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. © 2015 Wiley Periodicals, Inc.

Authors+Show Affiliations

Department of Urology, The University of Kansas Medical, Kansas City, Kansas.Department of Urology, Louisiana State University Health, Shreveport, Louisiana.Department of Urology, The University of Kansas Medical, Kansas City, Kansas.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

25820772

Citation

Parker, William P., et al. "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." Neurourology and Urodynamics, vol. 35, no. 5, 2016, pp. 604-8.
Parker WP, Gomelsky A, Padmanabhan P. 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. Neurourol Urodyn. 2016;35(5):604-8.
Parker, W. P., Gomelsky, A., & Padmanabhan, P. (2016). 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. Neurourology and Urodynamics, 35(5), 604-8. https://doi.org/10.1002/nau.22759
Parker WP, Gomelsky A, Padmanabhan P. 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. Neurourol Urodyn. 2016;35(5):604-8. PubMed PMID: 25820772.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Parker,William P, AU - Gomelsky,Alex, AU - Padmanabhan,Priya, Y1 - 2015/03/27/ PY - 2014/10/22/received PY - 2015/02/11/accepted PY - 2015/3/31/entrez PY - 2015/3/31/pubmed PY - 2017/6/28/medline KW - autologous pubovaginal sling KW - midurethral sling KW - street urinary incontinece KW - surgical mesh SP - 604 EP - 8 JF - Neurourology and urodynamics JO - Neurourol Urodyn VL - 35 IS - 5 N2 - AIMS: Given 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). METHODS: An 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. RESULTS: 288 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. CONCLUSIONS: Despite 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. © 2015 Wiley Periodicals, Inc. SN - 1520-6777 UR - https://www.unboundmedicine.com/medline/citation/25820772/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_ L2 - https://doi.org/10.1002/nau.22759 DB - PRIME DP - Unbound Medicine ER -