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_ DB - PRIME DP - Unbound Medicine ER -