AUTOLOGOUS FASCIAL SLINGS
The following are 2 articles published recently about the use of autologous fascial tissue to treat urinary incontinence. As it is usual in surgery there are prons and cons.
Resurgence of Autologous Fascial Slings in a Challenging Climate for Sling Surgery: A 20-Year Review of Comparative Data
Chen, Yi-Ju Amy MD∗; Jean-Michel, Marjorie MD, MBA
From the Obstetrical and Gynaecological Survey
Since the United Sates Food and Drug Administration's 2016 ban of transvaginal mesh use in vaginal prolapse surgery, there has been growing public scrutiny over the use of synthetic mesh slings for the surgical management of female stress urinary incontinence. Although long considered the mainstay of current practice, interest in biological alternatives has grown.
This is a review of the last 20 years of data comparing the success of autologous fascial slings and synthetic mesh slings in the treatment of female stress urinary incontinence (SUI).
Randomized controlled trials comparing autologous pubovaginal sling and synthetic slings for the primary surgical treatment of female SUI using several search engines and databases between January 1, 2000, and March 31, 2020.
Data were retrieved and compared across studies. Trials were evaluated for study setting, type, population characteristics, sample size, success definition and rate, recurrence rate, operative time, length of hospital stay, complications, and quality of life.
Results: Of the 1382 articles reviewed, 8 met eligibility criteria, representing 6 distinct cohorts and 726 subjects.
Synthetic slings available for review were either tension-free vaginal tape (TVT) or mini-sling. The vast majority of studies demonstrated similar short- and long-term success rates of autologous fascial slings and synthetic sling procedures utilizing a range of outcome measures. Both sling procedures had low recurrence rates in short- and long-term follow-up. However, autologous fascial slings procedures had significantly longer operative time, and longer hospital stay. Bladder perforation, on the other hand, occurred more commonly in TVT sling.
Health-related quality-of-life scores, including sexual function, were similar between groups.
Conclusions: Autologous fascial sling and synthetic slings are both highly effective surgical procedures for the treatment of female SUI. Although success rates are comparable, autologous fascial sling procedures are associated with LESS favorable operative measures.
Relevance: This review supports the effectiveness of autologous fascial slings in treating female stress urinary incontinence as concerns over the use of synthetic materials in vaginal surgery rise. However, clinicians must weigh the risks conferred by the autologous fascial slings.
Autologous Fascial Slings for Surgical Management of Stress Urinary Incontinence: A Come Back
J B Sharma, Karishma Thariani, Manasi Deoghare, and Rajesh Kumari
J Obstet Gynaecol India
REPORTED COMPLICATION OF AUTOLOGOUS FASCIAL SLINGS
Voiding dysfunction 1.5%-7.8%
De novo overactive bladder 15%-20%
Wound infection 8%-10%
Urinary retention 5%-20%
Urinary infections 6%