AUA 2018: Contemporary Review of Complications Associated with Autologous Rectus Fascia Pubovaginal Slings

San Francisco, CA ( The use of synthetic slings remains a viable option in the treatment of stress urinary incontinence (SUI), but due to growing concerns in the public regarding the use of vaginal mesh, there has been a resurgence in the utilization of autologous fascial slings for the management of SUI. However, data regarding the outcomes and potential complications due to autologous rectus fascial slings (ARFS) remains limited. 

Sophia Delpe, MD, presented data from Vanderbilt University regarding the complications and associated risk factors of ARFS, “Contemporary review of complications associated with autologous rectus fascia pubovaginal slings.” 

The investigators performed a retrospective review of women who underwent pubovaginal slings with autologous rectus fascia at their institution between January 2006 and December 2016. Exclusion criteria included concomitant abdominal surgery. Information regarding medical comorbidities and complications within 30 days of surgery was collected.

325 patients were included in the study. 227 (69.8%) of women did not have complications, and 98 (30.2%) had a total of 115 complications. Complications were associated with a history of prior SUI surgery (70% vs. 56.4%, p=0.018), and the use of chronic pain medications (15.3% vs. 7.9%, p=0.043). The investigators reported a 66.9% of Clavien Grade I complications, of which wound complications were the most common. 14.2% of patients had prolonged urinary retention lasting  >6 weeks. There were no Clavien IVb or V complications. 

Of note, there was no difference in age or body mass index (BMI) between those who had a complication and those who did not. Prior abdominal surgery, prior radiation therapy, immunosuppression, diabetes, cardiovascular disease, and pulmonary comorbidities were not associated with an increased risk of complications.

As the use of autologous rectus fascia increases as an alternative to synthetic mesh in the treatment of SUI, it is important to review potential complications related to the procedure and to identify possible risk factors that may be associated with them. Prior SUI surgery and chronic pain comorbidities were associated with increased complications, although BMI, prior abdominal surgery, and diabetes were not. The current study highlights that no SUI procedure is without potential risks and provides information that will aid in the planning and counseling of patients.

Presented by: Sophia Delpe, Nashville, TN
Co-Authors: Casey Kowalik, Nashville, TN, Pei Yang, Nashville, TN, W. Stuart Reynolds, Nashville, TN, Melissa Kaufman, Roger Dmochowski, Nashville, TN

Written by: Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA