This was first developed in 2005 by Dr. Andrianne. The sling is attached to corporotomies so when cylinders are inflated the sling leads to compression of the urethra to limit urine leakage. Cadaveric and synthetic materials are used. There is a <8% complication rate.
Dr. Choi describes a novel technique using autologous sling harvested from rectus fascia. A transverse penoscrotal incision is made and dissection carried down to corpora in a standard fashion. Corporotomies were made and about 3 cm down to the crus. The sling placement is as proximal as possible for good coaptation of urethra. The corpora then measured and dilated. The coprorotomies were measured in a side to side fashion for the sling measurement. This was measured to 3.5 cm and a 4x3 cm sling was chosen to account for contraction of the fascia. Of note, do not suture graft to urethra.
The rectus fascia was harvested in a standard manner. The sling was placed with 2-0 PDS in the corporotomies. There was no tension and a clamp was allowed to be placed in between the coprora and the sling. An AMS IPP was then placed in the standard manner and corpora were carefully closed with running 2-0 vicryl suture. The tubing was then connected and pump placed. The skin was closed in a standard manner.
Cystoscoy was performed and it then confirmed coaptation. See the image below.
A JP drain was placed and a compressive dressing applied. At the 1-month post op visit, the patients stress incontinence and climacturia resolved. He had no voiding issues and overall very happy with his outcome. Longer follow up studies are needed to see how patient outcomes will be with the autologous fascia.
Presented by: Judy Choi, MD, Department of Urology, UC Irvine Health
Written by: M Lira Chowdhury, DO, Fellow, Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction, The University of California Irvine, Department of Urology, @lirachowdhury at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida