SUFU 2019: Long-Term Outcomes of Autologous Pubovaginal Sling for Stress Urinary Incontinence

Miami, FL (UroToday.com) The autologous fascial pubovaginal sling (PVS) has historically been reserved for challenging cases, including patients with intrinsic sphincter deficiency (ISD), recurrent stress urinary incontinence (SUI), or a history of mesh complications. However, with the advent of mesh complications related to mid-urethral slings (MUS), the use of PVS has become a viable option for patients who prefer a biologic alternative to synthetic slings.

Katherine Amin, MD, and her group at the Virginia Mason Medical Center reported on the long-term follow-up outcomes of the PVS for the treatment of SUI. Based on a retrospective review of a prospectively collected database and annual mailed questionnaires, they analyzed results from patients who underwent PVS (using autologous rectus fascia or autologous fascia lata) for SUI at their institution. The follow-up questionnaires included patient-perceived percent-improvement, Urogenital Distress Inventory Short Form (UDI-6), and Patient Global Impression of Improvement (PGI-I). Success was defined as ≥70% improvement from baseline or <1 incontinence episode per week. Patients were considered dry if they answered “not at all” on question 3 of the UDI-6.

181 patients were included in the study, all of whom underwent PVS from 2000-2016. Mean age was 59.9 years, and 76% of patients had a history of previous SUI surgery. 73.9% had ISD (defined as Valsalva leak point pressure (VLPP) <60 cmH2O), and the mean VLPP was 35.9±26.4). 17.1% of patients had a concomitant prolapse procedure.

Of these 181 patients, 92 (50.8%) patients had questionnaire data with a follow-up of 12 months. 17/181 (9.4%) of patients had postoperative urinary retention, of which 15 (88.2%) had a resolution within 90 days. 14/181 patients (7.7%) had ≥ Clavien-Dindo Grade II complications within 90 days of surgery (Figure 1).

UroToday SUFU2019 Pubovaginal Sling

Among patients with follow-up data, mean and median follow-up time was 8.3 and 9.2 years (range 1.1-18.0), respectively. The reported success rate was 70.3%, and the patient-reported dry rate was 37.1%. The median PGI-I score was 2 or “much better” (IQR 1,4).

37.6% of patients developed de novo urgency urinary incontinence (UUI), 44.4% had persistent UUI, and 37.6% of patients had a resolution of their UUI. 14.9% of patients required a post-PVS procedure to treat UUI.

The authors concluded that autologous PVS was a safe and effective treatment option for SUI with lasting results.


Presented by: Katherine Amin, MD, Virginia Mason Medical Center 

Written by: Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida
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