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

Miami, FL ( 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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