Minimally-invasive autologous fascia sling at the mid-urethra: a case series.

The primary objective is to determine improvement of SUI symptoms using autologous fascia lata sling placed at the mid-urethra. The secondary objective is to determine the presence of leg pain following harvest of fascia lata graft.

Case series SETTING: Rural academic tertiary care center PATIENTS: all women who underwent an autologous fascia midurethral sling over a one-year period between June 2019 and September 2020 INTERVENTIONS: autologous fascia lata midurethral sling MEASUREMENTS: Incontinence Severity Index (ISI), Urodynamic Distress Inventory-6 (UDI-6), Likert pain scale.

19 women received an autologous fascial sling at the mid-urethra using the described technique; 16 fascia lata and 3 rectus fascia. Mean improvement in ISI score was 6 points. Mean improvement in UDI-6 and SUI subscale scores was 14 and 53 respectively, surpassing the MID for each. Median follow-up time was 9 months (range 2-16). Leg pain at the harvest site was bothersome in one patient beyond 6 weeks. Median time to passing voiding trial was 4 days (range 1-13 days). Four patients (21%) had post-operative voiding dysfunction, three of which resolved following sling loosening at a mean of 60 days after sling placement.

Mid-urethral autologous fascial sling placement significantly improves symptoms of SUI but carries a risk of voiding dysfunction. Harvesting fascia lata using a fascial stripper is associated with minimal post-operative morbidity.

Journal of minimally invasive gynecology. 2022 Jul 06 [Epub ahead of print]

Jonathan S Shaw, Kristen A Gerjevic, Catherine Pollack, Kris Strohbehn

Division of Urogynecology, Department of Obstetrics & Gynecology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: ., Division of Urogynecology, Department of Obstetrics & Gynecology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire., Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.