Autologous pubovaginal sling is a surgical option for patients with stress urinary incontinence (SUI), either as primary treatment, or in those who have failed synthetic sling placement. It is also favourable for patients at high risk of mesh erosion, for example in those who are immunocompromised or post-radiation. This video reviews the technical considerations in performing an autologous pubovaginal sling fashioned from rectus fascia in an immunocompromised patient with multiple previous abdominal surgeries.
The patient is a 63-year-old woman with SUI refractory to conservative management, with a background of Behcet's disease on long-term steroids. First, a 12 × 2cm rectus sheath graft was harvested through a Pfannenstiel incision. Stay sutures were placed to aid in subsequent sling placement. A vertical incision was made in the anterior vaginal wall after hydro-dissection with lignocaine/adrenaline solution and the plane was developed with a combination of blunt and sharp dissection. The trocars with the attached fascial sling were passed retropubically. Sling tensioning was assessed with a Q-tip test. An inadvertent bladder perforation was noted during the passage of the left trocar on intraoperative cystoscopy, which was managed conservatively with urinary catheterisation for one week post-operatively.
The patient was discharged well on postoperative day (POD) 2 and underwent a successful trial off catheter on POD7. At 1 month follow-up, the patient reported complete resolution of her SUI with no de-novo urgency or voiding dysfunction.
Autologous pubovaginal slings are an effective treatment option for SUI with minimal morbidity especially in patients with high risk of mesh erosion.
Urology. 2020 Jun 02 [Epub ahead of print]
Jeffrey J Leow, Clarissa Gurbani, Siying Yeow, Shirley Bang
Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. Electronic address: ., Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore., Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Urology, Khoo Teck Puat Hospital, Singapore., Advanced Urology Associates Pte Ltd, Singapore (formerly Department of Urology, Tan Tock Seng Hospital, Singapore.