Banked cadaveric fascia lata: 3-year follow-up

2019

OBJECTIVE To evaluate long term outcomes of autologous pubovaginal fascial sling (AFPVS) as a salvage procedure following different types of failed anti-incontinence surgeries. MATERIALS AND METHODS We retrospectively reviewed medical records of patients who had undergone salvage AFPVS after any kind of anti-incontinence surgery from 2005-2015 at our medical center. Patients were contacted by telephone. Revised Urinary Incontinence Scale (RUIS) was used to determine the success rate. RESULTS A total of 40 patients out of 51 were successfully contacted. Mean patient age was 50.8± 9.8 years (range30-75) and mean follow up was 62.6±32.4 months (range12-120). Of 40 patients, 14(35%) had pure SUI and 26(65%) complained of mixed urinary incontinence. A total of 15(37.5%) patients had a failed Burch colposuspention, 5(12.5%) TVT, 8(20%) TOT, 3 (7.5%) AFPVS and five (12.5%) patients had history of failed mini-sling procedure. Four (10%) patients had undergone more than one anti incontinence...

The Journal of Urology, 1997

Purpose: Bladder neck suspension using an autologous fascial sling is an established surgical technique for treatment of urinary stress incontinence. However, the biological fate a n d physical properties of autologous fascial sling yet remain to be determined.

Current Opinion in Urology, 2020

Scandinavian Journal of Urology, 2012

Objective.This article reports the early results of a novel sling used for the treatment of female stress urinary incontinence (SUI). This sling has a piece of autologous rectus fascia in its middle part and two arms of polypropylene mesh. Material and methods. The study included 44 women with SUI. The preoperative work-up involved complete history taking, physical examination, cough stress test (CST) and 1 h pad weight test (PWT). Two questionnaires, the Urogenital Distress Inventory-Short Form (UDI-6) and the Incontinence Impact Questionnaire-Short Form (IIQ-7), were also completed preoperatively. The previously described sling was then inserted via the transobturator route in all patients. Postoperatively, the previous work-up was repeated for objective evaluation of the procedure and the subjective improvement was assessed by the Patient Global Impression of Improvement scale. Results.At the end of the first year, 92.9% of the patients had a negative CST, 85.7% had 1 h PWT <1 g and the subjective cure rate was 90.5%. In addition, the scores for both UDI-6 and IIQ-7 were found to be decreased significantly (p < 0.001). The recorded complications included temporary urinary retention, dyspareunia, de novo urge incontinence and groin pain in 4.8%, 4.8%, 7.1% and 11.9% of patients, respectively. Conclusion. This hybrid sling appears to have good short-term efficacy and low cost.

The Journal of Urology, 2004

Purpose: Sling cystourethropexy for intrinsic sphincter deficiency has more recently been accepted as effective surgical treatment for all types of stress urinary incontinence. We report our experience using autologous fascia lata for sling cystourethropexy, regarding treatment efficacy, harvest site morbidity and patient satisfaction.

International Urogynecology Journal, 2019

Recent times have witnessed a resurgence in the use of autologous fascial slings as treatment for stress urinary incontinence. They have been found to have a high success rate, without risk of complications related to synthetic implanted material [1, 2]. Following Food and Drug Administration cautions and a temporary ban on the use of tapes for stress urinary incontinence in some countries, there is resultant patient fear, stigma and litigation associated with pelvic floor mesh [2]. This will likely lead to further utilization of autologous slings in the future. Correlations among ultrasound, surgical success and complications for mid-urethral slings with mesh have been described [3]. There is a paucity of research on the imaging of autologous slings for predicting either operative success or complications. We present these images to demonstrate how pelvic floor ultrasound could be used in the immediate post-operative period * Ranee Thakar

Neurourology and Urodynamics, 2004

AimsTo compare the long-term results of stress urinary incontinence (SUI) treatment involving the fascial or vaginal sling operations.To compare the long-term results of stress urinary incontinence (SUI) treatment involving the fascial or vaginal sling operations.Material and MethodsTwo-hundred-thirty-two women were consecutively submitted to fascial or vaginal sling operations due to urodynamic proven SUI. The fascial group had a median age of 47.3 years with a parity of 2.2 and 1.8 surgeries/patient, while the vaginal group demonstrated a median age of 48.5 years with a median parity of 3.1 and 2.2 anterior surgeries/patient. The results were subjectively classified as cured—no further pads, greatly improved—very rare dribbling, improved—eventual dribbling necessitating one pad, no cure—with no urine loss change and worse. The number of pads/day, the presence of urgency or urge-incontinence episodes were all measured. Statistical analysis using Fisher's exact test was employed.Two-hundred-thirty-two women were consecutively submitted to fascial or vaginal sling operations due to urodynamic proven SUI. The fascial group had a median age of 47.3 years with a parity of 2.2 and 1.8 surgeries/patient, while the vaginal group demonstrated a median age of 48.5 years with a median parity of 3.1 and 2.2 anterior surgeries/patient. The results were subjectively classified as cured—no further pads, greatly improved—very rare dribbling, improved—eventual dribbling necessitating one pad, no cure—with no urine loss change and worse. The number of pads/day, the presence of urgency or urge-incontinence episodes were all measured. Statistical analysis using Fisher's exact test was employed.ResultsThe patients were followed up for an average time of 70.3 and 44.9 months, in the fascial and vaginal sling group respectively. Subjective clinical success rate was 93.7% for the fascial sling group and 79.8% for the vaginal one, however, the stratification of the results favored the fascial sling group mostly with 74.4% (94 cases) of the cases with total urinary control and no voiding dysfunctions. Only two cases (1.6%) in this group classified themselves as worsened. On the other hand, the vaginal sling subset revealed cure with total clinical satisfaction and no urinary complaint in 61.5% (62 females) (P > 0.05). Thirteen cases (12.5%) reported recurrence of the urine loss under stress and these constituted the failure group. The average number of pads diminished from 3.3 (±0.8) to 0.2 (±0.2) and from 3.2 (±0.7) to 0.6 (±0.5) after the surgery, for the fascial and vaginal sling operations respectively. Return to daily activities occurred after 9.3 days (±1.2, max: 33, min: 2) for the fascial slings and 5.3 days (±0.2, max: 17, min: 2) in the vaginal group. Surgical complications were compared between the groups. Time to urethral voiding varied according to expertise, demonstrating a diminishing tendency after the initial 20 cases. Female obstruction was observed in 11.1% of the fascial slings and 8.6% after vaginal approach, but none in the vaginal group required urethrolysis. Looking individually, the FS group migrated to the worse results while the VWS group started to lose the efficiency after 6 months.The patients were followed up for an average time of 70.3 and 44.9 months, in the fascial and vaginal sling group respectively. Subjective clinical success rate was 93.7% for the fascial sling group and 79.8% for the vaginal one, however, the stratification of the results favored the fascial sling group mostly with 74.4% (94 cases) of the cases with total urinary control and no voiding dysfunctions. Only two cases (1.6%) in this group classified themselves as worsened. On the other hand, the vaginal sling subset revealed cure with total clinical satisfaction and no urinary complaint in 61.5% (62 females) (P > 0.05). Thirteen cases (12.5%) reported recurrence of the urine loss under stress and these constituted the failure group. The average number of pads diminished from 3.3 (±0.8) to 0.2 (±0.2) and from 3.2 (±0.7) to 0.6 (±0.5) after the surgery, for the fascial and vaginal sling operations respectively. Return to daily activities occurred after 9.3 days (±1.2, max: 33, min: 2) for the fascial slings and 5.3 days (±0.2, max: 17, min: 2) in the vaginal group. Surgical complications were compared between the groups. Time to urethral voiding varied according to expertise, demonstrating a diminishing tendency after the initial 20 cases. Female obstruction was observed in 11.1% of the fascial slings and 8.6% after vaginal approach, but none in the vaginal group required urethrolysis. Looking individually, the FS group migrated to the worse results while the VWS group started to lose the efficiency after 6 months.ConclusionsSling operations are a safe and efficacious option to treat SUI, however, the results can vary according to the technique employed. Shorter efficacy and fewer complications are observed in vaginal wall sling operations, while durable results, but with a higher rate of voiding dysfunctions compromising the long-term clinical satisfaction may be observed after excessive urethral suspensions, as in fascial sling suspension. © 2004 Wiley-Liss, Inc.Sling operations are a safe and efficacious option to treat SUI, however, the results can vary according to the technique employed. Shorter efficacy and fewer complications are observed in vaginal wall sling operations, while durable results, but with a higher rate of voiding dysfunctions compromising the long-term clinical satisfaction may be observed after excessive urethral suspensions, as in fascial sling suspension. © 2004 Wiley-Liss, Inc.

American Journal of Obstetrics and Gynecology, 2000

The Bible and Interpretation (https://bibleinterp.arizona.edu/), 2024

Hebrew Bible. In my view, such postmodern disavowals of universal conceptsincluding knowledge, empathy, tolerance, equality, and inalienable human rights-are symptoms of something deeper, a reaction to the uncertainty of the modern world and the decline of the humanities. We need not retreat into all-or-nothing thinking and esoteric governmental conspiracies. To paraphrase a Renaissance author who had his own issues, the fault is not in Orientalism, but in ourselves.