Autologous rectus fascia sling placement in the management of female stress urinary incontinence

Introduction and hypothesis Autologous pubovaginal sling placement remains a treatment option in index patients, given high, long-term success rates. This video reviews the technical considerations for performing an autologous rectus fascia sling. Methods The patient is a 47-year-old woman with stre...

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Bibliographic Details
Published in:International Urogynecology Journal 2018-09, Vol.29 (9), p.1403-1405
Main Authors: Miller, Adam R., Linder, Brian J., Lightner, Deborah J.
Format: Article
Language:English
Subjects:
Bladder
Fascia
Fasciotomy
Female
Gynecology
Humans
IUJ Video
Medicine
Medicine & Public Health
Middle Aged
Prostheses and Implants
Suburethral Slings
Treatment Outcome
Urethra - injuries
Urinary incontinence
Urinary Incontinence, Stress - surgery
Urogenital Surgical Procedures - instrumentation
Urogenital Surgical Procedures - methods
Urology
Vagina
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Summary:Introduction and hypothesis Autologous pubovaginal sling placement remains a treatment option in index patients, given high, long-term success rates. This video reviews the technical considerations for performing an autologous rectus fascia sling. Methods The patient is a 47-year-old woman with stress urinary incontinence (SUI) refractory to conservative management. First, a 10-cm rectus fascial segment is harvested and prepped with placement of nonabsorbable stay sutures for later sling passage. Then, an inverted U -shaped incision is made in the anterior vaginal wall based on the bladder neck, and perforation of the endopelvic fascia is performed. Following passage of the sling in the retropubic space, it is secured to periurethral tissue. Cystoscopy is then used to evaluate for bladder perforation and to confirm sling tensioning. Results The patient was discharged on the same day of surgery with a suprapubic tube in place, which was removed on postoperative day 7 after passing a capping trial. At 6 weeks’ follow-up, the patient had complete resolution of SUI, with no de novo urgency symptoms, and could empty her bladder to completion. Conclusion Autologous pubovaginal sling placement remains an effective treatment option for the management of female SUI. This video highlights important technical considerations for this procedure.
ISSN:0937-3462
1433-3023
1433-3023
DOI:10.1007/s00192-018-3643-1