Safety concerns with the use of mesh in vaginal surgery have been ongoing. Autologous fascial slings (AFS) avoid foreign body complications. We compared the long-term (17-year) outcomes of two AFS repair methods-the standard sling and short sling (sling-on-string), and assessed durability and patient satisfaction of these for the treatment of stress urinary incontinence (SUI).
A total of 107 patients from three urogynaecology units who had participated in a randomised controlled trial assessing standard (n = 52) and short (n = 55) slings were followed up for a median period of 17 years. Primary outcomes were Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores to assess the impact on the quality of life and symptom distress. Logistic quantile regression was employed to compare the two methods. Secondary outcomes included long-term complications and patient satisfaction.
Mean scores showed no statistically significant difference between the standard and short slings at the 17-year follow-up relating to IIQ and UDI scores, leakage or urgency (p > 0.05). Improved bladder function was observed at 17 years compared with baseline (standard sling-IIQ scores mean difference [MD] 1.22 [CI: 0.69, 1.74], UDI scores MD 0.83 [CI: 0.70, 0.97]; short sling-IIQ score MD 1.14 [CI: 0.73, 1.54], UDI scores MD 0.54 [CI: 0.40, 0.67]) with age-related deterioration over time. Re-operation rates were low and patient satisfaction rates were high (67.2%) at follow-up.
Autologous fascial slings are an effective and durable option for management of SUI and the short sling procedure can be recommended owing to plausible surgical advantages.
International urogynecology journal. 2024 Feb 01 [Epub ahead of print]
Deepa B Nair, Zainab Khan, Tapas Mishra, Jagrati Chopra, Kathie Wareham, Simon J Emery
Department of Obstetrics and Gynaecology, Singleton Hospital, Swansea, UK. ., Department of Obstetrics and Gynaecology, Singleton Hospital, Swansea, UK., Southampton Business School, University of Southampton, Southampton, UK., Department of Obstetrics and Gynaecology, University Hospitals Southampton, Southampton, UK., Clinical Research Unit, Swansea University, Swansea, UK., Pelvic Floor Unit, Singleton Hospital, Swansea, UK.