OBJECTIVE - To evaluate short-term outcomes of autologous transobturator (ATO) urethral sling placement using rectus fascia for female stress urinary incontinence.
METHODS - We evaluated the outcomes of 33 consecutive females that underwent ATO sling placement with rectus fascia for stress incontinence from 2013-2014.
Patients were seen at 3 months postoperatively and mailed a questionnaire at least one year after surgery for further follow-up. Outcomes were measured by ICIQ-FLUTS and compared between pre and postoperative responses using Wilcoxon Signed Rank test. Retreatment-free survival rates were evaluated via Kaplan-Meier method.
RESULTS - Median patient age was 62 years old (IQR 47.5;70.5) with a median BMI of 28.6 kg/m(2) (IQR 24.7kg/m(2); 32.4kg/m(2)). When isolated sling placement was performed, 88% (15/17) were outpatient procedures. Median follow-up was 14.9 months (IQR 3.6,18.7), during which five patients underwent repeat anti-incontinence surgery. For those without retreatment, 25/28 (89%) completed ICIQ-FLUTS at last follow-up. Compared to preoperative scores, patients who completed ICIQ-FLUTS questionnaires at 1-year or greater (N=18) showed significant improvement in all domains: frequency (p=0.007), voiding (p=0.02) and incontinence (p=0.004), and in quality of life related to frequency (p=0.008), voiding (p=0.002) and incontinence (p=0.01). Among those who completed questionnaires both at 3-month and at least 1 year after surgery (N=17), there was no significant deterioration in ICIQ-FLUTS scores. Overall retreatment-free survival rate was 92% at 1 year. Notably, no patients suffered severe (Clavien III-V) complications or required sling release.
CONCLUSIONS - Autologous transobturator urethral sling placement appears safe, with promising short-term outcomes. Longer follow-up and external validation are needed.
Urology. 2016 Mar 29 [Epub ahead of print]
Brian J Linder, Daniel S Elliott
Department of Urology, Section of Pelvic and Reconstructive Urology, Mayo Clinic, Rochester, MN., Department of Urology, Section of Pelvic and Reconstructive Urology, Mayo Clinic, Rochester, MN.