Skip to main content

Advertisement

SpringerLink
Log in

Allograft Pubovaginal Slings: a Systematic Review

  • Voiding Dysfunction Evaluation (B Brucker and B Peyronnet, Section Editors)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Stress urinary incontinence (SUI) in women is the most common form of urinary incontinence and can be treated with different surgical procedures. As a sling procedure, the materials used are synthetic in midurethral sling (MUS) and non-synthetic tissue in pubovaginal sling (PVS): autografts (autologous), allografts, and xenografts. Cadaveric fascia (CAF) has been offered as an autograft substitute for years despite higher costs and unknown long-term outcomes. Herein, we review the use of allograft PVS in terms of overall efficacy to date. A literature search was performed with PRISMA through PubMed and Cochrane databases to identify studies published before September 2021. Key terms included “pubovaginal sling,” “allograft,” and “incontinence.” Systematic reviews, meta-analyses, and articles where sample patient populations were not diagnosed with SUI or did not receive allograft PVS were excluded.

Recent Findings

Twenty-two publications were found: eight were excluded, and fourteen met the criteria for review. Several publications compared the efficacy of CAF to autograft. Postoperative SEAPI scores displayed improved symptoms from baseline and success rates were equal to autografts. Two studies demonstrated a shorter lifespan of CAF. The origin of allograft material was considered. Other publications demonstrated that CAF had shorter operation times and post-operative hospital stays and lower infection rates.

Summary

Allograft PVS has shown to be an efficacious option based on quantitative patient satisfaction scores. APVS provides less morbidity including shorter operation time, postoperative hospital stays, and low infection rates; however, there are a limited number of studies comparing allograft PVS to other PVS materials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Irwin GM. Urinary incontinence. Prim Care. 2019;46(2):233–42. https://doi.org/10.1016/j.pop.2019.02.004.

    Article  Google Scholar 

  2. Saboia DM, Firmiano MLV, Bezerra KC, Vasconcelos JAN, Oria MOB, Vasconcelos CTM. Impact of urinary incontinence types on women’s quality of life. Rev Esc Enferm USP. 2017;51:e03266. https://doi.org/10.1590/S1980-220X2016032603266.

    Article  Google Scholar 

  3. Saadoun K, Ringa V, Fritel X, Varnoux N, Zins M, Breart G. Negative impact of urinary incontinence on quality of life, a cross-sectional study among women aged 49–61 years enrolled in the gazel cohort. Neurourol Urodyn. 2006;25(7):696–702. https://doi.org/10.1002/nau.20245.

    Article  Google Scholar 

  4. Stress urinary incontinence (sui). 2019; https://www.fda.gov/medical-devices/urogynecologic-surgical-mesh-implants/stress-urinary-incontinence-sui. Accessed January 23rd, 2022.

  5. Bayrak O, Osborn D, Reynolds WS, Dmochowski RR. Pubovaginal sling materials and their outcomes. Turk J Urol. 2014;40(4):233–9. https://doi.org/10.5152/tud.2014.57778.

    Article  Google Scholar 

  6. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017;318(16):1592–604. https://doi.org/10.1001/jama.2017.12137.

    Article  Google Scholar 

  7. • Hermieu N, Schoentgen N, Aoun R, et al. Surgical management of suburethral sling complications and functional outcomes. Prog Urol. 2020;30(7):402–10. https://doi.org/10.1016/j.purol.2020.04.022. The article by Hermieu N et al provided inspiration to review the efficacy of various slings and the materials that are used. It provided an excellent background context for various slings and their associated complications, especially mesh.

    Article  Google Scholar 

  8. Ordorica R, Rodriguez AR, Coste-Delvecchio F, Hoffman M, Lockhart J. Disabling complications with slings for managing female stress urinary incontinence. BJU Int. 2008;102(3):333–6. https://doi.org/10.1111/j.1464-410X.2008.07608.x.

    Article  Google Scholar 

  9. Albo ME, Richter HE, Brubaker L, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356(21):2143–55. https://doi.org/10.1056/NEJMoa070416.

    Article  Google Scholar 

  10. Flynn BJ, Yap WT. Pubovaginal sling using allograft fascia lata versus autograft fascia for all types of stress urinary incontinence: 2-year minimum followup. J Urol. 2002;167(2 Pt 1):608–12. https://doi.org/10.1097/00005392-200202000-00034.

    Article  Google Scholar 

  11. Brown SL, Govier FE. Cadaveric versus autologous fascia lata for the pubovaginal sling: surgical outcome and patient satisfaction. J Urol. 2000;164(5):1633–7.

    Article  Google Scholar 

  12. Almeida SH, Gregorio E, Grando JP, Rodrigues MA, Fraga FC, Moreira HA. Pubovaginal sling using cadaveric allograft fascia for the treatment of female urinary incontinence. Transplant Proc. 2004;36(4):995–6. https://doi.org/10.1016/j.transproceed.2004.03.058.

    Article  Google Scholar 

  13. Wright EJ, Iselin CE, Carr LK, Webster GD. Pubovaginal sling using cadaveric allograft fascia for the treatment of intrinsic sphincter deficiency. J Urol. 1998;160(3 Pt 1):759–62. https://doi.org/10.1097/00005392-199809010-00035.

    Article  Google Scholar 

  14. Onur R, Singla A, Kobashi KC. Comparison of solvent-dehydrated allograft dermis and autograft rectus fascia for pubovaginal sling: questionnaire-based analysis. Int Urol Nephrol. 2008;40(1):45–9. https://doi.org/10.1007/s11255-007-9210-1.

    Article  Google Scholar 

  15. Soergel TM, Shott S, Heit M. Poor surgical outcomes after fascia lata allograft slings. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(4):247–53. https://doi.org/10.1007/s001920170047.

    Article  Google Scholar 

  16. Huang YH, Lin AT, Chen KK, Pan CC, Chang LS. High failure rate using allograft fascia lata in pubovaginal sling surgery for female stress urinary incontinence. Urology. 2001;58(6):943–6. https://doi.org/10.1016/s0090-4295(01)01430-3.

    Article  Google Scholar 

  17. Amundsen CL, Visco AG, Ruiz H, Webster GD. Outcome in 104 pubovaginal slings using freeze-dried allograft fascia lata from a single tissue bank. Urology. 2000;56(6 Suppl 1):2–8. https://doi.org/10.1016/s0090-4295(00)00673-7.

    Article  Google Scholar 

  18. Onur R, Singla A. Solvent-dehydrated cadaveric dermis: a new allograft for pubovaginal sling surgery. Int J Urol. 2005;12(9):801–5. https://doi.org/10.1111/j.1442-2042.2005.01139.x.

    Article  Google Scholar 

  19. Elliott DS, Boone TB. Is fascia lata allograft material trustworthy for pubovaginal sling repair? Urology. 2000;56(5):772–6. https://doi.org/10.1016/s0090-4295(00)00825-6.

    Article  Google Scholar 

  20. Walsh IK, Nambirajan T, Donellan SM, Mahendra V, Stone AR. Cadaveric fascia lata pubovaginal slings: early results on safety, efficacy and patient satisfaction. BJU Int. 2002;90(4):415–9. https://doi.org/10.1046/j.1464-410x.2002.02913.x.

    Article  Google Scholar 

  21. •• Brennand EA, Ugurlucan FG, Brown HW, et al. Female pelvic medicine and reconstructive surgery challenges on behalf of the collaborative research in pelvic surgery consortium: managing complicated cases: series 5: management of recurrent stress urinary incontinence after midurethral sling exposure. Int Urogynecol J. 2020;31(9):1747–54. https://doi.org/10.1007/s00192-020-04385-3. Similarily, the article by Brennand EA et al. demonstrated the benefits and risks of using allograft materials in PVS. This article addressed important variables to consider with PVS allograft and autograft, as well as the efficacy of both. We found this article be of peculiar interest as it reinforced the need to consider each patient as a unique individual, while analyzing mesh, autograft, and allograft methods.

    Article  Google Scholar 

  22. Buck BE, Malinin TI. Human bone and tissue allografts. Preparation and safety. Clin Orthop Relat Res. 1994(303):8–17.

  23. Hinton R, Jinnah RH, Johnson C, Warden K, Clarke HJ. A biomechanical analysis of solvent-dehydrated and freeze-dried human fascia lata allografts. A preliminary report. Am J Sports Med. 1992;20(5):607–12. https://doi.org/10.1177/036354659202000521.

    Article  Google Scholar 

  24. Lemer ML, Chaikin DC, Blaivas JG. Tissue strength analysis of autologous and cadaveric allografts for the pubovaginal sling. Neurourol Urodyn. 1999;18(5):497–503. https://doi.org/10.1002/(sici)1520-6777(1999)18:5%3c497::aid-nau12%3e3.0.co;2-k.

    Article  Google Scholar 

  25. Fitzgerald MP, Mollenhauer J, Brubaker L. Failure of allograft suburethral slings. BJU Int. 1999;84(7):785–8. https://doi.org/10.1046/j.1464-410x.1999.00246.x.

    Article  Google Scholar 

  26. Carbone JM, Kavaler E, Hu JC, Raz S. Pubovaginal sling using cadaveric fascia and bone anchors: disappointing early results. J Urol. 2001;165(5):1605–11.

    Article  Google Scholar 

  27. Krambeck AE, Dora CD, Sebo TJ, Rohlinger AL, DiMarco DS, Elliott DS. Time-dependent variations in inflammation and scar formation of six different pubovaginal sling materials in the rabbit model. Urology. 2006;67(5):1105–10. https://doi.org/10.1016/j.urology.2005.11.036.

    Article  Google Scholar 

  28. Dora CD, Dimarco DS, Zobitz ME, Elliott DS. Time dependent variations in biomechanical properties of cadaveric fascia, porcine dermis, porcine small intestine submucosa, polypropylene mesh and autologous fascia in the rabbit model: Implications for sling surgery. J Urol. 2004;171(5):1970–3. https://doi.org/10.1097/01.ju.0000121377.61788.ad.

    Article  Google Scholar 

  29. Amundsen CL, Flynn BJ, Webster GD. Urethral erosion after synthetic and nonsynthetic pubovaginal slings: differences in management and continence outcome. J Urol. 2003;170(1):134–7. https://doi.org/10.1097/01.ju.0000064442.45724.af.

    Article  Google Scholar 

  30. Miller EA, Amundsen CL, Toh KL, Flynn BJ, Webster GD. Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling. J Urol. 2003;169(6):2234–7. https://doi.org/10.1097/01.ju.0000063590.13100.4d.

    Article  Google Scholar 

  31. Hathaway JK, Choe JM. Intact genetic material is present in commercially processed cadaver allografts used for pubovaginal slings. J Urol. 2002;168(3):1040–3. https://doi.org/10.1097/01.ju.0000024392.41524.83.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine, University of Texas Medical Branch, Galveston, TX, USA

    Cynthia Cabrales, Brian Liao & Corey Able

  2. Department of Surgery, Division of Urology, University of Texas Medical Branch, Galveston, TX, USA

    George Coba & Bilal Farhan

Authors
  1. Cynthia Cabrales
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Corey Able
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George Coba
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bilal Farhan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by CC and BL. The first draft of the manuscript was written by CC, BL, and CA. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bilal Farhan.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors. All studies reported in this article have been reported to have complied with all applicable ethical standards. There were no individuals reported in this study. Informed consent is not applicable to this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Voiding Dysfunction Evaluation

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cabrales, C., Liao, B., Able, C. et al. Allograft Pubovaginal Slings: a Systematic Review. Curr Bladder Dysfunct Rep 17, 257–262 (2022). https://doi.org/10.1007/s11884-022-00667-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-022-00667-2

Keywords

Search

Navigation