Skip to main content

A randomised controlled trial comparing two autologous fascial sling techniques for the treatment of stress urinary incontinence in women: short, medium and long-term follow-up

International Urogynecology Journal volume 18, pages 1263–1270 (2007)Cite this article

Abstract

This randomised control trial compares full-length autologous slings (Group A: 81 women) with a modified “sling-on-a-string” (Group B: 84 women) technique for the treatment of stress urinary incontinence (SUI). Primary outcomes are quality of life (QoL) scores; Group A/Group B. The IIQ-7 scores decrease from 1.91/1.85 at baseline to 0.65/0.72 at 12 months and 0.85/0.92 at +5 years. The UDI-6 scores decrease from 1.85/1.61 at baseline to 0.66/0.62 at 12 months and 1.22/1.08 at +5 years. The incidence of SUI is 13% at 3 months but averages 53% at +5 years. Both techniques offer similar improvements. The shorter sling is quicker, less painful and with less hospital readmissions. The ‘sling-on-a-string’ technique is as effective as the standard technique with better short-term sequelae. The incidence of SUI post-autologous slings rises over the long term.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Royal College of Obstetricians and Gynaecologists (2003) Surgical treatment of urodynamic stress incontinence. Green-top guideline no. 35. October

  2. Abrams P, Hilton P, Lucas M, Smith T (2005) A proposal for a new classification for operative procedures for stress urinary incontinence. BJU Int 96:232–233

    PubMed  Article  Google Scholar 

  3. Aldridge A (1942) Transplantation of fascia for the relief of urinary stress incontinence. Am J Obstet Gynecol 44:398–441

    Google Scholar 

  4. Bidmead J, Cardozo L (2000) Sling techniques in the treatment of genuine stress incontinence. BJOG 107(2):147–156

    PubMed  Article  CAS  Google Scholar 

  5. Leach GE, Dmochowski RR, Appell RA, Blaivas JG, Hadley HR, Luber KM, Mostwin JL, O’Donnell PD, Roehrborn CG (1997) Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. J Urol 158(3):875–880

    PubMed  Article  CAS  Google Scholar 

  6. Bemelmans BLH, Chapple CR (2003) Are slings now the gold standard treatment for the management of female urinary stress incontinence and if so which technique? Curr Opin Urol 13:301–307

    PubMed  Article  Google Scholar 

  7. Kobashi KC, Govier F (2005) The completely dry rate: a critical re-evaluation of the outcomes of slings. Neurourol Urodyn 24:602–605

    PubMed  Article  Google Scholar 

  8. Department of Health (UK) (2006) Hospital episodes statistics. Department of Health [online]. Available from: URL: http://www.hesonline.nhs.uk

  9. Schumaker SA, Wyman JF, Uebersax JS, McClish D, Fanti JA for the Continence Program in Women (CPW) Research Group (1994) Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Qual Life Res 3:291–306 (Rapid communications of Oxford Ltd, Oxford)

    Google Scholar 

  10. Uebersax JS, Wyman JF, Schumaker SA, McClish D, Fanti JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Neurourol Urodyn 14:131–139

    PubMed  Article  CAS  Google Scholar 

  11. Barrington JW, Fulford SCV, Bales G, Stephenson TP (1998) The modified rectus fascial sling for genuine stress incontinence. J Obstet Gynaecol 18:61–62

    PubMed  Article  CAS  Google Scholar 

  12. Fulford SCV, Flynn R, Barrington J, Appanna T, Stephenson TP (1999) An assessment of the surgical outcome and urodynamic effects of the pubovaginal sling for stress incontinence and the associated urge syndrome. J Urol 162:135–137

    PubMed  Article  CAS  Google Scholar 

  13. Simsiman AJ, Powell CR, Stratford RR, Menefee SA (2005) Suburethral sling materials: best outcome with autologous tissue. Am J Obstet Gynecol 193:2112–2116

    PubMed  Article  Google Scholar 

  14. National Institute for Health and Clinical Excellence (UK): Interventional procedure guidance 154. Insertion of biological slings for stress urinary incontinence in women. www.nice.org.uk/IPG154

  15. Bezerra CA, Bruschini H, Cody DJ (2005) Traditional suburethral sling operations for urinary incontinence in women. The Cochrane Database of Systematic Reviews (3): CD001754. DOI 10.1002/14651858. CD001754.pub2

  16. Clyne OJ, O’Sullivan O, Flood HD (2005) Pubovaginal sling for urodynamic stress incontinence: effect on patient quality of life. Ir Med J 98(3):75–77

    PubMed  CAS  Google Scholar 

  17. Wadie BS, Edwan A, Nabeeth AM (2005) Autologous fascial sling vs. polypropylene tape at short-term follow-up: a prospective randomised study. J Urol 174:990–993

    PubMed  Article  Google Scholar 

  18. Bai SW, Sohn WH, Chung DJ, Park JH, Kim SK (2005) Comparison of the efficacy of Burch colposuspension, pubovaginal sling, and tension-free vaginal tape for stress urinary incontinence. Int J Gynaecol Obstet 91:246–251

    PubMed  Article  CAS  Google Scholar 

  19. McBride AW, Ellerkmann RM, Bent AE, Melick CF (2005) Comparison of long-term outcomes of autologous fascia lata slings with suspend tutoplast fascia lata allograft slings for stress incontinence. Am J Obstet Gynecol 192:1677–1681

    PubMed  Article  Google Scholar 

  20. Maher CF, O’Reilly BA, Dwyer PL, Carey MP, Cornish A, Schulter P (2005) Pubovaginal sling versus transurethral macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised control trial. BJOG 112:797–801

    PubMed  Article  Google Scholar 

  21. Corcos J, Collet JP, Shapiro S, Herschorn S, Radomski SB, Schick E, Gajewski JB, Benedetti A, Macramallah E, Hyams B (2005) Multicenter randomised clinical trial comparing surgery and collagen injection for treatment of female stress urinary incontinence. Urology 65(5):898–904

    PubMed  Article  CAS  Google Scholar 

  22. Morgan TO, Westney OL, McGuire EJ (2000) Pubovaginal sling: 4-year outcome analysis and quality of life assessment. J Urol 163:1845–1848

    PubMed  Article  Google Scholar 

  23. Blaivas JG, Jacobs BJ (1991) Pubovaginal fascial sling for the treatment of complicated stress urinary incontinence. J Urol 145:1214–1218

    PubMed  CAS  Google Scholar 

  24. Hilton P (2002) Trials of surgery for stress incontinence—thoughts on the ‘Humpty Dumpty principle’. BJOG 109:1080–1081

    Google Scholar 

  25. Ward KL, Hilton P, UK & Ireland TVT Trial Group (2004) A prospective multicenter randomised trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol 190:324–331

    PubMed  Article  Google Scholar 

Download references

Acknowledgement

The study was supported by a grant from the Welsh Office of Research and Development.

Author information

Affiliations

  1. Joint Urogynaecology Service, Suite 17, Singleton Hospital, Sketty, Swansea, SA2 8QA, UK

    K. Guerrero, S. Emery & M. Lucas

  2. School of Business and Economics, University of Wales Swansea, Swansea, SA2 8PP, UK

    A. Watkins

  3. Clinical Research Unit, Morriston Hospital, Swansea, SA6 6NL, UK

    K. Wareham

  4. Department of Urology, Princess of Wales Hospital, Bridgend, CF31 1RQ, UK

    T. Stephenson

  5. Department Obstetrics and Gynaecology, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, UK

    V. Logan

Authors
  1. K. Guerrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Watkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Emery
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Wareham
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Stephenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Logan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Lucas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Guerrero.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Guerrero, K., Watkins, A., Emery, S. et al. A randomised controlled trial comparing two autologous fascial sling techniques for the treatment of stress urinary incontinence in women: short, medium and long-term follow-up. Int Urogynecol J 18, 1263–1270 (2007). https://doi.org/10.1007/s00192-007-0307-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-007-0307-y

Keywords

  • Autologous slings
  • Stress urinary incontinence
  • Quality of life
  • Surgery