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International Urogynecology Journal

, Volume 29, Issue 9, pp 1403–1405 | Cite as

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

  • Adam R. Miller
  • Brian J. Linder
  • Deborah J. Lightner
IUJ Video

Abstract

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.

Keywords

Pubovaginal sling Urinary incontinence Stress Urogenital surgical procedures 

Notes

Compliance with ethical standards

Conflicts of interest

None.

Consent

Written informed consent was obtained from the patient for publication of this case report video article and any accompanying images.

Supplementary material

192_2018_3643_MOESM1_ESM.mp4 (69.4 mb)
ESM 1 (MP4 71,042 kb)

References

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    Kobashi KC, Albo ME, Dmochowski RR, et al. Surgical treatment of female stress urinary incontinence: AUA/SUFU guideline. J Urol. 2017;198:875–83.  https://doi.org/10.1016/j.juro.2017.06.061.CrossRefPubMedGoogle Scholar
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    Chaikin DC, Rosenthal J, Blaivas JG. Pubovaginal fascial sling for all types of stress urinary incontinence: long-term analysis. J Urol. 1998;160:1312–6.CrossRefPubMedGoogle Scholar
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    Athanasopoulos A, Gyftopoulos K, McGuire EJ. Efficacy and preoperative prognostic factors of autologous fascia rectus sling for treatment of female stress urinary incontinence. Urology. 2011;78:1034–8.  https://doi.org/10.1016/j.urology.2011.05.069.CrossRefPubMedGoogle Scholar
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    Morgan TO Jr, Westney OL, McGuire EJ. Pubovaginal sling: 4-year outcome analysis and quality of life assessment. J Urol. 2000;163:1845–8.CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Department of UrologyMayo ClinicRochesterUSA

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