FASCIA OR MESH ? 20 YEARS’EXPERIENCE IN RETROPUBIC SUB-URETHRAL SLING SURGERY FOR FEMALE STRESSURINARY INCONTINENCE: COMPARISON BETWEEN AUTOLOGOUS FASCIA ANDPROLENE MESH
Taipei Veterans Gen.Hosp., Taipei, Taiwan.
Introduction: Although syntheticmid-urethral slings (S-MUSs) are currently the most popular surgicaltreatment for women with stress urinary incontinence (SUI), anautologous fascial sling remains an effective alternative. US Foodand Drug Administration has put alerts on the use of mesh in thevagina. While this primarily relates to vaginal prolapse mesh, theuse of synthetic mesh in the vagina has come under scrutiny. Therehas been an increased tendency in recent years to bring AF-PVSs intopopular use again.
Objective: The purpose of this study isto compare our experiences of autologous rectus fascial pubovaginalslings (AF-PVSs) with S-MUSs, especially focusing on reoperationrates.
Methods: We retrospectively recruited femalepatients with SUI demonstrated on urodynamics who hadanti-incontinence surgery done between August 1996 and January 2015.Patients who received prior anti-incontinence surgery, or concomitantsurgical treatment for pelvic organ prolapse or urethral diverticulumwere excluded. Patients were divided into two groups based on thematerial of sling: AF-PVS and S-MUS. All the patients in S-MUS groupunderwent retropubic approaches either with a self-tailoredpolypropylene mesh or commercially available polypropylene mesh kit.According to the type of vaginal incision, S-MUS group was subdividedinto single midline incision (SI) and two-vertical incision withsub-urethral tunnel (BI). Patient’s demographic data, perioperativefactors and the reoperation rates were analyzed with Fisher exacttest and Mann-Whitney U test.
Results: total of 464patients were included in the study, with 121 (mean age 53.5 ±10.5years) receiving AF-PVSs and 343 (mean age 57.3 ±9.6 years)undergoing S-MUSs . The age were different between two groups ( 53.5±10.5 vs. 57.3 ±9.6 , p < 0.01). Operating time ( 156.9 ± 39.4mins vs 83.9 ± 29.3 mins, p < 0.01 ) and hospital stay ( 3.7 ±1.7 days vs 2.6 ± 1.3 days, p < 0.01 ) were significantly longerin AF-PVS group compared with S-MUS group.(Table 1) There was noreoperation for operative complications in AF-PVS group. However, 23(7.0%) patients of S-MUS group underwent reoperations forcomplications, including 15 vaginal mesh erosion/exposure, 2 woundinfection and 7 voiding dysfunction.(Table 2) Vaginal mesh exposurerate was higher in SI group than in BI group (7.3% vs 1.7%, p<0.02).Reoperation rate for recurrent SUI was not different between AF-PVSand S-MUS group (3.3% vs 1.7%, p = 0.29). The mean periods ofreoperations for recurrent SUI were 60.3 months in AF-PVS group and11.0 months in S-MUS group after the initial sling procedures ( p =0.07 ).
Conclusions: Comparing with autologous fascia,synthetic mid-urethral slings have shorter operation time andhospital stay, but with a significant higher complication rate.Two-incision sub-urethral tunnel approach is preferred for syntheticmid-urethral sling.