Failure of allograft suburethral slings.
OBJECTIVE
To report our experience of using freeze-dried irradiated fascia lata allografts for suburethral sling procedures.


METHODS
Between December 1996 and September 1998, 35 patients (mean age 60.25 years, range 37-79) underwent suburethral sling placement with fascia allograft. These patients were reviewed, with the findings at the time of any surgical re-exploration. Eleven (31%) had undergone prior surgery for genuine stress incontinence and 32 (91%) had a preoperative diagnosis of intrinsic sphincter deficiency.


RESULTS
On re-operation for persistent or recurrent stress incontinence, the allograft was present but grossly degenerated in two (6%) patients and completely absent in five (14%) patients. Histology of a retrieved graft fragment showed both fibroblast proliferation and degeneration within the graft.


CONCLUSIONS
The use of freeze-dried, irradiated fascia lata for suburethral sling procedures was associated with a material failure rate of >/=20%. We caution against its use in this setting.
Fitzgerald
M P
MP
Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Rush-Presbyterian-St.Luke's Medical Center, Chicago, Illinois, USA. mfitzger@rush.edu
Mollenhauer
J
J
Brubaker
L
L
D000328:Adult; D000368:Aged; D015925:Cryopreservation; D005206:Fascia Lata / Q000637:transplantation*; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D014184:Transplantation, Homologous; D017211:Treatment Failure; D014522:Urethral Diseases / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000473:pathology / Q000601:surgery*