Cadaveric fascia lata sling: analysis of five recent adverse outcomes.
OBJECTIVE
To report a series of adverse outcomes of urethral sling procedures that used allograft fascia lata and to review the literature regarding the use of this material in genitourinary reconstruction.


METHODS
Five neurologically normal patients presented to our center between August 1999 and October 1999 with complaints of recurrent incontinence or voiding dysfunction after undergoing urethral sling procedures at outside institutions that used fascia lata allografts. All patients underwent a thorough evaluation, including history and physical examination, voiding cystourethrography, and urodynamic studies. Sections of fascia were removed for histology in 2 patients at the time of operation.


RESULTS
Three patients were diagnosed with de novo bladder outlet obstruction, 1 with recurrent urethral hypermobility, and 1 with intrinsic sphincteric deficiency. Histology of cadaveric fascia demonstrated collagen with almost complete absence of cellularity. There was no evidence of capillary or fibroblast ingrowth. All patients underwent reoperation and have had clinical improvement with short-term follow-up.


CONCLUSIONS
Although distressing, the present series of adverse outcomes may simply reflect an overall increase in the number of sling procedures being performed nationally. Although decreased operative time and morbidity have been attributed to the use of fascia lata in urethral sling procedures, it is essential to ensure that long-term safety and efficacy will not be jeopardized before accepting it as a new standard of care.
Blander
D S
DS
Department of Urology, University of Texas Southwestern Medical School, Dallas, Texas, USA.
Zimmern
P E
PE
D000328:Adult; D000368:Aged; D002102:Cadaver; D003094:Collagen / Q000032:analysis; D005206:Fascia Lata / Q000473:pathology* / Q000637:transplantation*; D006801:Humans; D008487:Medical History Taking; D008875:Middle Aged; D010808:Physical Examination; D012008:Recurrence; D012086:Reoperation; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014521:Urethra / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis / Q000209:etiology*; D014549:Urinary Incontinence / Q000209:etiology*; D014563:Urodynamics
D003094:Collagen