Cadaveric fascia lata pubovaginal slings: early results on safety, efficacy and patient satisfaction.
OBJECTIVE
To prospectively evaluate and quantify the efficacy of cadaveric fascia lata (CFL) as an allograft material in pubovaginal sling placement to treat stress urinary incontinence (SUI).


METHODS
Thirty-one women with SUI (25 type II and six type III; mean age 63 years, range 40-75) had a CFL pubovaginal sling placed transvaginally. The operative time, blood loss, surgical complications and mean hospital stay were all documented. Before and at 4 months and 1 year after surgery each patient completed a 3-day voiding diary and validated voiding questionnaires (functional inquiry into voiding habits, Urogenital Distress Inventory and Incontinence Impact Questionnaire, including visual analogue scales).


RESULTS
The mean (range) operative time was 71 (50-120) min, blood loss 78.7 (20-250) mL and hospital stay 1.2 (1-2) days; there were no surgical complications. Over the mean follow-up of 13.5 months, complete resolution of SUI was reported by 29 (93%) patients. Overactive bladder symptoms were present in 23 (74%) patients before surgery, 21 (68%) at 4 months and two (6%) at 1 year; 80% of patients with low (< 15 cmH2O) voiding pressures before surgery required self-catheterization afterward, as did 36% at 4 months, but only one (3%) at 1 year. Twenty-four (77%) patients needed to adopt specific postures to facilitate voiding. After surgery there was a significant reduction in daytime frequency, leakage episodes and pad use (P < 0.05). The severity of leak and storage symptoms was also significantly less (P < 0.002), whilst the severity of obstructive symptoms remained unchanged. Mean subjective levels of improvement were 69% at 4 months and 85% at 1 year, with corresponding objective satisfaction levels of 61% and 69%, respectively. At 1 year, approximately 80% of the patients said they would undergo the procedure again and/or recommend it to a friend.


CONCLUSIONS
Placing a pubovaginal sling of CFL allograft is a highly effective, safe surgical approach for resolving SUI, with a short operative time and rapid recovery. Storage symptoms are significantly improved, and subjective improvement and satisfaction rates are high.
Walsh
I K
IK
Department of Urology, University of California, Davis, Sacramento, CA, USA. chwalshian@talk21.com
Nambirajan
T
T
Donellan
S M
SM
Mahendra
V
V
Stone
A R
AR
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002102:Cadaver; D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D017060:Patient Satisfaction; D011126:Polypropylenes / Q000627:therapeutic use; D011446:Prospective Studies; D013536:Suture Techniques; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina / Q000601:surgery
D011126:Polypropylenes