title: Long-term outcomes of autologous pubovaginal fascia slings: is there a difference between primary and secondary slings?
abstract: BACKGROUND
  To report our long-term pubovaginal slings (PVS) outcomes between primary (PVS1) and secondary (PVS2) autologous fascia PVS, with the hypothesis that outcomes in PVS1 will be better than in PVS2.
  
  
  METHODS
  IRB approved retrospective study of women undergoing PVS between 1996 and 2011 with minimum 6 months follow-up. Data reviewed included demographics, questionnaires that is, UDI-6, IIQ-7, QOL, prior anti-incontinence procedure, associated repairs, urodynamic findings and repeat procedures. Primary outcome and surgical success defined by: (1) QOL ≤ 3, (2) UDI question 3 on SUI ≤ 1, and (3) no SUI re-treatment/operation. Secondary outcomes included all other patient reported outcome measures (PROM).
  
  
  RESULTS
  Of 110 patients, 84 had follow-up. Mean age was 61 years (38-88) and median follow-up was 89 months (7-189). Demographic findings and type of fascia used were similar between the two groups. Mean postoperative scores were not statistically significant for total UDI-6 score (P = 0.62), IIQ-7 (P = 0.30) and QOL (P = 0.35) between groups, but was statistically significant compared to baseline (P = 0.001) as expected. Twelve patients, 3 in PVS1 and 9 in PVS2 underwent subsequent procedures. Surgical success rate was 76% in PVS1 and 52% in PVS2 for those with completed questionnaires. Overall, 78% (28) in PVS1 and 69% (33) in PVS 2 required no further surgical intervention at last follow-up.
  
  
  CONCLUSIONS
  At long-term follow-up of average 7.4 years, primary and secondary PVS patients had comparable favourable functional outcomes with low morbidity. However, secondary PVS patients had lower success rates as per our definition with higher rate of additional procedures.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Dominic
authors.initials: D
authors.lastname: Lee
authors.forename: Sunshine
authors.initials: S
authors.lastname: Murray
authors.forename: Chasta D
authors.initials: CD
authors.lastname: Bacsu
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Zimmern
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology*
keywords: complications; functional outcomes; long term; pubovaginal slings