title: Success of autologous pubovaginal sling after failed synthetic mid urethral sling.
abstract: OBJECTIVE
  There is no consensus on the management of persistent or recurrent stress incontinence after a failed synthetic mid urethral sling. After a mesh complication or sling failure many women and surgeons prefer to avoid a repeat mesh procedure and choose an autologous pubovaginal sling. However, little empirical work has been performed to assess the efficacy.
  
  
  METHODS
  We performed a retrospective review of 66 women who underwent autologous pubovaginal sling with rectus fascia after 1 or more failed synthetic mid urethral sling from 2007 to 2012.
  
  
  RESULTS
  Mesh removal was performed before autologous pubovaginal sling in 21 patients (31.8%) while 6 (9.1%) had mesh removed simultaneously with autologous pubovaginal sling. Indications for the autologous pubovaginal sling were pure stress urinary incontinence in 16 patients (24.2%) and mixed incontinence in 50 (75.8%), 8 of whom were deemed complex with a prior urethral diverticulum or urethrovaginal fistula/urethral mesh erosion. At a mean of 14.5 months after autologous pubovaginal sling 46 (69.7%) patients reported cure of stress urinary incontinence. Of these patients 25 (37.9%) had complete cure with no stress or urgency incontinence, 17 had cure of stress urinary incontinence but had persistent urgency incontinence, and 4 had cure of stress urinary incontinence but experienced do novo urgency incontinence. Requiring a mesh excision did not predict worse outcomes compared to cases in which mesh was not removed (p=0.13). Patients with pure stress urinary incontinence were significantly more likely to be cured of all incontinence (62.5%) than those women with preoperative mixed incontinence (30.0%) (p=0.006).
  
  
  CONCLUSIONS
  Even after a failed synthetic mid urethral sling, autologous pubovaginal sling is effective and cured stress urinary incontinence in 69.7% of cases.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jaclyn C
authors.initials: JC
authors.lastname: Milose
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Sharp
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Chang
authors.initials: C
authors.lastname: He
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: John
authors.initials: J
authors.lastname: Stoffel
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: annepell@med.umich.edu.
authors.forename: Anne P
authors.initials: AP
authors.lastname: Cameron
mesh_terms: D064592:Autografts; D005205:Fascia / Q000637:transplantation; D005260:Female; D006801:Humans; D008875:Middle Aged; D011474:Prosthesis Design; D012074:Remission Induction; D012189:Retrospective Studies; D053825:Suburethral Slings; D013526:Surgical Mesh; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: autografts; stress; suburethral slings; surgical mesh; urinary incontinence