title: Autologous fascia pubovaginal slings after prior synthetic anti-incontinence procedures for recurrent incontinence: A multi-institutional prospective comparative analysis to de novo autologous slings assessing objective and subjective cure.
abstract: Given the paucity of prospective data on the treatment of incontinent women with prior synthetic mid-urethral sling (MUS), we sought to report our prospective experience with autologous fascia pubovaginal sling placement (AF-PVS) after prior synthetic mid-urethral sling (MUS).
  
  
  
  An IRB-approved, multi-institutional, prospective cohort of patients from 2010 to 2013 undergoing AF-PVS for urinary incontinence was evaluated and stratified for the presence of a prior MUS. Pre-operative characteristics and validated quality of life questionnaires (IIQ-7 and UDI-6) were compared to post-operative pad usage, scores on the IIQ-7 and UDI-6, complications, and visual analog scale assessment of improvement.
  
  
  
  288 patients met inclusion criteria, 59 (20.4%) of whom had undergone a prior MUS before AF-PVS placement. Of these 59 patients, 20 (33.9%) had a prior vaginal extrusion and 5 (8.5%) had suffered from obstruction requiring sling lysis or excision. With a median of 14 months follow-up, prior MUS placement was not associated with a significant difference in objective (55.9% vs. 62.4%, P = 0.37) or subjective cure (66.1% vs. 69.0%, P = 0.75) when compared to patients undergoing placement of an initial AF-PVS. Patients undergoing AF-PVS after prior MUS did have a significantly higher rate of urinary retention requiring intermittent catheterization (8.5% vs. 3.1%, P < 0.001) and re-operation (13.6% vs. 3.5%, P = 0.01) for persistent incontinence.
  
  
  
  Despite higher rates of retention and need for repeat operation, AF-PVS after failed MUS is an acceptable treatment option with no difference in success as compared to patients undergoing initial AF-PVS placement. Neurourol. Urodynam. 35:604-608, 2016. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Urology, The University of Kansas Medical, Kansas City, Kansas.
authors.forename: William P
authors.initials: WP
authors.lastname: Parker
authors.affiliation: Department of Urology, Louisiana State University Health, Shreveport, Louisiana.
authors.forename: Alex
authors.initials: A
authors.lastname: Gomelsky
authors.affiliation: Department of Urology, The University of Kansas Medical, Kansas City, Kansas.
authors.forename: Priya
authors.initials: P
authors.lastname: Padmanabhan
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D005205:Fascia / Q000637:transplantation*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D053825:Suburethral Slings; D014182:Transplantation, Autologous; D014549:Urinary Incontinence / Q000601:surgery*
chemical_list: D001672:Biocompatible Materials
keywords: autologous pubovaginal sling; midurethral sling; street urinary incontinece; surgical mesh