title: Outcomes of Autologous Fascia Pubovaginal Sling for Patients with Transvaginal Mesh Related Complications Requiring Mesh Removal.
abstract: OBJECTIVE
  We reviewed the outcomes of the autologous fascial pubovaginal sling as a salvage procedure for recurrent stress incontinence after intervention for polypropylene mesh erosion/exposure and/or bladder outlet obstruction in patients treated with prior transvaginal synthetic mesh for stress urinary incontinence.
  
  
  METHODS
  In a review of surgical databases at 2 institutions between January 2007 and June 2013 we identified 46 patients who underwent autologous fascial pubovaginal sling following removal of transvaginal synthetic mesh in simultaneous or staged fashion. This cohort of patients was evaluated for outcomes, including subjective and objective success, change in quality of life and complications between those who underwent staged vs concomitant synthetic mesh removal with autologous fascial pubovaginal sling placement.
  
  
  RESULTS
  All 46 patients had received at least 1 prior mesh sling for incontinence and 8 (17%) had received prior transvaginal polypropylene mesh for pelvic organ prolapse repair. A total of 30 patients underwent concomitant mesh incision with or without partial excision and autologous sling placement while 16 underwent staged autologous sling placement. Mean followup was 16 months. Of the patients 22% required a mean of 1.8 subsequent interventions an average of 6.5 months after autologous sling placement with no difference in median quality of life at final followup. At last followup 42 of 46 patients (91%) and 35 of 46 (76%) had achieved objective and subjective success, respectively. There was no difference in subjective success between patients treated with a staged vs a concomitant approach (69% vs 80%, p = 0.48).
  
  
  CONCLUSIONS
  Autologous fascial pubovaginal sling placement after synthetic mesh removal can be performed successfully in patients with stress urinary incontinence as a single or staged procedure.
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Olugbemisola
authors.initials: O
authors.lastname: McCoy
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Taylor
authors.initials: T
authors.lastname: Vaughan
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: S Walker
authors.initials: SW
authors.lastname: Nickles
authors.affiliation: Department of Urology, University of Southern California, Los Angeles, California.
authors.forename: Matt
authors.initials: M
authors.lastname: Ashley
authors.affiliation: Leahy Clinic, Burlington, Massachusetts.
authors.forename: Lara S
authors.initials: LS
authors.lastname: MacLachlan
authors.affiliation: Department of Urology, University of Southern California, Los Angeles, California.
authors.forename: David
authors.initials: D
authors.lastname: Ginsberg
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, South Carolina. Electronic address: rovnere@musc.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Rovner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D005205:Fascia / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D053825:Suburethral Slings; D013526:Surgical Mesh / Q000009:adverse effects*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods
keywords: autografts; salvage therapy; suburethral slings; surgical mesh; urinary incontinence