Autologous fascial slings for stress urinary incontinence: a 17-year follow-up of a randomised controlled study
Autologous fascial slings for stress urinary incontinence: a 17-year follow-up of a randomised controlled study
Introduction and hypothesis: safety concerns with the use of mesh in vaginal surgery have been ongoing. Autologous fascial slings (AFS) avoid foreign body complications. We compared the long-term (17-year) outcomes of two AFS repair methods—the standard sling and short sling (sling-on-string), and assessed durability and patient satisfaction of these for the treatment of stress urinary incontinence (SUI).
Methods: a total of 107 patients from three urogynaecology units who had participated in a randomised controlled trial assessing standard (n = 52) and short (n = 55) slings were followed up for a median period of 17 years. Primary outcomes were Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores to assess the impact on the quality of life and symptom distress. Logistic quantile regression was employed to compare the two methods. Secondary outcomes included long-term complications and patient satisfaction.
Results: mean scores showed no statistically significant difference between the standard and short slings at the 17-year follow-up relating to IIQ and UDI scores, leakage or urgency (p > 0.05). Improved bladder function was observed at 17 years compared with baseline (standard sling—IIQ scores mean difference [MD] 1.22 [CI: 0.69, 1.74], UDI scores MD 0.83 [CI: 0.70, 0.97]; short sling—IIQ score MD 1.14 [CI: 0.73, 1.54], UDI scores MD 0.54 [CI: 0.40, 0.67]) with age-related deterioration over time. Re-operation rates were low and patient satisfaction rates were high (67.2%) at follow-up.
Conclusions: autologous fascial slings are an effective and durable option for management of SUI and the short sling procedure can be recommended owing to plausible surgical advantages.
Autologous fascial slings, Long-term follow-up, Patient satisfaction, Randomized controlled trial, Stress urinary incontinence
649-659
Nair, Deepa B.
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Khan, Zainab
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Mishra, Tapas
218ef618-6b3e-471b-a686-15460da145e0
Chopra, Jagrati
304b2688-a013-4483-935f-bc8d7bb49664
Wareham, Kathie
38f3a69c-3c42-4f51-be11-87e277dd8b27
Emery, Simon J.
110ada40-6836-48c0-8a73-aa72196d1027
March 2024
Nair, Deepa B.
0f0c05d1-478e-4928-9d19-c41edfc83daf
Khan, Zainab
4bb00483-3482-41b1-bb28-fd62b4c08915
Mishra, Tapas
218ef618-6b3e-471b-a686-15460da145e0
Chopra, Jagrati
304b2688-a013-4483-935f-bc8d7bb49664
Wareham, Kathie
38f3a69c-3c42-4f51-be11-87e277dd8b27
Emery, Simon J.
110ada40-6836-48c0-8a73-aa72196d1027
Nair, Deepa B., Khan, Zainab, Mishra, Tapas, Chopra, Jagrati, Wareham, Kathie and Emery, Simon J.
(2024)
Autologous fascial slings for stress urinary incontinence: a 17-year follow-up of a randomised controlled study.
International Urogynecology Journal, 35 (3), .
(doi:10.1007/s00192-023-05702-2).
Abstract
Introduction and hypothesis: safety concerns with the use of mesh in vaginal surgery have been ongoing. Autologous fascial slings (AFS) avoid foreign body complications. We compared the long-term (17-year) outcomes of two AFS repair methods—the standard sling and short sling (sling-on-string), and assessed durability and patient satisfaction of these for the treatment of stress urinary incontinence (SUI).
Methods: a total of 107 patients from three urogynaecology units who had participated in a randomised controlled trial assessing standard (n = 52) and short (n = 55) slings were followed up for a median period of 17 years. Primary outcomes were Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores to assess the impact on the quality of life and symptom distress. Logistic quantile regression was employed to compare the two methods. Secondary outcomes included long-term complications and patient satisfaction.
Results: mean scores showed no statistically significant difference between the standard and short slings at the 17-year follow-up relating to IIQ and UDI scores, leakage or urgency (p > 0.05). Improved bladder function was observed at 17 years compared with baseline (standard sling—IIQ scores mean difference [MD] 1.22 [CI: 0.69, 1.74], UDI scores MD 0.83 [CI: 0.70, 0.97]; short sling—IIQ score MD 1.14 [CI: 0.73, 1.54], UDI scores MD 0.54 [CI: 0.40, 0.67]) with age-related deterioration over time. Re-operation rates were low and patient satisfaction rates were high (67.2%) at follow-up.
Conclusions: autologous fascial slings are an effective and durable option for management of SUI and the short sling procedure can be recommended owing to plausible surgical advantages.
Text
IUJ_S2_V1_Autologous_Fascial_Slings_for_Stress_Urinary_Incontinence (1)
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Text
IUJ S2 V1 Autologous Fascial Slings for Stress Urinary Incontinence
- Accepted Manuscript
Restricted to Repository staff only until 1 February 2025.
Available under License Other.
Request a copy
More information
Accepted/In Press date: 15 November 2023
e-pub ahead of print date: 1 February 2024
Published date: March 2024
Additional Information:
Funding Information:
The study received approval from the National Research Ethics Service (14/LO/1862) and was funded by Research and Development, NHS Wales.
Publisher Copyright:
© 2024, The International Urogynecological Association.
Publisher Copyright:
© 2024, The International Urogynecological Association.
Keywords:
Autologous fascial slings, Long-term follow-up, Patient satisfaction, Randomized controlled trial, Stress urinary incontinence
Identifiers
Local EPrints ID: 487187
URI: http://eprints.soton.ac.uk/id/eprint/487187
ISSN: 0937-3462
PURE UUID: 79569f93-88a7-4b20-bef5-f92ac0b822df
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Date deposited: 16 Feb 2024 10:12
Last modified: 24 May 2024 01:46
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Contributors
Author:
Deepa B. Nair
Author:
Zainab Khan
Author:
Jagrati Chopra
Author:
Kathie Wareham
Author:
Simon J. Emery
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