Autologous Pubovaginal Sling for the Treatment of Stress Urinary Incontinence in a Patient With High Risk of Mesh Erosion.

OBJECTIVE: Autologous pubovaginal sling is a surgical option for patients with stress urinary incontinence (SUI), either as primary treatment, or in those who have failed synthetic sling placement.1,2 It is also favorable for patients at high risk of mesh erosion, for example, in those who are immunocompromised or postradiation.3-5 This video reviews the technical considerations in performing an autologous pubovaginal sling fashioned from rectus fascia in an immunocompromised patient with multiple previous abdominal surgeries. METHODS: The patient is a 63-year-old woman with SUI refractory to conservative management, with a background of Behcet's disease on long-term steroids. First, a 12  ×  2 cm rectus sheath graft was harvested through a Pfannenstiel incision. Stay sutures were placed to aid in subsequent sling placement. A vertical incision was made in the anterior vaginal wall after hydro-dissection with lignocaine/adrenaline solution and the plane was developed with a combination of blunt and sharp dissection. The trocars with the attached fascial sling were passed retropubically. Sling tensioning was assessed with a Q-tip test. An inadvertent bladder perforation was noted during the passage of the left trocar on intraoperative cystoscopy, which was managed conservatively with urinary catheterization for one week postoperatively. RESULTS: The patient was discharged well on postoperative day 2 and underwent a successful trial off catheter on postoperative day 7. At 1-month follow-up, the patient reported complete resolution of her SUI with no de-novo urgency or voiding dysfunction. CONCLUSION: Autologous pubovaginal slings are an effective treatment option for SUI with minimal morbidity especially in patients with high risk of mesh erosion.

Artificial urinary sphincters for treating postprostatectomy incontinence: A contemporary experience from the UK.

OBJECTIVES: To report a real-time contemporary practice and outcome of artificial urinary sphincter (AUS) in patients with postradical prostatectomy urinary incontinence (PPI) in the UK. METHODS: A retrospective observational study of patients who underwent AUS implantation (AMS 800) from 2007 to 2013. Data were collected on patients' demographics, infection and erosion rate, mechanical failure, reoperation, and continence rates. The study strictly included patients with postradical PPI only. Minimum follow-up was 15 months. RESULTS: Eighty-four AUSs were implanted over a period of 6 years. Patients' age ranged between 51 and 78 (median 69, mean 69.25) years. Median follow-up was 37 months, mean 39 months, and range 15-92 months. Among the 83 follow-up patients, 38.5% (32/83) reported that they were completely dry with no pads; 42.2% (35/83) of patients were socially continent (using 1 pad/day) and 19.3% (16/83) using ≥2 pads/day. One patient was lost to follow-up. Reoperation rate was 13.25% (11/83), including nine mechanical failures (10.8%). Two implant infections (2.4%) required explantation, out of which one had erosion (1.2%). Bladder overactivity developed in 6% of patients. Of the 83, 15 (18%) had pelvic radiotherapy. CONCLUSION: The implantation of AUS in patients with post-PPI has lower complications and reoperation rates than historical impression painted in the literature. This can be beneficial in counseling as well as during the education process of patients going through the decision process for prostate cancer treatment. Furthermore, these figures can add to our quest to increase the awareness of the success of anti-incontinence surgery among patients.