Minimally Invasive Autologous Fascia Sling at the Midurethra: A Case Series.

STUDY OBJECTIVE: The primary objective was to determine the improvement in stress urinary incontinence symptoms using autologous fascia lata sling placed at the midurethra. The secondary objective was to determine the presence of leg pain after harvest of fascia lata graft. DESIGN: Case series. SETTING: Rural academic tertiary care center. PATIENTS: All women who underwent an autologous fascia midurethral sling over a 1-year period between June 2019 and September 2020. INTERVENTIONS: Autologous fascia lata midurethral sling. MEASUREMENTS: Incontinence severity index, urodynamic distress inventory-6, and Likert pain scale. MAIN RESULTS: Nineteen women received an autologous fascial sling at the midurethra using the described technique-16 fascia lata and 3 rectus fasciae. Mean improvement in incontinence severity index score was 6 points. Mean improvement in urodynamic distress inventory-6 and SUI subscale scores was 14 and 53, respectively, surpassing the minimally important difference for each. Median follow-up time was 9 months (range 2-16). Leg pain at the harvest site was bothersome in 1 patient beyond 6 weeks. Median time to passing voiding trial was 4 days (range 1-13 days). Four patients (21%) had postoperative voiding dysfunction, 3 of which resolved after sling loosening at a mean of 60 days after sling placement. CONCLUSION: Midurethral autologous fascial sling placement significantly improves symptoms of SUI but carries a risk of voiding dysfunction. Harvesting fascia lata using a fascial stripper is associated with minimal postoperative morbidity.

Autologous Fascia Lata for Combined Sacrocolpopexy and Rectopexy.

ABSTRACT: We present a case series and video of our technique using autologous fascia lata for combined sacrocolpopexy and rectopexy, with or without resection.

The impact of frailty in older women undergoing pelvic floor reconstructive surgery.

IMPORTANCE AND OBJECTIVE: Women ≥ 65 years old commonly undergo pelvic surgery but are often not screened for coexisting frailty, the presence of which increases the risk of postoperative complications. In the absence of a current consensus, the objective of this review is to discuss the incorporation of a frailty assessment into the work-up of women undergoing pelvic floor reconstructive surgery. METHODS: This is a review of the literature, focusing on measurements of frailty including the Edmonton Frail Scale, FRAIL scale, Groningen Frailty Indicator, frailty phenotype, Tilburg Frailty Indicator, a 70-item frailty index, Mini-Cog score, Charlson comorbidity index, timed up and go test, and life-space assessment. Their use in the perioperative management of older women undergoing pelvic floor reconstructive surgery will be discussed. DISCUSSION AND CONCLUSION: Understanding the concept of frailty and how it may affect surgical decisions and outcomes is essential. The timed up and go test, life space assessment and Mini-Cog assessment at a minimum should be considered preoperatively in patients over the age of 65 years old planning pelvic floor or elective surgery.

Video Summary:http://links.lww.com/MENO/A676.

Old wine into new wineskins: an update for female stress urinary incontinence.

PURPOSE OF REVIEW: To review minimally invasive modifications of traditional surgeries for female stress urinary incontinence (SUI) in light of increased demand. RECENT FINDINGS: Prior to the synthetic mid-urethral sling (MUS), traditional procedures were used to correct SUI. Often these were retropubic colposuspension procedures for a hypermobile urethra and fascial slings for sphincter deficiency but fell out of favor because of increased morbidity compared with synthetic MUS. As controversy rages over use of mesh in female pelvic reconstructive surgery, more women desire nonmesh alternatives. Traditional approaches have been modified to enable colposuspensions and fascial slings to be performed minimally invasively without minimizing efficacy. SUMMARY: Minimally invasive modifications to traditional procedures for SUI have been available for about a decade but interest has been recently reignited in the setting of patient concern over mesh.

Vesicovaginal fistula: an unexpected consequence of changing sexual practices?

Vesicovaginal fistula (VVF) is commonly associated with obstetric trauma, but in developed nations it is typically iatrogenic. To date, there have been no published reports of VVF resulting from consensual sexual activity with sex toys. A 19-year-old gravida 0 presented with leakage of clear urine from the vagina following repetitive use of a sex toy with her female partner. The fistula was repaired in the operating room using a vaginal approach and a layered closure. This is the first case report of a VVF caused by consensual sex toy use between same-sex partners. As sex toy use increases, counselling providers will need to be aware of possible adverse sequelae.

Decreasing transobturator sling groin pain without decreasing efficacy using TVT-Abbrevo.

INTRODUCTION AND HYPOTHESIS: Groin pain following a transobturator (TO) midurethral sling is not uncommon and can be difficult to manage. We sought to determine if decreasing the mesh burden in the groin would decrease pain. The primary objective was to compare the incidence of post-operative groin pain following placement of full-length TVT-Obturator versus the shorter TVT-Abbrevo. Secondarily, we aimed to compare the efficacy between both devices 6 months after surgery. METHODS: This is a retrospective cohort study of all women who underwent a TO midurethral sling by the division of urogynecology at one institution between 1 January 2007 and 31 October 2013. Charts were reviewed and the incidence of post-operative groin pain in the two groups dichotomized as present or absent and compared using a Chi-squared test. Validated questionnaire scores of the groups were compared using t tests. RESULTS: There were 125 patients who received a TVT-Obturator and 100 patients who received a TVT-Abbrevo. No differences in demographic data were present between the groups. Twelve patients (9.6 %) in the TVT-Obturator group and 1 patient (1 %) in the TVT-Abbrevo group experienced bothersome groin pain (P value = 0.007). The complete pre- and 6-month post-operative ISI, UDI-6 and PFIQ-7 scores were available for 76 (61 %), 47 (38 %), and 45 (36 %) patients following TVT-Obturator and 57 (57 %), 30 (30 %), and 28 (28 %) following TVT-Abbrevo treatment. At 6 months the mean improvement in questionnaire scores for the TVT-Obturator and TVT-Abbrevo groups were as follows: 5.0 and 5.1 for ISI (P value = 0.9), 8.3 and 7.9 for UDI-6 (P value = 0.8), and 4.8 and 6.1 for PFIQ-7 (P value = 0.4). CONCLUSION: Use of TVT-Abbrevo reduces post-operative groin pain compared with the full-length TVT-Obturator, without any reduction in efficacy.

Congenital prepubic sinus in an adolescent female: a case report and review of the literature.

Congenital prepubic sinus is a rare anomaly, especially in women; only 17 cases in 13 reports were found in the English literature after a search in the PubMed during 1990-2013. We report the diagnosis and successful minimally invasive excision of a congenital prepubic sinus in an adolescent female patient. Our experience and a review of the literature suggest the most likely etiology to be a variant of dorsal urethral duplication.