Synthetic vs nonsynthetic slings for female stress and mixed urinary incontinence: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to systematically review objective and subjective success and surgical outcomes of suburethral sling surgery for female patients with stress or mixed urinary incontinence using synthetic vs nonsynthetic material with corresponding surgical approaches (retropubic or transobturator). DATA SOURCES: We systematically searched Medline, Embase, EBM Reviews, ClinicalTrials.gov, and Web of Science Core Collection using standardized Medical Subject Headings (MeSH) without date restrictions (PROSPERO-registered). We double-screened studies and used backward citation chaining. STUDY ELIGIBILITY CRITERIA: We included peer-reviewed randomized controlled trials and prospective or retrospective comparative studies examining outcomes of retropubic or transobturator synthetic vs nonsynthetic (autologous, allograft, or xenograft) slings for female stress or mixed urinary incontinence, with available English or French full texts. We excluded minislings (single insertion point). We allowed slings for recurrent stress or mixed urinary incontinence, and slings concomitant with prolapse surgery, with at least 6 weeks of postoperative follow-up. We excluded systematic reviews, meta-analyses, review studies, case-control studies, case reports, studies that did not describe surgical approach or material, and studies of combination slings. METHODS: We evaluated study quality using RoB, the Cochrane risk-of-bias tool for randomized controlled trials, and the Newcastle-Ottawa scale for observational studies. We used pooled relative risk with 95% confidence intervals to estimate the effect of sling material type on each outcome through meta-analysis and meta-regression, as appropriate. RESULTS: We screened 4341 abstracts, assessed 104 full texts, and retained 35 articles (30 separate studies). For retropubic synthetic vs nonsynthetic slings, there was no difference in the number of objectively or subjectively continent patients. The rates of reoperation for stress urinary incontinence and overall were higher with nonautologous retropubic slings than with synthetic slings. Compared with autologous slings, retropubic synthetic slings were associated with higher subjective continence in populations with ≥25% recurrent stress urinary incontinence (relative risk, 1.27; 95% confidence interval, 1.12-1.43). There were no differences in continence between transobturator synthetic and nonsynthetic slings. Subjective satisfaction was better in the transobturator synthetic group than in the autologous sling group (relative risk, 1.42; 95% confidence interval, 1.03-1.94). CONCLUSION: Synthetic and nonsynthetic slings have comparable objective and subjective success, with synthetic materials generally showing better operative outcomes and fewer complications.

Clinical, anatomical and perioperative outcomes of abdominal sacral colpopexy using autologous fascia: A systematic review of the literature.

OBJECTIVES: Although sacral colpopexy is considered the gold standard for the treatment of advanced apical prolapse, several warnings and restrictions has been delivered to urogynecological surgeons in order to avoid the implants of prosthetics meshes. The purpose of this systematic review is to investigate the role of sacral colpopexy performed with autologous tissue in literature. METHODS: a systematic review according to PRISMA guidelines was performed in June 2022 through the Medline, Web of Science and Scopus databases. Quality assessment of each article was performed according to Critical Appraisal tool of Oxford center for EBM, LoE according to SORT standards, ROBINS-I tool for methodological assessment in non-randomized trials. From 236 screened records, 7 articles were considered eligible for this systematic review. RESULTS: Collected data showed objective cure rate ranging from 94.7% to 100% in medium term follow up. Subjective cure rate was specifically investigated in 2 studies with high satisfaction rates. Complication rate ranged from 0 to 36.8%, with 90.1% graded ≤2 according to Clavien-Dindo classification. CONCLUSIONS: sacral colpopexy with autologous fascia shows satisfying outcomes in terms of safety and efficacy and may be taken in account in particular clinical situations.

Therapeutic effect of autologous fascia urethral suspension on female stress urinary incontinence and analysis of risk factors affecting the efficacy.

OBJECTIVE: To observe the therapeutic effect of autologous fascial urethral suspension on female stress urinary incontinence and analyze the risk factors affecting the therapeutic effect. METHOD: The clinical data of 89 female patients with stress urinary incontinence treated in our hospital from February 2018 to February 2020 were retrospectively analyzed (training group). Another cohort of 45 patients treated in Xi'an Gaoxin Hospital from March 2020 to March 2021 were retrospectively enrolled as the validation group. Surgery-related parameters (including operation time, intraoperative blood loss, indwelling time of catheter, and hospital stay) were recorded. The scores of the urinary incontinence questionnaire short form (IC-IQ-SF), urinary incontinence quality of life questionnaire (I-QOL), and pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) were compared before and after the operation. The clinical efficacy of the treatment was counted. The risk factors affecting the treatment efficacy were analyzed. The efficacy prediction model was established by logistics regression equation and verified by the data from the validation group. RESULTS: After the treatment, the urine leakage score, urine leakage score quality of life score, and the total score were evidently reduced compared with those before the treatment (P < 0.05). Patients' I-QOL score and PISQ-12 score increased significantly after the treatment (P < 0.05). Multivariate logistics regression analysis revealed that age, BMI, history of pelvic surgery, and length of hospital stay were risk factors affecting the outcome of patients (P < 0.05). The ROC curve analysis revealed that the area under the curve of the efficacy score in predicting the treatment efficacy was 0.828, and that in the validation group was 0.895. CONCLUSION: The treatment effect of autologous fascia urethral suspension in female patients with stress urinary incontinence was significant. It improved the quality of life of patients. The risk factor analysis showed that age, BMI, history of pelvic surgery, and length of hospital stay were risk factors affecting the treatment outcome of patients.

Structural and clinical outcomes after superior capsule reconstruction using an at least 6-mm-thick fascia lata autograft including the intermuscular septum.

BACKGROUND: Superior capsule reconstruction (SCR) is a viable treatment option for irreparable rotator cuff tears. However, graft tear rate is highly variable in the previous studies, and the impact of graft tears on clinical outcomes after arthroscopic SCR remains controversial. We aimed to investigate the graft tear rate, timing of graft tear, and the impact of graft tears on clinical outcomes after arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum. METHODS: This retrospective multi-institutional study included 154 patients (79 women and 75 men; mean age, 69.9 yr; age range, 49-87 yr) with irreparable rotator cuff tears who underwent arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum and completed a minimum 2-year follow-up. Postoperative graft integrity was evaluated by magnetic resonance imaging examinations performed at 3, 6, 12, and 24 mo after surgery. The presence of a full-thickness defect within the graft was diagnosed as a graft tear. In contrast, a graft without a full-thickness defect was diagnosed as a healed graft. We compared the following data between patients with and without graft tears: (1) baseline characteristics, (2) visual analog scale pain score, (3) Japanese Orthopaedic Association score, (4) American Shoulder and Elbow Surgeons shoulder score, and (5) active range of motion. RESULTS: The overall graft tear rate was 11.7% (18 of 154 patients). Of 18 graft tears, 14 (77.8%) occurred within 6 mo after SCR. Two additional graft tears were diagnosed at 12 mo postoperatively and another 2 at 24 mo after SCR. The visual analog scale, American Shoulder and Elbow Surgeons, and Japanese Orthopaedic Association scores improved significantly after SCR in both patients with and without graft tears (all P < .0001). However, patients with graft tears showed significantly inferior postoperative visual analog scale, American Shoulder and Elbow Surgeons, and Japanese Orthopaedic Association scores (1.9, 75.2, and 77.4, respectively) than those without graft tears (0.5, 93.1, and 92.3, respectively; all P < .01). CONCLUSIONS: The overall graft tear rate after arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum was low (11.7%), relatively to that reported in previous studies. The majority of graft tears (77.8%) occurred within 6 mo after SCR. Graft healing was associated with more favorable clinical outcomes after SCR.

In situ repair or reconstruction of the abdominal aorta-iliac artery by autologous fascia-peritoneum with posterior rectus sheath for the treatment of the infected abdominal aortic and iliac artery aneurysms: A case series and literature review.

Background: Infected abdominal aortic and iliac artery aneurysms are considered acute and severe diseases with insidious onset, rapid development, and high mortality in vascular surgery. Currently, there is no better treatment, either anatomic or extra-anatomical repair. Case presentation: From February 2018 to April 2022, 7 patients with infected abdominal aortic and iliac artery aneurysms did not have sufficient autologous venous material for repair. With the consent of the Ethics Committee of the hospital, it uses the autologous peritoneal fascial tissue with rectus sheath to repair or reconstruct the infected vessels in situ. There were 5 cases of infected abdominal aortic aneurysm, 1 case of an infected common iliac aneurysm, and 1 case of the infected internal iliac aneurysm. Aortoduodenal fistula was found in 3 cases, all of them were given duodenal fistula repair and gastrojejunostomy and cholecystostomy. Three cases of infected abdominal aortic aneurysms were repaired with the autologous peritoneal fascial tissue patch, and 2 cases of infected abdominal aortic aneurysms were reconstructed by the autologous peritoneal fascial tissue suture to bifurcate graft in situ, the autologous peritoneal fascial tissue suture reconstructed the rest 2 cases of infected iliac aneurysm to tubular graft in situ. It was essential that Careful debridement of all infected tissue and adequate postoperative irrigation and drainage. Antibiotics were administered perioperatively, and all patients were subsequently treated with long-term antibiotics based on bacterial culture and susceptibility results of infected tissues and blood. All 7 patients had underwent surgery successfully. But there were 2 cases died of anastomotic infection or massive hemorrhage after the operation, the other 5 cases survived. The follow-up time was 2-19 months. The enhanced CT of postoperation showed that the reconstructed arteries were smooth without obvious stenosis or expansion, and no abdominal wall hernia occurred. Conclusion: In situ repair or reconstruction with autologous peritoneal fascial tissue with rectus sheath is a feasible treatment for the infected aneurysm patients without adequate autologous venous substitute, but it still needs long-term follow-up and a large sample to be further confirmed.

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.

Comparison of Autologous Rectus Fascia and Synthetic Sling Methods of Transobturator Mid-Urethral Sling in Urinary Stress Incontinence.

OBJECTIVE: This study aims to compare the efficacy and complications between mesh obtained from the autologous rectus fascia and synthetic mesh used in transobturator tape procedure in the surgical treatment of urinary stress incontinence. METHODS: A total of 62 female patients who underwent operation due to urinary stress incontinence were included in the study. From these, 31 patients underwent autologous rectus fascia with mid-urethral sling (Group 1), and the remaining 31 patients underwent the same operation using synthetic multilaminar propylene sling (Group 2). The groups were compared preoperative and postoperative according to results of Urogenital Distress Inventory-Short Form (UDI-6) and Incontinence Impact Questionnaire-Short Form (IIQ-7). Demographic characteristics, surgical features, and complications were also compared between the groups. P < 0.05 values were considered statistically significant. RESULTS: The mean age was found as 54.74 ± 0.87 in Group 1 and 55.58 ± 0.76 in Group 2. There was no significant difference between the groups in terms of the preoperative and postoperative UDI-6 results ​​(p=0.258, p=0.349). Similarly, the preoperative and postoperative IIQ-7 results did not show a significant difference between the groups (p=0,483, p=0,367). There was also no significant difference in demographic characteristics and complications between the groups. Only the mean operational time was significantly longer in Group 1 (p=0.029). CONCLUSION: Transobturator tape procedure with autologous rectus fascia is as effective and safe as synthetic mesh. This procedure provides an inexpensive and consumable option without posing a risk of mesh erosion and with low complication rates.

Sacrocolpopexy using autologous rectus fascia: Cohort study of long-term outcomes and complications.

OBJECTIVE: To evaluate objective and subjective outcomes of patients who underwent sacrocolpopexy using autologous rectus fascia to provide more data regarding non-mesh alternatives in pelvic organ prolapse surgery. DESIGN: Ambispective cohort study with retrospective and prospective data. SETTING: A single academic medical centre. POPULATION: Women who underwent abdominal sacrocolpopexy using autologous rectus fascia between January 2010 and December 2019. METHODS: Patients were recruited for a follow-up visit, including completing the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse Quantification (POP-Q) examination. Demographic and clinical characteristics were collected. MAIN OUTCOME MEASURES: Composite failure, anatomic failure, symptomatic failure and retreatment. RESULTS: During the study period, 132 women underwent sacrocolpopexy using autologous rectus fascia. The median follow-up time was 2.2 years. Survival analysis showed that composite failure was 0.8% (95% CI 0.1%-5.9%) at 12 months, 3.5% (95% CI 1.1%-10.7%) at 2 years, 13.2% (95% CI 7.0%-24.3%) at 3 years and 28.3% (95% CI 17.0%-44.8%) at 5 years. The anatomic failure rate was 0% at 12 months, 1.4% (95% CI 0.2%-9.2%) at 2 years, 3.1% (95% CI 0.8%-12.0%) at 3 years and 6.8% (95% CI 2.0%-22.0%) at 5 years. The symptomatic failure rate was 0% at 12 months, 1.3% (95% CI 0.2%-9.0%) at 2 years, 2.9% (95% CI 0.7%-11.3%) at 3 years and 13.1% (95% CI 5.3%-30.3%) at 5 years. The retreatment rate was 0.8% (95% CI 0.1%-5.9%) at 12 months and 2 years, 9.4% (95% CI 4.2%-20.3%) at 3 years and 13.0% (95% CI 6.0%-27.2%) at 5 years. CONCLUSION: Autologous rectus fascia sacrocolpopexy may be considered a safe and effective alternative for patients who wish to avoid synthetic mesh. TWEETABLE ABSTRACT: Sacrocolpopexy using autologous rectus fascia is a safe and effective alternative to synthetic mesh.

Effect of Fascia Implantation and Controlled Release of Basic Fibroblast Growth Factor for Muscle Atrophy in Rat Laryngeal Paralysis.

OBJECTIVE: To improve lateral thyroarytenoid (TA) muscle atrophy after laryngeal paralysis, reconstruction of the vascular network of the atrophied muscle is necessary. We therefore evaluated whether the controlled release of basic fibroblast growth factor (bFGF) with autologous fascia implantation could affect vascular reconstruction in the lateral TA muscle. STUDY DESIGN: Animal experiment. SETTING: Laboratory. METHODS: Unilateral laryngeal paralysis was induced in 20 rats. The rats were implanted with autologous fascia and a gelatin hydrogel sheet with or without 1 µg of bFGF (fascia and bFGF + fascia groups; n = 5 each) and with only a gelatin hydrogel sheet with bFGF (bFGF group: n = 5). Another group remained untreated (n = 5) at 4 months after paralysis. At 3 months since transplantation, intra- and intergroup comparisons of the muscle volumes and total area of blood vessels in the lateral TA muscle were performed. RESULTS: When compared with the untreated group, the bFGF + fascia group showed a significant increase in muscle volume (P =.0008) and vascular area (P =.0002) in the lateral TA muscle, whereas the other 2 treated groups demonstrated an insufficient effect. CONCLUSION: bFGF + fascia implantation showed histologic improvement in severe laryngeal paralysis. We demonstrated that the decrease in lateral TA muscle mass after paralysis might be countered by the reconstruction of the vascular network. Our findings indicate that hypovascular and denervated areas of the laryngeal muscle can be regenerated by the implantation of growth factors and scaffolds with surgical stress. LEVEL OF EVIDENCE: 5.

A randomized trial of psychological intervention on perioperative anxiety and depression of patients with severe blepharoptosis undergoing autologous fascia lata frontal muscle suspension.

BACKGROUND: Perioperative negative emotion of surgical patients has a greater impact on surgical efficacy and prognosis. The study aimed to analyze the effect of psychological intervention on perioperative anxiety and depression of patients with severe blepharoptosis undergoing autologous fascia lata frontal muscle suspension, and provide a reference for improving and optimizing patient care plans. METHODS: Ninety-two patients with severe blepharoptosis who underwent autologous fascia lata frontal muscle suspension in our hospital from February 2018 to January 2020 were selected as the research subjects. Patients were numbered according to the order of operation, and were divided into a control group (46 cases) and an observation group (46 cases) using a numerical random table method. Patients in both groups received routine nursing intervention during the perioperative period, and patients in the observation group also received psychological intervention during this period. The two groups of patients were evaluated using the Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D). Numerical rating scale (NRS) results for surgical site pain were evaluated and compared between the groups. The perioperative compliance rate and nursing satisfaction rate of the two groups of patients were investigated and compared. Intraoperative and postoperative complications were collected, sorted, and compared between the two groups of patients. RESULTS: (I) The HAM-A and HAM-D scores of the observation group before and after surgery were significantly lower than those of the control group (P<0.05). (II) The NRS scores of patients in the observation group were markedly lower than those in the control group at 6 h and 24 h postoperatively (P<0.05). (III) The intra- and post-operative complication rate of the observation group was lower than that of the control group (P<0.05). (IV) The compliance rate and the total satisfaction rate of patients with the perioperative care in the observation group was considerably higher compared to that of patients in the control group (P<0.05). CONCLUSIONS: Our results showed that psychological intervention can effectively alleviate the negative emotions in patients with severe blepharoptosis who underwent autologous fascia lata frontal muscle suspension, improve their compliance with medical care, reduce their pain, and increase their satisfaction rate. Therefore, psychological intervention has high clinical value.

Histologic changes during healing with autologous fascia lata graft after superior capsule reconstruction in rabbit model.

BACKGROUND: Superior capsule reconstruction (SCR) has been developed to improve shoulder function and relieve pain in the treatment of irreparable rotator cuff tears. Previous studies have reported that graft healing can enhance favorable outcomes after SCR. On the other hand, graft tears often lead to less desirable outcomes and sometimes require additional surgical procedures. However, the healing process underlying this remains unclear. In this study, we aimed to investigate histologic changes occurring during the healing process associated with autologous fascia lata graft after SCR in vivo. We hypothesized that (1) autologous fascia lata graft can regenerate the fibrocartilaginous insertion into both the greater tuberosity and superior glenoid and (2) the midsubstance of the grafted fascia gradually remodels into tendon- and/or ligament-like tissue after SCR. METHODS: Irreparable supraspinatus tendon defects were created in 24 mature Japanese white rabbits (age, 6 months; mean weight, 3.2 kg). Four weeks after creation of the defects, the right shoulders were subjected to SCR using autologous fascia lata grafts. The left shoulders were left untreated. Samples from the shoulders were harvested at 4, 8, 12, and 16 weeks after surgery to undergo histologic and immunohistochemical examinations. RESULTS: Macroscopically, we did not observe graft tears after SCR in our experiments. Histologically, the number of chondrocyte-like cells gradually increased, and the extracellular matrices around those cells contained glycosaminoglycan at the fascia-bone junction after SCR. The unmineralized fibrocartilage, mineralized fibrocartilage, and tidemark were observed 16 weeks after SCR. The distribution of type II collagen presented a pattern similar to that of a normal tendon and ligament insertion. The cells and collagen fiber gradually oriented parallelly to the long axis in the midsubstance of the grafted fascia lata. Additionally, type III collagen was replaced with type I collagen in the midsubstance of the grafted fascia lata after SCR. CONCLUSIONS: SCR using fascia lata autograft regenerated the fibrocartilaginous insertion at both the greater tuberosity and superior glenoid. The midsubstance of the grafted fascia gradually remodeled into tendon- and/or ligament-like tissue. These results suggest that the fascia lata autograft has the capacity for graft-to-bone healing and remodeling after SCR.

New combined surgery for cervical cancer complicated by pelvic organ prolapse using autologous fascia lata: A case report.

Radical hysterectomy and immediate sacral colpopexy using autologous fascia lata could be considered a treatment option for cervical cancer complicated by severe and symptomatic pelvic organ prolapse.

Feasibility of the Reconstruction with Fascia Lata Patch on the Abdominal Wall Defect After Resection of the Abdominal Desmoid Tumor.

INTRODUCTION: The abdominal desmoid tumor shows invasive development and high local recurrence rate. The primary treatment method is complete removal of the tumor because of the high recurrence rate; however, the problem for the surgeon is the reconstruction of the abdominal wall after resection of the abdominal desmoid tumor. CASE PRESENTATION: A 63-year-old man underwent open drainage and ileostomy for the perforation of ileocecal tumor. After 3 months, he underwent right hemicolectomy and ileostomy closure. Pathological examination revealed no malignancy, and the ileocecal tumor showed the presence of abscess. He noticed a palpable mass in the left abdomen. Enhanced abdominal computed tomography (CT) revealed a large abdominal incisional hernia and an enhanced mass of 40 mm in the left rectus muscle. Needle biopsy was performed and the diagnosis was desmoid tumor. He underwent resection of the desmoid tumor and repair of hernia. We performed wide local resection, with a 2-cm surgical margin. The hernia was repaired by simple closure, and the defect in the left abdomen was repaired with reconstruction using the fascia lata patch through plastic surgery. CONCLUSION: We encountered a case of abdominal wall desmoid tumor combined with a large abdominal incisional hernia. We selected the use of autologous fascia based on the risk of recurrence. The patient has not shown recurrence of incisional hernia or desmoid tumor 22 months after surgery. The use of fascia lata patch can be considered as a satisfactory alternative for such reconstruction cases.

Optimising the tension of an autologous fascia pubovaginal sling to minimize retentive complications.

AIM: To determine the optimal degree of pubovaginal slings (PVS) tension, measured by lax sling dimensions to minimize the risk of urinary retention. METHODS: This prospective study analyzed female patients undergoing PVS for stress urinary incontinence (SUI) by two surgeons over 24 months from January 2016. Intra-operative measurements of lax sling dimensions tented over rectus fascia were recorded. Logistic regression was used to analyse the likelihood of urinary retention (more than 3 months of intermittent self-catheterisation (ISC) or surgical revision) for given PVS dimensions. The secondary analysis assessed for an association between PVS measurements and persistent SUI. RESULTS: Fifty-one patients were recruited with a median age of 53 (34-78) and follow-up of 11 (3-20) months. All but one patient reported improvement of SUI. Ten (19.6%) patients developed postoperative urinary retention. Five (9.8%) resolved after a temporary period of ISC. The other five (9.8%) required ongoing ISC or sling division. A strong association existed between short sling height and prolonged urinary retention (P = 0.00). Receiver operating characteristic (ROC) curve analysis showed a sling height of 40 mm had a sensitivity of 100% and specificity of 51% for retentive complications (area under curve [AUC] = 0.90). Lax sling height up to 60 mm was not associated with persistent SUI. CONCLUSIONS: Stretching the sling suspension sutures at least 40 mm above the rectus fascia was associated with a lower risk of urinary retention than less than 40 mm. This simple technique would appear to be worth evaluating in a larger sample. A looser sling did not compromise the cure of SUI at a mean follow-up of 11 months.

An Internet-based survey to evaluate the comfort and need for further pubovaginal sling training.

INTRODUCTION AND HYPOTHESIS: The pubovaginal sling (PVS) dates to the 1940s as an efficacious surgical treatment for stress urinary incontinence (SUI). Recently, it has been replaced by the midurethral sling (MUS). Since 2008, international regulatory agencies increased regulation and issued warnings on vaginal mesh for repair of pelvic organ prolapse (POP), which has led to increased scrutiny of the MUS. Thus, the need for surgical comfort with PVS is resurfacing. We sought to evaluate the surgical practice patterns among international urogynecologists for the treatment of SUI and identify whether a need and interest for more training exists. METHODS: We developed a short, Internet-based survey for members of the International Urogynecological Association (IUGA). Descriptive analyses, binomial and multivariate logistic regressions were calculated to determine significant associations. RESULTS: Among 556 members who responded to the survey, 72% did not offer PVS in practice. Among those who did, there was as significant relationship between offering PVS and practicing in the United States, board-certification in urogynecology, PVS exposure in training, increasing number of PVS performed during training, and comfort with PVS. Members interested in further PVS training were younger, less comfortable with PVS, performed fewer PVS, or had no exposure in training. CONCLUSION: Most IUGA members do not offer PVS in clinical practice. As would be expected, members who performed more PVS in training and were more comfortable with PVS were likely to offer it to patients. Our results highlight a learning gap, especially among younger providers who are not comfortable with PVS and desire further training in this procedure.

Comparison of the effect between autologous fascia and artificial duramater in duramatral neoplasty / 新乡医学院学报

Objective To compare the effect between autologous fascia and artificial duramater in duramatral neoplas ty.Methods A total of 140 patients with hypertensive intracerebral hemorrhage who underwent craniotomy in Zhoukou Hospital of Traditional Chinese Medicine from February 2014 to May 2017 were selected.The patients were divided into observation group (n =90) and control group (n =50) according to dural repair method.The autologous fascia was used to repair dura mater in the observation group,and the artificial duramater was used to repair dura mater in the control group.The Glasgow Coma Scale (GCS) score,activity of daily living(ADL) and the incidence of postoperative complication were compared between the two groups.Results The eusemia rate of ADL in the observation group and the control group was 98.89％ (89/90) and 90％ (45/50) respectively at three months after operation,the eusemia rate of ADL in the observation group was significantly higher than that in the control group (x2 =6.191,P ＜ 0.05).There was no significant difference in GCS score between the two groups before operation (t =2.362,P ＞ 0.05),the GCS score at three months after operation were significantly higher than that before operation in the two groups (t =7.123,9.612;P ＜ 0.05),the GCS score in the observation group was significantly higher than that in the control group at three months after operation (t =5.710,P ＜ 0.05).The incidence of postoperative cerebrospinal leak,incision infection,cenencephalocele and epilepsy was 1.11％ (1/90),1.11％ (1/90),2.22％ (2/90) and 3.33％ (3/90) respectively in the observation group;and the incidence of postoperative cerebrospinal leak,incision infection,cenencephalocele and epilepsy was 10.00％ (5/50),8.00％ (4/50),12.00％ (6/50) and 14.00％ (7/50) respectively in the control group;the incidence of postoperative cerebrospinal leak,incision infection,cenencephalocele and epilepsy in the observation group was significantly lower than that in the control group (x2 =6.191,5.704,5.514,4.429;P ＜ 0.05).Conclusion The autologous fascia is easy to suture,and there is no rejection reaction.It can significantly improve the prognosis of patients and reduce the incidence of complications in duramatral neoplasty.

The efficacy of autogenous femoral lateral iliotibial fascia in the treatment of female stress incontinence / 中华泌尿外科杂志

Objective To analyze the safety and efficacy of autogenous femoral lateral iliotibial fascia(autologous fascia lata) in the treatment of female stress incontinence.Methods The clinical data of 7 female patients with stress incontinence admitted from January 2016 to June 2017 were retrospectively analyzed.The mean age was 58.2 years (range 45-72 years).The mean disease duration was 10.7 years (range 5-21 years).The mean Body mass index (BMI) was 24.1 kg/m2 (range 20.3-31.4 kg/m2).7 patients had severe subjective scores according to clinical symptoms.The average score of urinary incontinence questionnaire-simple form (ICIQ-SF) of international urinary incontinence advisory committee was 14.3 ± 1.1,the score of incontinence-quality of life (I-QOL) was 24.3 ± 4.8,respectively.During general anesthesia,the patient was placed in a half-recumbent position with the right leg straight down and the left leg bent over.The position of patella as well as the iliotibial band of the lateral femoral muscles were marked on the body surface.The iliotibial fascia of the lateral femoral muscle was exposed through a transverse incision 4-6 cm perpendicular to the iliotibial fascia of the lateral femoral muscle.The fascia of the lateral iliac tibial fascia of the lateral vastus with a width of 1.5 to 2.0 cm and a length of 12 to 14 cm was cut.The fascia was immersed in physiological saline and sutured with two 2-0 CT1PDS absorbable sutures or 2-0 vascular sutures at both ends of the fascia for 3 consecutive needles to form a sling.Then the urethral catheter was placed in the position of lithotomy,and then urethral suprapubic suspension was performed using autologous fascia through bilateral paravaginal incisions.The duration of surgery,intraoperative blood loss,intraoperative complications,postoperative catheter indwelling time,the length of hospital stay and postoperative complications were recorded.The situation of urinary incontinence as well as life quality before and after surgery were compared respectively.Results The operation was successfully performed.The mean operative time was 117.6 min(range 95-140 min).The mean intraoperative blood loss was 70.3 ml (range 50-90 ml).No complication was observed during the operation.The mean postoperative indwelling catheterization was 5.8 days (range 5-7 days).The mean postoperative hospital stay was 6.3 days (range 5-8 days).All 7 patients were cured after surgery,2 patients experienced urinary retention after removal of the catheter.The mean follow-up time was 18.2 months(range 13-24 months).No urinary incontinence or complications was observed postoperatively in all cases.Patient ICIQ-SF urinary incontinence questionnaire summary score and quality of life score of I-QOL questionnaire of 1 year post operation were 0.6 ± 0.5 and 96.1 ± 4.3,which were significantly improved compared with that before surgery(P ＜ 0.01).Conclusion It is safe to use autologous femoral lateral muscle iliotibial fascia in the middle segment of urethra suspension for the treatment of female stress incontinence,and the curative effect is affirmative through one-year observation.

The Effectiveness and Satisfaction of Modified Fascial Sling Operation Using Allograft Fascia in Stress Urinary Incontinence: Comparison with Autologous Fascia / 대한비뇨기과학회지

PURPOSE: We retrospectively evaluated and compared the success rate, and satisfaction with the operation, in patients who had undergone the modified fascial sling procedure using autologous and allograft fascia. MATERIALS AND METHODS: We compared 65 consecutive women (44%), having undergone the modified fascial sling procedure using allograft cadaveric fascia lata between September 1999 and April 2002 (group 1), with 82 consecutive women (56%), having undergone the procedure using autologous rectus fascia between December 1996 and August 1999 (group 2). The surgical outcomes, and the satisfaction of patients, were assessed by questionnaire. RESULTS: In group 1 the mean follow-up was 26 months (range 12-32), and 59 (91%) of the patients were cured, and 4 (6%) improved. In group 2, the mean follow-up was 51 months (range 32-64), and 73 (90%) of the patients were cured, and 6 (7%) improved. From the questionnaires, there was no difference in the satisfaction with the operation between the groups, but was somewhat lower than the success rate. The mean operation time for group 1 was significantly shorter than for group 2, and postoperative pain control in group 1 was significantly less than in group 2. De novo urge incontinence developed in 2 (3.1%) and 3 (3.7%) patients from groups 1 and 2, respectively. CONCLUSIONS: The modified fascial sling procedure, using allograft fascia, was more advantageous because of the decreased operation time and the reduction in pain control, although there were no significant differences in the success rates and satisfaction between the two groups. Therefore, the modified fascial sling procedure, using allograft fascia, is an effective treatment for all types of stress urinary incontinence, with a high cure rate and an acceptable low morbidity. A longer follow-up period will be required to confirm our results.

Preliminary Results of Vocal Fold Augmentation by Injection of Autologous Fascia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vocal fold augmentation by injection under direct visual control is a quick, easy, and accurate operation. However, when autologous fat or bovine collagen is used, both showed considerable resorption over time and gave variable results. Autologous fascia is a newly introduced graft material and has a low metablolic requirements with also a relatively stable histological characteristics. The goal of this study was to confirm the autologous fascia as a new injection material of vocal fold augmentation and assess the impact of the fascia injection on voice acoustics. MATERIALS AND METHOD: Six subjects with vocal cord palalysis and three with sulcus vocalis were analyzed after injection. The temporalis muscle fascia and abdominal fat were harvested. The fascia was cut into small pieces and injected using the pressure syringe with a 18 G needle on the lateral aspect of the vocal fold under the direct visual control. The preoperative and postoperative parameters including jitter, shimmer, signal to noise ratio, and maximum phonation time were analyzed. RESULTS: There was significant improvement in all parameters measured in the group of vocal cord palsy. But there was no definite improvement in the sulcus vocalis group. There was only one laryngeal complication, the postoperative granuloma at leakage site of injection. CONCLUSION: According to these preliminary results, it is suggested that vocal fold augmentation by injection of autologous fascia can be a stable and effective surgical treatment for vocal cord palsy.