The fate of rectus fascia suburethral slings
Division of Urogynecology and Pelvic Reconstructive Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL, USA. American Journal of Obstetrics and Gynecology
(Impact Factor: 4.7).
11/2000; 183(4):964-6. DOI: 10.1067/mob.2000.107091
Autologous rectus fascia is commonly used to construct suburethral slings for the treatment of genuine stress incontinence. This fascia performs well and has not been associated with clinical problems related to its choice as a sling material. However, the histologic appearance of such slings after implantation has not been documented.
At the time of revision of autologous rectus fascia suburethral slings in 5 patients, biopsy specimens of the slings were obtained and submitted for histologic examination. A specimen of rectus fascia before implantation was also obtained from a sixth patient who had no symptoms.
After implantation autologous rectus fascia slings remain viable. There is fibroblast proliferation, neovascularization, and remodeling of the graft. No evidence of inflammatory reaction or of graft degeneration was detected. A linear orientation of connective tissue and fibroblasts was seen in some areas, whereas other areas had remodeled to form tissue similar to noninflammatory scar.
Autologous rectus fascia slings undergo extensive remodeling after implantation.
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ABSTRACT: To determine the long term success of the cruciate fascial sling procedure for the treatment of genuine stress incontinence in women.
In 1998, a pre-validated questionnaire was sent to all women who had a cruciate fascial sling between 1979 and 1996 under the care of the senior author at a District General Hospital and in private practice.
Questionnaires were sent to 246 women; 198 (80%) were returned.
Overall, 142 women felt that they were much improved or cured. The success rate was 74% (95% CI 70%-81%) in women having the sling as a primary procedure and 67% (95% CI 54%-81%) in women having the sling as a secondary procedure. There was no relationship between symptom severity score and age at time surgery, duration of follow up, current weight or body mass index, previous surgery for stress incontinence or concomitant surgery. Of the 103 women with six or more years of follow up, 29 felt that their operation had failed, 16 of whom thought that it lasted between five and 10 years. Urgency was experienced by 29% of women, three needed to perform intermittent self-catheterisation, and 9% found it difficult to empty their bladder. Thirty-seven women (19%) experienced problems that they attributed to the abdominal wound.
Although inevitably there are some failures over time, the cruciate fascial sling has good long term success rates. Direct comparison with the literature is impossible, as few studies have relied on properly validated questionnaires.
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ABSTRACT: Over the past decade, urethral slings have emerged as the procedure of choice for the surgical correction of most types of female urinary stress incontinence. A variety of materials, autologous, alloplastic, and synthetic, have been used successfully as urethral slings. In the next decade, it is hoped that a better understanding of the factors that influence surgical success will translate into continued refinement of surgical technique.
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