Abstract
Study design
This study is a retrospective chart analysis.
Objectives
Surgical treatment of stress urinary incontinence (SUI) in women with neurogenic lower urinary tract dysfunction (NLUTD) is a challenge, as minimally invasive procedures do not seem to be effective, whereas synthetic implants are associated with substantial risks. Thus, we evaluated the results of an autologous sling procedure in this group of patients
Setting
This study was performed at a spinal cord injury rehabilitation center in Switzerland.
Methods
In this retrospective analysis, we evaluated the objective, subjective, and urodynamic results in women undergoing autologous sling insertion for SUI due to NLUTD at our institution.
Results
The data of 17 women who underwent fascial sling surgery were analyzed. After a median follow-up of 40 months, 8 women (47%) were continent, and another 8 patients (47%) significantly improved (1 pad/day). Median video-urodynamic parameters remained unchanged after sling insertion, but two women developed de novo detrusor overactivity. Postoperative complications occurred in 6 of the 17 patients (35.3%), which required surgical interventions in 2 women (12%) (urethral erosion by the sling and complete occlusion of the urethra after removal of the catheter), which could be resolved without loss of continence.
Conclusion
In our case series, autologous fascial slings were effective in the treatment of SUI in women with NLUTD. As they are more effective than minimally invasive procedures, are associated with fewer complications than AUS, and seem to omit possible severe long-term consequences of synthetic slings, they are an excellent treatment option in this group of patients. Urodynamic controls are recommended, as de novo detrusor overactivity may occur after sling insertion.
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Data availability
Additional data are available from the corresponding author on reasonable request.
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JP: project development, manuscript writing, and data collection. JW: manuscript editing and data management.
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This study had been approved by the Ethikkomitee Nordwest- und Zentralschweiz by a general consent for retrospective data evaluation. The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. All subjects included in this study have signed this consent. All data were encrypted and kept confidential.
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Pannek, J., Wöllner, J. Management of stress urinary incontinence in female patients with spinal cord injury by autologous fascial sling: time for a revival?. Spinal Cord Ser Cases 8, 57 (2022). https://doi.org/10.1038/s41394-022-00524-8
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DOI: https://doi.org/10.1038/s41394-022-00524-8
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