PUBOVAGINAL SLING USING CADAVERIC ALLOGRAFT FASCIA FOR THE TREATMENT OF INTRINSIC SPHINCTER DEFICIENCY

Purpose: Pubovaginal sling is the definitive management of female stre ss urinary incontinence due to intrinsic sphincter deficiency. Customa rily, autologous fascia has been used, although synthetic material has its proponents. Harvesting autologous fascia at surgery is associated with postoperative discomfort, and synthetic material has a history o f infection and erosion. To assess whether allograft fascia is free fr om these drawbacks, we retrospectively compared the outcome of women u ndergoing pubovaginal sling using either autologous or:cadaveric allog raft fascia. Materials and Methods: We reviewed our experience during the last 28 months with patients treated with the pubovaginal sling fo r intrinsic sphincter deficiency. All patients underwent preoperative video urodynamics. The outcome was assessed using the SEAPI scoring sy stem. Special attention was devoted to local sling tolerance. Operativ e time and length of hospital stay were compared between patients with allograft and autograft pubovaginal sling. Results: A total of 92 wom en (mean age 60 years) underwent allograft (59) or autograft (33) pubo vaginal sling. Preoperative parameters, such as percent of patients wh o had had previous incontinence surgery, mean leak point pressure and SEAPI incontinence score, were similar in both populations. Mean follo wup was 11.5 months (range 1 to 28) for the overall population. The SE API scoring system showed that patients were markedly improved, with n o significant difference between the allograft and autograft groups. A llograft and autograft pubovaginal slings were equally well tolerated, and no infection or erosion was encountered. Mean operative time and hospital stay were significantly shorter when using allograft compared to autograft fascia. Conclusions: The success rates of allograft and autograft pubovaginal sling were equally high, and no complications re lated to the cadaveric origin of the allograft fascia were observed. A llograft pubovaginal sling was well tolerated, and its use significant ly shortened operative time and hospital stay.