Cadaveric fascia lata sling: Analysis of five recent adverse outcomes

Objectives. To report a series of adverse outcomes of urethral sling proced ures that used allograft fascia lata and to review the literature regarding the use of this material in genitourinary reconstruction. Methods. Five neurologically normal patients presented to our center betwee n August 1999 and October 1999 with complaints of recurrent incontinence or voiding dysfunction after undergoing urethral sling procedures at outside institutions that used fascia lata allografts. All patients underwent a tho rough evaluation, including history and physical examination, voiding cysto urethrography, and urodynamic studies. Sections of fascia were removed for histology in 2 patients at the time of operation. Results. Three patients were diagnosed with de novo bladder outlet obstruct ion, 1 with recurrent urethral hypermobility, and 1 with intrinsic sphincte ric deficiency. Histology of cadaveric fascia demonstrated collagen with al most complete absence of cellularity. There was no evidence of capillary or fibroblast ingrowth. All patients underwent reoperation and have had clini cal improvement with short-term follow-up. Conclusions. Although distressing, the present series of adverse outcomes m ay simply reflect an overall increase in the number of sling procedures bei ng performed nationally. Although decreased operative time and morbidity ha ve been attributed to the use of fascia lata in urethral sling procedures, it is essential to ensure that long-term safety and efficacy will not be je opardized before accepting it as a new standard of care. UROLOGY 56: 596-59 9, 2000. (C) 2000, Elsevier Science Inc.