Is fascia lata allograft material trustworthy for pubovaginal sling repair?

Objectives. In a recent publication, cadaveric fascia lata used for pubovag inal sling procedures was reported as having an early, rapid, and high fail ure rate. Recurrent incontinence was reported to occur from 1 week to 5 mon ths after surgery. The study concluded that cadaveric tissue should not be used for urogynecologic procedures. Their results, however, were significan tly different from what we found in clinical practice. We reviewed our seri es of cadaveric pubovaginal slings to determine the occurrence of rapid bre akdown of cadaveric sling tissue leading to recurrent stress urinary incont inence. Methods. At our institution, since June 1998, pubovaginal slings have been performed using only cadaveric fascia lata. Because all of the failures in the aforementioned study occurred within 5 months (mean 11 weeks) of surger y, we included in our series only patients with a minimum of 12 months of f ollow-up to ensure a long enough follow-up period for failure of the donor tissue to occur. Duration of follow-up and current continence status was do cumented. Results. Twenty-six patients, with a mean follow-up of 15 months (range 12 to 20), were evaluated. Twenty-four of 26 (92%) patients used one or fewer pads per day: 20 of 26 (77%) were completely dry and 4 of 26 (15.4%) used o nly one pad per day. Two of 26 (7.7%) required two pads per day. Twenty-fiv e of 26 (96% reported being "significantly improved" and were "very pleased and satisfied" with the results of surgery. Conclusions. We found no evidence of rapid degradation of solvent-dehydrate d cadaveric tissue resulting in early recurrent incontinence. We think thes e data support the continued use of cadaveric allograft material, especiall y given its intraoperative and postoperative advantages. Clearly, long-term evaluation of the durability of the cadaveric slings in comparison with au tologous fascia is warranted. UROLOGY 56: 772-776, 2000. (C) 2000, Elsevier Science Inc.