Autologous fascia advised for incontinence slings. (Rectus or Fascia Lata).

ST. LOUIS -- Not all materials for constructing urinary incontinence slings are created equal, Dr. Fred E. Govier said at the 11th International Pelvic Reconstructive and Vaginal Surgery Conference.

The hands down best material for a sling is some form of autologous fascia. "I don't care if it's rectus or fascia lata." Within 2 weeks, that fascia is fixed and by 4 weeks "it is cement. You can't move it, and if you get a good result initially, late failures are extremely rare." Unfortunately, one has to accept the morbidity of harvesting this tissue if it is used, said Dr. Govier, head of urology and renal transplantation at Virginia Mason Medical Center, Seattle.

By contrast, cadaveric slings in some cases are still movable 4-5 weeks after surgery. And late failures are not uncommon, depending on the method by which the cadaveric tissue has been processed.

Case in point: In a study involving 35 patients who received slings made out of freeze-dried, irradiated fascia lara grafts, 8 required reoperations for persistent or recurrent stress incontinence. The sling failed in seven of the eight patients: The allograft was present but grossly degenerated in two and completely absent in five (Br. J. Urol. 84[7]:785-88, 1999).

Echoing those findings was another more recent study in which a single surgeon placed a bone-anchored, cadaveric fascia sling in 154 patients. After an average follow-up of only 11 months, 17% of patients required reoperations for moderate to severe recurrent incontinence. The anchors were in position and the sutures intact, but across the board the sling materials were fragmented, attenuated, or absent altogether (J. Urol. 165[5]:1605-11, 2001).

Fresh-frozen cadaveric tissue may not be much better than the freeze-dried kind. In his own case series he has now identified 11 intermediate failures in 131 patients. All patients were completely cured at 3 months, but failed in a ...