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Fascia Lata Sling A viable alternative for Stress Incontinence
Mary Grey Maher, MD, Sophia Delphe, MD.
Yale University School of Medicine, New Haven, CT, USA.
Urinary incontinence is a highly prevalent condition which impacts approximately 50% of women, many have a tress incontinent component, and 10% of these women report a significant impact on quality of life, and thus will undergo surgical treatment.
The Synthetic Mid Urethral Sling has largely become the standard of care for surgical management of SUI and is currently favored given its minimal invasiveness and cure rate. Complications involving mesh erosion and extrusion have been reported creating a neo-population of mesh averse patients. In addition, it is unclear what the fate of the mesh sling will be in the future given fewer companies manufacturing the product. In the past, the autologous rectus fascial sling had originally been the gold standard and then later the alternative procedure to a mesh sling.
We aim to suggest a similar but less invasive, highly successful, outpatient procedure using fascia lata, in the same or more complicated index SUI patient.
A retrospective chart review was done of 11 patients between 2013-2015 who underwent autologous fascia lata sling. Pre and Post UDI 6 and IIQ-7 surveys were completed. The overall costs were analyzed including
use of intraoperative time, post-operative narcotic use, inpatient versus outpatient stay; and subjective and objective stress continence outcomes were analyzed.
A total of 11 patients underwent fascia lata slings. The average age of patients in this series is 60 with an age range of 44-86. On post operative assessment 86 % of all patients had no SUI. Median change in UDI-6 was 18 to 6.5; and median change in IIIQ-7 was 21 to 2.5. A cost difference of approximately $1920 was appreciated, with mesh sling and autologous fascial sling costing more due to cost of the material and cost of hospital stay respectively. Few fascia lata patients required IV narcotics for pain control and most used minimal PO narcotics, patients who had a fascia lata sling without concomitant surgery were not admitted unless they had comorbid disease.
The Fascia Lata Sling is a viable clinical option with subjective and objective measures of success. Additionally, it is less morbid than the ARF Sling; and less costly than the PV sling with mesh. The Fascia Lata Sling should be considered in the mesh averse population seeking a less invasive surgery for SUI, as well as potentially those with multiple prior anti-incontinence procedures and/or prior abdominal surgery.
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