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Clin Obstet Gynecol 2021 Jun;64(2):297-305

Northwestern University Feinberg School of Medicine, Chicago, Illinois.

The aim was to describe contemporary surgical procedures for the treatment of stress urinary incontinence (SUI) in women. The 4 most commonly performed surgical procedures for the treatment of SUI were reviewed using standardized terminology. We addressed the history and evolution of the procedures as well as the mechanisms of action by which they work. Read More

Urology 2021 Apr 11. Epub 2021 Apr 11.

Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110. Electronic address:

Objective: To review the rates of persistent and de novo stress urinary incontinence (SUI) following urethral diverticulum (UD) repairs performed without concomitant SUI surgical procedures.

Methods: Following IRB approval, charts of women who underwent UD excision by three FPMRS surgeons were reviewed. Data collected from the electronic medical record included demographic information, preoperative symptoms and evaluation (validated questionnaires [UDI-6, QoL]), imaging studies, operative details, post-operative symptoms, and subsequent surgical interventions. Read More

Int Neurourol J 2021 Mar 29. Epub 2021 Mar 29.

Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.

Currently, midurethral sling is widely used as a standard treatment in stress urinary incontinence (SUI) patients. According to several studies, the failure rate of midurethral sling (MUS) has been reported to be approximately 5-20%. In general, the sling failure can be defined as the state that SUI persists even after the surgery or that incontinence is improved temporarily and then recurs. Read More

Int Urogynecol J 2021 Mar 12. Epub 2021 Mar 12.

Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.

Introduction And Hypothesis: The objective was to report on the very long-term outcome of a published series of autologous pubovaginal slings (PVS) in women with stress urinary incontinence (SUI).

Methods: Following institutional review board approval, a cohort of well characterized, non-neurogenic women who underwent an autologous PVS (primary [PVS1] and secondary [PVS2]) for SUI was re-evaluated for their very long-term outcome status. Data collected included demographics, validated questionnaires (Urogenital Distress Inventory - short form [UDI-6], Incontinence Impact Questionnaire - short form 7, quality of life), SUI retreatment/operations, and subjective patient-reported SUI improvement (%) and symptom recurrence. Read More

J Formos Med Assoc 2021 Jan 16. Epub 2021 Jan 16.

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan. Electronic address:

Background/purpose: The impact of neurologic disorders on the clinical outcome of suburethral sling procedures has seldom been studied. Our aim is to elucidate factors predicting further anti-incontinence interventions or transvaginal urethrolysis after a re-adjustable pubovaginal sling procedure (PVS), especially in patients with neurologic disorders.

Methods: Medical records of all consecutive women who underwent re-adjustable PVS for stress urinary incontinence (SUI) were reviewed. Read More

Int Neurourol J 2020 Sep 30;24(3):222-230. Epub 2020 Sep 30.

Department of Urology, KonKuk University Medical Center, KonKuk University School of Medicine, Seoul, Korea.

Stress urinary incontinence (SUI) is a highly prevalent health condition that significantly impacts the quality of life. Traditional methods of treatment for SUI, such as pubovaginal sling and Burch colposuspension, have been replaced by the midurethral sling because of its high efficacy, low complication and morbidity rates, and short learning curve. Although multiple behavioral and operative treatments exist, midurethral slings are the gold standard for the treatment of SUI in women. Read More

Curr Opin Obstet Gynecol 2020 Dec;32(6):449-455

Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California, USA.

Purpose Of Review: After the Food and Drug Administration Public Health Notification in 2011 regarding transvaginal mesh, there has been a decline in the use of mid-urethral slings (MUS). However, they are an effective treatment option for stress urinary incontinence (SUI) with minimal complications. The management of recurrent SUI after sling continues to be debated. Read More

Eur J Obstet Gynecol Reprod Biol 2020 Sep 3;252:349-354. Epub 2020 Jul 3.

Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India.

Objective: To compare short term results of autologous rectus fascia pubovaginal sling surgery with synthetic transobturator vaginal tape procedure in treatment of female stress urinary incontinence (SUI) STUDY DESIGN: It was a comparative study on 30 women between 25-65 years of age with urodynamic proven SUI who were randomly allocated to autologous rectus fascia pubovaginal sling surgery (Group I)(15 women) and synthetic transobturator vaginal tape procedure (Group II) (15 women). Preoperative and postoperative ICIQ (International Consultation on Incontinence Questionnaire) score, urodynamic study and serum CRP and IL-6 were done in all cases.

Results: The baseline characteristics in terms of age, body mass index (BMI), parity, mean ICIQ score and mean preoperative CRP and IL-6 levels were similar in two groups. Read More

Neurourol Urodyn 2020 08 8;39(6):1862-1867. Epub 2020 Jun 8.

University of Iowa, Iowa City, Iowa.

Background: Prevailing theories and treatments of female stress urinary incontinence are built on 120 years of evolution in understanding the structure and function of the female bladder neck and urethra and of considering why treatments failed. In our management of patients, it is important to understand and appreciate how our management of female stress urinary incontinence has evolved and which treatments have prevailed as we advance our knowledge for future treatments.

Aims: The purpose of this review is to describe how advances in technology impacted and shaped prevailing theories or understanding of the pathophysiology of stress urinary incontinence and influences our treatment approach. Read More

Am J Obstet Gynecol 2020 08 3;223(2):273.e1-273.e9. Epub 2020 Jun 3.

Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University, Washington, DC.

Background: Urethral diverticulum is a rare entity and requires a high suspicion for diagnosis based on symptoms and physical exam with confirmation by imaging. A common presenting symptom is stress urinary incontinence (SUI). The recommended treatment is surgical excision with urethral diverticulectomy. Read More

Urology 2020 Sep 2;143:266. Epub 2020 Jun 2.

Advanced Urology Associates Pte Ltd, Singapore (formerly Department of Urology, Tan Tock Seng Hospital, Singapore).

Objective: Autologous pubovaginal sling is a surgical option for patients with stress urinary incontinence (SUI), either as primary treatment, or in those who have failed synthetic sling placement. It is also favorable for patients at high risk of mesh erosion, for example, in those who are immunocompromised or postradiation. This video reviews the technical considerations in performing an autologous pubovaginal sling fashioned from rectus fascia in an immunocompromised patient with multiple previous abdominal surgeries. Read More

Am J Obstet Gynecol 2020 May 1;222(5):480.e1-480.e7. Epub 2020 Apr 1.

Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, University of Louisville, Louisville, KY.

Background: As a result of the vaginal mesh controversy, surgeons are performing more nonmesh, autologous fascia pubovaginal slings to treat stress urinary incontinence in women. The rectus abdominis fascia is the most commonly harvested site for autologous pubovaginal slings, so it is crucial that surgeons are familiar with the relationship between this graft harvest site and the ilioinguinal and iliohypogastric nerves, which can be injured during this procedure.

Objective: The aims of this study were as follows: (1) to estimate the safest area between the bilateral courses of the ilioinguinal and iliohypogastric nerves in which a rectus abdominis fascia graft could be harvested with minimal risk of injury to these nerves and (2) to determine the location and dimensions of a graft harvest site that maximized graft length while remaining close to the pubic symphysis. Read More

Female Pelvic Med Reconstr Surg 2020 03;26(3):162-172

Introduction And Hypothesis: Standardized terminology for surgical procedures commonly performed to treat stress urinary incontinence in women is needed to facilitate research, clinical care, and teaching in female pelvic medicine and reconstructive surgery.

Methods: This report combines the input of members of the American Urogynecologic Society and the International Urogynecological Association, assisted by external referees. Extensive searches of the literature were performed, including Instructions for Use brochures and original source documents where possible. Read More

Int Urogynecol J 2020 03;31(3):465-478

Introduction And Hypothesis: Standardized terminology for surgical procedures commonly performed to treat stress urinary incontinence in women is needed to facilitate research, clinical care, and teaching in female pelvic medicine and reconstructive surgery.

Methods: This report combines the input of members of the American Urogynecologic Society and the International Urogynecological Association, assisted by external referees. Extensive searches of the literature were performed, including Instructions for Use brochures and original source documents where possible. Read More

Urology 2020 Mar 27;137:190-195. Epub 2019 Dec 27.

Department of Urology, University of Arizona College of Medicine, Tucson, AZ. Electronic address:

Objective: To address renewed interest in nonmesh transvaginal Pelvic Organ Prolapse (POP) repair since the FDA reclassification of transvaginal mesh, our goal was to develop a transvaginal sacrospinous fixation for anterior and apical POP using only autologous fascia lata. We report our experience in 33 patients.

Methods: Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair utilizes a 4 × 14 cm piece of fascia lata harvested through a 3-4-inch upper thigh incision. Read More

Turk J Urol 2019 05 21;45(3):230-232. Epub 2018 Dec 21.

Department of Urology, Health Science University Haseki Training and Research Hospital, İstanbul, Turkey.

Objective: The aim of this study is to describe a novel transobturator midurethral sling surgery technique by using rectus abdominis fascia.

Material And Methods: A 54-year-old woman complaining of urinary leakage during effort was diagnosed as pure stress urinary incontinence after detailed questioning, pelvic examination, uroflowmetry and measurement of residual urine volume. She was anxious about complications related to synthetic meshes. Read More

Arch Esp Urol 2019 Nov;72(9):891-903

Médico y cirujano. Universidad del Rosario. Magister en Epidemiología Universidad del Rosario-Universidad CES. Profesor de carrera escuela de Medicina y Ciencias de la Salud. Universidad del Rosario. Bogotá D.C. Colombia.

Objective: Female urinary incontinence has a prevalence of up to 40%. Stress urinary incontinence is the most frequent type, about 50%. When primary management fails, it is unclear what the behavior should be. Read More

Low Urin Tract Symptoms 2020 Jan 13;12(1):2-7. Epub 2019 Aug 13.

Department of Surgery, Concord Repatriation General Hospital, University of Sydney and Macquarie University, Sydney, Australia.

The contemporary management of stress urinary incontinence (SUI) has seen renewed interest in the use of autologous fascia for the formation of a retropubic suburethral sling. Traditionally, it has been used in only the most severe of incontinence cases, such as those women with intrinsic sphincter deficiency, or in patients requiring concomitant reconstructive procedures. In the current climate surrounding transvaginal mesh, many doctors and patients are shying away from the less morbid synthetic midurethral sling. Read More

Res Rep Urol 2019 19;11:179-188. Epub 2019 Jun 19.

Department of Surgery and Epidemiology & Biostatistics, Western University, London, Ontario, Canada.

Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) affect many women in their lifetime. In this review, we describe and evaluate the latest treatment options for SUI and POP, including the controversy around transvaginal mesh (TVM) use. Growing evidence supports the utilization of pelvic floor muscle training as first-line treatment for both SUI and POP. Read More

Female Pelvic Med Reconstr Surg 2020 08;26(8):493-497

Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Objective: To compare perioperative and functional outcomes of autologous fascia lata versus rectus fascia pubovaginal sling in female patients with stress urinary incontinence (SUI).

Methods: The charts of all patients undergoing pubovaginal sling for SUI from 2012 to 2017 at a single center were retrospectively reviewed. Patients were divided into 2 groups: those with the sling harvested from the fascia lata (FL group) and those with the sling harvested from the rectus fascia (RF group). Read More

Neurourol Urodyn 2019 09 3;38(7):1889-1900. Epub 2019 Jul 3.

Department of Urology, UCLH, London, UK.

Aims: To assess the incidence and management of urodynamic stress urinary incontinence (USUI) in women undergoing transvaginal excision of a urethral diverticulum (UD) at our institution.

Methods: A prospective database, capturing patients undergoing urethral diverticulectomy over a 9-year period (May 2007 to August 2016), was reviewed focusing on USUI and subsequent management.

Results: One hundred patients underwent UD excision (with modified Martius labial fat-pad flap interposition). Read More

Urology 2019 09 20;131:71-76. Epub 2019 Jun 20.

Departments of Urology and Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Objective: To investigate trends in stress urinary incontinence (SUI) surgery before and after the 2011 Foods and Drug Administration notification and the 2014 (American Urogynecologic Society [AUGS]/Society for Urodynamics Female Pelvic Medicine and Urogenital Reconstruction [SUFU]) position statement.

Methods: A retrospective chart review was performed to identify patients presenting for evaluation of SUI by 2 Female Pelvic Medicine and Reconstructive Surgery specialists between June 1, 2010 and May 31, 2017. Rates of surgical treatment modality (synthetic midurethral slings [MUS] versus autologous fascial pubovaginal sling versus bulking agents) were analyzed at 6-month intervals. Read More

Neurourol Urodyn 2019 08 2;38 Suppl 4:S21-S27. Epub 2019 May 2.

Department of Urology, Massachusetts General Hospital, Boston, Massachusetts.

Introduction: Stress urinary incontinence (SUI) is common in women and can significantly impact quality of life.

Methods: This is a review of the 6th International Consultation on Incontinence (ICI) chapter analyzing level of evidence on surgical treatment of SUI as well as the consensus algorithm that resulted from the detailed work in the committee report as of April 2017. Included studies in this review were selected to highlight the algorithm for management. Read More

Neurourol Urodyn 2019 06 18;38(5):1409-1416. Epub 2019 Apr 18.

Department of Urology, Western Health, University of Melbourne, Melbourne, Australia.

Aim: To determine the optimal degree of pubovaginal slings (PVS) tension, measured by lax sling dimensions to minimize the risk of urinary retention.

Methods: This prospective study analyzed female patients undergoing PVS for stress urinary incontinence (SUI) by two surgeons over 24 months from January 2016. Intra-operative measurements of lax sling dimensions tented over rectus fascia were recorded. Read More

Curr Urol Rep 2019 Mar 30;20(5):23. Epub 2019 Mar 30.

University of Pennsylvania Health System and Perelman School of Medicine, Philadelphia, PA, USA.

Purpose Of Review: The purpose of this paper is to review (1) the epidemiology and pathophysiology of pelvic organ prolapse (POP) and occult stress urinary incontinence (SUI), (2) examine the data on combined operative management of POP and occult SUI, (3) discuss the approaches to clinical decision making, and (4) present future therapies.

Recent Findings: Prospective data on many approaches to concomitant treatment of prolapse and occult stress urinary incontinence, such as minimally invasive sacrocolpopexy and midurethral sling, or older approaches that have regained favor among patients and clinicians wishing to avoid synthetic mesh, such as native tissue prolapse repair and pubovaginal sling, are limited. Safe durable treatments with absorbable graft materials that promote a beneficial host response are intriguing but may be far from clinical implementation. Read More

Low Urin Tract Symptoms 2019 Sep 22;11(4):206-210. Epub 2019 Mar 22.

Department of Urology, New York University Langone Health, New York, New York.

Objective: This study assessed stress urinary incontinence (SUI) outcomes after sling excision for urinary tract perforation or vaginal exposure, and compared the outcomes of concomitant versus staged autologous fascia pubovaginal sling (AFPVS).

Methods: A retrospective chart review of all patients who underwent midurethral sling (MUS) excision for urinary tract perforation or vaginal exposure at a tertiary referral center between 2010 and 2015 was performed. Therapeutic strategies were categorized as concomitant AFPVS, staged AFPVS, and no anti-incontinence procedure. Read More

Female Pelvic Med Reconstr Surg 2020 Oct;26(10):603-606

National Obstetric Fistula Centre, Abakaliki, Nigeria.

Objectives: The aim of this study was to compare the success rates of transvaginal retropubic urethropexy with fascia lata pubovaginal sling (PV sling) for treatment of postrepair urinary incontinence at a fistula center in Nigeria.

Methods: This was a retrospective review of 60 patients who had transvaginal retropubic urethropexy and 46 patients who had PV sling on account of postrepair incontinence at National Obstetric Fistula Centre, Abakaliki, Nigeria, between January 2014 and December 2016. Data were retrieved from the hospital records. Read More

Neurourol Urodyn 2019 08 7;38 Suppl 4:S51-S58. Epub 2018 Dec 7.

Chief Division of Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction, Department of Urology | UC Irvine Health, Orange, California.

Aims: Stress urinary incontinence (SUI) is common in the adult females. Surgical treatment options include synthetic mid-urethral sling (MUS), autologous sling, bulking agents, and Burch colposuspension. The autologous pubovaginal sling (PVS) has re-emerged in response to complications of synthetic MUSs and FDA communications regarding the use of vaginal mesh. Read More

Best Pract Res Clin Obstet Gynaecol 2019 Jan 30;54:31-40. Epub 2018 Oct 30.

Mercy Hospital for Women, Melbourne, Australia. Electronic address:

Mid-urethral sling procedures (MUS) have been the surgical option of choice for most gynaecologists and urologists treating stress urinary incontinence (SUI) in women around the world for almost 20 years, since their introduction in the late 1990s. The evidence suggests that the long-term effectiveness of the MUS is good and similar to the Burch Colposuspension and the fascial pubovaginal slings. The bulking agents are now being put forward as another minimally invasive option for the surgical treatment of SUI. Read More

Urol J 2019 05 5;16(2):193-197. Epub 2019 May 5.

Shahid Labbafi Nejad Medical Center, Urology and Nephrology Research Center (UNRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: To evaluate long term outcomes of autologous pubovaginal fascial sling (AFPVS) as a salvage procedure following different types of failed anti-incontinence surgeries.

Materials And Methods: We retrospectively reviewed medical records of patients who had undergone salvage AFPVS after any kind of anti-incontinence surgery from 2005-2015 at our medical center. Patients were contacted by telephone. Read More