Fascial Slings for Stress Incontinence

In Brief Objective: To evaluate quality of life and outcome after fascial slings for stress incontinence, to explore its potential role in contemporary management of stress incontinence, and to analyze the results with focus on patients with intrinsic sphincter deficiency (ISD), obesity, and patients with previously failed surgical management of stress urinary incontinence. Methods: Analysis of prospectively collected outcome data were combined with a cross-sectional quality of life survey using the Kings health Questionnaire (KHQ). Risk factors were subanalyzed with respect to outcome and quality of life scores. Results: Data of 50 patients who underwent fascial slings for genuine stress incontinence were analyzed. The overall dry or improved rates among at initial, final, and questionnaire reviews were 97.9% (47/48), 97.7% (43/44), and 95% (38/40), respectively (dry rates were 87.5%, 79.5%, and 72.5%). When analyzing the initial 50 patients as common denominator and unreviewed patients as failures, the calculated success (dry and improved) rate at initial, final, and questionnaire reviews were 94%, 86%, and 76%, respectively. Forty patients responded to the KHQ survey. The median time from surgery to KHQ was 40 months (mean: 51.7, range: 7–136). Patients with ISD/high BMI/previous history of failed incontinence procedures produced results comparable with the overall outcome. Conclusion: Fascial sling procedure is effective and safe in patients with previously failed incontinence operations and the obese. The results of fascial sling for ISD are encouraging but need further prospective studies to verify any potential benefit in the management of ISD. Long-term outcome and quality of life survey suggested that fascial sling procedures produce durable results in patients with stress urinary incontinence and is effective in patients with intrinsic sphincter deficiency, obesity, and recurrent incontinence after previous surgical treatment.