Autologous fascia pubovaginal slings after prior synthetic anti- @entity322 procedures for recurrent XXXX : A multi-institutional prospective comparative analysis to de novo autologous slings assessing objective and subjective cure.

@entity1 @entity322
AIMS: Given the paucity of prospective data on the treatment of incontinent @entity1 with prior synthetic mid-urethral sling (MUS), we sought to report our prospective experience with autologous fascia pubovaginal sling placement (AF-PVS) after prior synthetic mid-urethral sling (MUS). METHODS: An IRB-approved, multi-institutional, prospective cohort of @entity1 from 2010 to 2013 undergoing AF-PVS for @entity322 was evaluated and stratified for the presence of a prior MUS. Pre-operative characteristics and validated quality of life questionnaires (IIQ-7 and UDI-6) were compared to post-operative pad usage, scores on the IIQ-7 and UDI-6, complications, and visual analog scale assessment of improvement. RESULTS: 288 @entity1 met inclusion criteria, 59 (20.4%) of whom had undergone a prior MUS before AF-PVS placement. Of these 59 @entity1 , 20 (33.9%) had a prior vaginal extrusion and 5 (8.5%) had suffered from obstruction requiring sling lysis or excision. With a median of 14 months follow-up, prior MUS placement was not associated with a significant difference in objective (55.9% vs. 62.4%, P   =   0.37) or subjective cure (66.1% vs. 69.0%, P   =   0.75) when compared to @entity1 undergoing placement of an initial AF-PVS. @entity1 undergoing AF-PVS after prior MUS did have a significantly higher rate of urinary retention requiring intermittent catheterization (8.5% vs. 3.1%, P   <   0.001) and re-operation (13.6% vs. 3.5%, P   =   0.01) for persistent @entity322 . CONCLUSIONS: Despite higher rates of retention and need for repeat operation, AF-PVS after failed MUS is an acceptable treatment option with no difference in success as compared to @entity1 undergoing initial AF-PVS placement. Neurourol. Urodynam.    2015 Wiley Periodicals, Inc.
