Cadaveric fascial sling with bone anchors: minimum of 24 months of follow-up.

摘要

OBJECTIVES: Available published studies to define outcomes using cadaveric fascia for transvaginal urethral sling placement have revealed, in general, disappointing outcomes. However, limited data exist detailing long-term outcomes using this sling type and, more specifically, fascial grafts prepared using solvent-dehydrated techniques. We present our long-term outcomes using non-frozen solvent-dehydrated cadaveric fascia lata for transvaginal urethral sling placement with bone anchors. METHODS: A retrospective review was performed of 354 patients who had undergone non-frozen solvent-dehydrated cadaveric fascia lata for transvaginal urethral sling placement with bone anchors with a minimal follow-up of 24 months. A subjective assessment was performed using validated incontinence and quality-of-life questionnaires performed at 6 and 12 months and annually thereafter. RESULTS: A total of 238 patients (67%) completed follow-up questionnaires with a minimum of 24 months of follow-up. Of the 238 respondents, 71%, 67%, and 65% reported fewer than one episode of stress urinary incontinence per week, and 63%, 58%, and 59% of respondents reported minimal clinical improvement of 70% at a minimal follow-up of 24, 48, and 60 months, respectively. The corresponding rates of dryness were 34%, 27%, and 22% for the same follow-up periods. The Urogenital Distress Inventory, 6-item, and Incontinence Impact Questionnaire, 7-item, scores were not significantly different statistically when compared at each assessed follow-up point. CONCLUSIONS: Our data suggest that non-frozen solvent-dehydrated cadaveric fascia lata for transvaginal urethral sling placement with bone anchors is a safe and efficacious procedure for the treatment of stress urinary incontinence. Mild decreases in subjective satisfaction and improvement were seen during an extended follow-up period, although the validated questionnaire scores remained stable throughout the same period. However, a significant reduction in the dry rate was also observed during extended follow-up.