Use of Rectus Abdominis Fascial Sling as treatment of recurrent stress urinary incontinence in a patient with removed previous synthetic sub-urethral sling
IUGA Academy. Cifuentes M. Jun 30, 2018; 213271; 254 Topic: Stress Incontinence
Dra Melissa Cifuentes
Dra Melissa Cifuentes

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Use of rectus abdominis fascial sling as treatment of recurrent stress urinary incontinence in a patient with removed previous synthetic sub-urethral sling

Cifuentes, M1; Finsterbush, C2; Perrot, I1; Veragua, R1; Opazo, C1; Bernier, P3

1: Universidad de Valparaíso; 2: Hospital Barros Luco, Universidad de Chile, Universidad de Santiago de Chile; 3: Clínica Alemana

Introduction: Stress Urinary Incontinence that relapses after removing a midurethral sling due to inherent complications, happens to be a clinically difficult situation to resolve. One of the options available nowadays is the use of an autologous graft obtained either from the fascia lata or the rectus abdominis fascia.

Purpose: To show step-by-step the main surgical stages elaborating a rectus abdominis fascial sling.

Patients and Methods: The patient is a 46 year old woman who in 2013 went under a polypropylene sling surgery due to urge/stress mixed incontinence. Later on, the patient evolved with pelvic pain, persistent urinary tract infection and voiding dysfunction. In 2016 the patient was diagnosed with urethral mesh exposition and a endourethral mesh removal surgery was needed. During the post-operative evolution the patient developed urinary incontinence under minimal stress, with a urethral mobility higher than 30 degrees and a leak-point pressure of 80 water cm, reverting with a sub urethral support maneuver.

Results: A rectus abdominis fascia sub urethral sling was performed. The main surgical steps included: Rectus abdominis fascia graft extraction, preparation of the graft and installing the sutures on the lateral edges, urinary catheter positioning and identification of the bladder neck, inverted U shaped vaginal incision, peri-urethral fascia incision and endopelvic fascia perforation, transferring the graft sutures from the vaginal incision to the abdominal incision. Cystoscopy to rule out possible unadverted bladder perforations. In the end, the fascia graft is correctly positioned, tying the sutures with a tense free technique and suturing the incisions. A cough test is made within the surgical procedure. The patient evolved with a complete urinary continence and effective micturition at a five month follow up.

Conclusions: The rectus abdominis fascia sub urethral sling is a reproducible and effective surgical strategy as a treatment of stress urinary incontinence. Special interest groups include women who reject the use of synthetic mesh material, patients with risk factors regarding the use of a mesh and the ones who have already suffered a complication due to a previous sub urethral mesh.


Work supported by industry: no.

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