Autologous pubovaginal sling shows high success rate

Ann Arbor, MI-Autologous pubovaginal slings (APVS) are associated with a high success rate following synthetic midurethral sling failure, according to recently published data.

First author Jaclyn C. Milose, MD, explained to Urology Times that there is currently no consensus on the management of stress urinary incontinence after failed synthetic midurethral sling, and there are little data assessing the efficacy of APVS. Dr. Milose added that the University of Michigan, Ann Arbor places “a significant number” of these slings.

“We very rarely get a patient who comes in who has had no prior procedure for stress incontinence, and so we perform many autologous slings. We felt like it was a great patient population to look at and see how successful these autologous slings are at treating these patients,” said Dr. Milose, chief resident at the University of Michigan, who worked on the study with Anne Pelletier Cameron, MD, and colleagues.

Because of the high volume of APVS performed at their institution, Dr. Milose and colleagues decided to evaluate success rates in patients who had undergone APVS following one or more failed synthetic midurethral slings and identify factors associated with APVS failure. They performed a retrospective review of 108 patients who underwent an APVS following one or more failed synthetic midurethral slings between 2000 and 2012.

Data were presented at the AUA annual meeting in Orlando, FL and subsequently published online in the Journal of Urology (Sept. 19, 2014).

The primary outcome was success of APVS. “Cure” was defined as no stress or urgency incontinence, and “improved” signified cure of stress urinary incontinence (SUI) only or significantly improved SUI. Average patient age was 55.7 years. Reasons for synthetic sling failure included recurrent or persistent stress incontinence alone (62.3%), mixed incontinence (2%), recurrent stress incontinence for retention (7.7%), and infection/erosion/fistula (27.7%). Dr. Milose reported that 56.5% of patients required mesh removal, 32.4% required synthetic sling excision prior to APVS, and 24.1% underwent sling excision at the same time as APVS.

Next: cure/improvement rate

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94% cure/improvement rate

Overall, 39.8% of patients were cured with no incontinence and 69.4% were cured of SUI. Total cure/improvement rate was 94%. Of the patients, 5.5% showed no improvement, and the rate of retention following APVS was 12%. Four patients required urethrolysis.

In terms of predicting APVS failure, patients who had mesh excision did not appear to have worse outcomes than those who had not, while patients with pure SUI were more likely to be cured than those with mixed or complex incontinence.

Dr. Milose told Urology Times that the 94% total cure/improvement rate indicates that APVS “is a very successful procedure following synthetic sling failures and that it should be high on the list of treatment options.”

“I think [clinicians] should take away from this study that this is a great procedure to use following a failed sling and that even in our patients who were very complicated, it was still very successful,” Dr. Milose said.

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